Nervous manifestations in Eales's disease.

IN 1880 and again in 1882 Henry Eales of Birmingham described the clinical picture of primary recurrent retinal haemorrhage in young adults. His seven cases were all young men, whose ages ranged from 14 to 29. They had in common a history of headache, epistaxis, variations in peripheral circulation, dyspepsia, and chronic constipation. One was diagnosed as having mitral incompetence, and in two the urine contained the slightest trace of albumen, but otherwise they bore no stigmata of bodily disease. Eales regarded the condition as a very rare one, and believed it to be a vaso-motor neurosis which, by causing constriction of alimentary vessels and compensatory dilatation of those of the head, led to rupture of retinal and nasal vessels and consequent haemorrhage. Eales's disease is now a well-recognized entity, though it is agreed to be rare. Characteristically its age of onset is between 15 and 40 years, affecting both sexes, but with a preponderance in males. In most cases both eyes are ultimately attacked, though symptoms may be unilateral for some while. The retinal haemorrhages are very frequently accompanied by bleeding into the vitreous body, and it is the latter occurrence which most often drives the patient to seek medical advice. The ophthalmoscopic picture ranges from one of obstruction of the central retinal vein with multiple haemorrhages and generalized venous distension to one of variation in calibre and local sheathing of a single vessel, often peripherally situated. The vitreous may be faintly hazy or so clouded with blood as to make the fundus invisible. At a later stage retinitis proliferans and permanent vitreous opacities may be found. The course of the disorder is unpredictable but generally unfavourable. Many suggestions have been made as to its aetiology. Up to now there have been two main theories current, neither of which commands unqualified support: the first that it is a manifestation of tuberculosis, and the second that it is a localized and early stage of Buerger's disease. The idea that it is a tuberculous affection of the retinal vessels seems to have grown up about the turn of the 20th century (Simon, 1896; Noll, 1909; Axenfeld and Stock, 1911; Fleischer, 1914). It was based partly on evidence gained from the examination of eyes 'removed for secondary glaucoma, and partly