Retinal Vasculitis

IN 1880 Henry Eales described, in a number of young adult males, a condition of recurrent haemorrhages within the retina and vitreous, which he considered to be the result of some primary retinal disorder in the absence of any obvious constitutional upset; he entitled his paper " Primary Retinal Haemor- rhage in Young Men".Many similar cases have been described since that time, and it is now generally recognized that the condition is essentially an inflammatory affection of the retinal veins (periphlebitis), although in some cases there may be involvement also of the retinal arteries (periarteritis).It is therefore more accurate to describe the disease as a retinal perivasculitis, or better still as a retinal vasculitis, since the vessel wall itself is involved and not merely its surrounding connective tissues.There is little understanding of the true nature of the inflammation, and, although some reports indicate a tuberculous aetiology (Axenfeld and Stock, 1911; Gilbert, 1935), it is likely that the condition is not an expression of a single disease but a clinical phenomenon common to several diseases (Ballantyne and Michaelson, 1937).The authors of the early descriptions of the condition considered that the brunt of the disease was borne by the veins in the periphery of the retina, and that any involvement of the veins in the central part of the fundus was the result of spread from the veins in the periphery (Eales, 1880, 1882; Ballantyne, 1909; Davis, 1912; Igersheimer, 1912), but sporadic reports have since appeared which indicate that in some cases there is a primary involve- ment of the central retinal vein within the optic nerve-head (Gilbert, 1913; Siegrist, 1913; Davis, 1920; Ballantyne and Michaelson, 1937).It is the purpose of the present communication to draw attention to this latter group of cases which show certain characteristic features: oedema of the optic nerve-head and adjacent retina, generalized dilatation of the retinal veins, little or no involvement of the retinal arteries, a variable amount of retinal haemorrhage, and an almost complete absence of vitreous haemorrhage, and, therefore, of retinitis proliferans.Furthermore, these cases are seldom associated with any gross disturbance of vision, unless there is obvious involvement of the macula by oedema or haemorrhage, and, even when vision is affected, more or less normal vision is usually restored within a relatively *