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Ophthalmology

The invention of the ophthalmoscope in 1851 by Hermann von Helmholtz revolutionized the study of the human eye by giving doctors a non-invasive way to observe the posterior part of the eye (the fundus) in live, conscious subjects.1 The field of ophthalmology itself could almost be said to have coalesced around the invention. Other ophthalmologists quickly designed their own versions of the instrument; those of Eugène Follin and Xavier Galezowski appear below.2 Within a decade, the appearance of the human eye through an ophthalmoscope—vividly red-orange, spiderwebbed with nerves and blood vessels radiating out from the optic disk—became an iconic part of medical imagery.

Among the brightest stars of ophthalmoscopic era were Henri Parinaud and the aforementioned Galezowski, whose Paris-based practices achieved international recognition. Galezowski, who immigrated from Poland to study at the Faculté de Médecine, set up a popular private clinic in Paris and became known for his diagnostic accuracy and surgical dexterity.3 Parinaud was involved with the neurological revolution at the Salpêtrière, and contributed to the study of neuro-ophthalmic conditions such as strabismus, ophthalmoplegic migraine, and the gaze paresis called dorsal midbrain syndrome or, eponymously, Parinaud's syndrome.4 In the last quarter of the 19th century, neurologists like Jean-Martin Charcot were using ophthalmoscopes as part of the standard neurological examination.5

Étude opthalmoscopeique sur les altérations du nerf optique et sur les maladies cérébrales dont elles dépendent

Ophthalmoscopic examination of optic nerve damage from the thesis of Xavier Galezowski. His 1865 medical degree from the Faculté de Médecine de Paris is his second, as he had already graduated from the University of Petersburg in 1858.

Du strabisme et spécialment des conditions de succès de la strabotimie

Strabismus is an eye misalignment commonly known as being cross-eyed. This is an instrument for measuring the degree of deviation and a method for realigning one deviated eye using an implanted hook.  

Des rétinites secondaires ou symptomatiques

Cases of retinal inflammation as seen through an ophthalmoscope, circa 1868. The disseminated white spots in Figure 1 are of signs of diabetic retinopathy. Figure 3 shows the effect of a syphilitic infection on the choroid.

Dissertation sur le fongus médullaire de l’oeil

Cases of fungal eye infections documented in the 1820s. Such infections can be caused when the eye traumatically comes into contact with a bacteria- or parasite-bearing foreign object. 

De la communication de la carotide interne et du sinus caverneux (aneurysme arterio-veineux)

A carotid-cavernous fistula occurs when a perforation in the internal carotid artery (red) causes it to mix with blood from the ophthalmic vein (blue), which can cause bleeding and swelling in the eye.

Études cliniques sur divers modes d'exploration de l'oeil, dans ses maladies

A stand-mounted Follin ophthalmoscope, circa 1852. Candles quickly fell out of favor as a source of illumination, replaced by gas lamps in the 1860s and electric bulbs in the 1880s.6

Étude clinique et anatomique sur le sarcome de la choroïde et sur la melanose intra-oculaire

The early stages of a cancerous ocular tumors ("B") as seen through an ophthalmoscope and accompanied by tissue samples.

De la réclination capsule-lenticulaire, du nouveau procede d’abaissement de la cataracte avec une aiguille nouvelle

Cataract surgery, circa 1833. The surgeon makes a semicircular incision around the cornea and tries to remove the entire lenticular capsule in one piece. This procedure was first performed in Paris in 1748.7

De la rétinite pigmentaire: étude clinique avec quinze observations nouvelles et quatre figures en chromo-lithographie

Ophthalmoscopic examination of patients diagnosed with retinitis pigmentosa, a condition that affects the retina's ability to respond to light.

De la physique appliquée au diagnostic

Tubular indirect ophthalmoscope designed by Galezowski in 1862: highly portable and possible to use in the presence of ambient light.8

Altération des membranes internes de l’oeil dans l’abuminurie et le diabète

Ophthalmoscopic view of an eye showing the characteristic "cotton wool" white spots of diabetic retinopathy.

Du traitement de l'ectropion cicatriciel

In the patients shown above, facial trauma and scarring have caused the lower eyelid tissue to droop and turn outward abnormally, a condition called cicatricial ectropion, circa 1860.

Études anatomiques, ou recherches sur l'organisation de l'oeil, considéré chez l'homme et dans quelques animaux

The optical anatomy of certain fish, in a thesis comparing human and animal eyes.

Du zona ophthalmique et des lésiions oculaires qui s'y rattachent

Ophthalmic herpes zoster, a shingles infection that affects the eyes, circa 1872.

L'Angoigraphie fluoresceinique: Étude et valeur clinique des temps de circulations retinienne dans les stenoses et les occlusions des carotides internes, dans les occlusions artérielles et dans les thromoses veineuses retiniennes

Fluorescein angiography (a method of examination of eye circulation) in a case of central retinal artery occlusion, circa 1971.

Des rétinites secondaires ou symptomatiques

Figure 6 shows optic neuritis in a case of tubercular meningitis. Figure 7 shows neuroretinitis, an inflammation of the optic nerve.

De l'ophthalmoscope

Basic ophthalmoscope, circa 1856.

Recherches Anatomiques sur les veines de l'orbite, leurs anastomoses avec les veines des régions voisines

A map of the orbital region veins, circa 1887.

Essais ophthalmoscopiques

An unexplained pigment cluster in an otherwise healthy eye, circa 1871.

Notes

  1. Keeler, "The Ophthalmoscope and the Lifetime of Hermann von Helmholtz." For an excellent explanation of how the ophthalmoscope works and why it is necessary to view the fundus, see Timberlake and Kennedy, "The Direct Ophthalmoscope," 9-12.
  2. For a contemporary account of this proliferation of ophthalmoscopes, see Zander, The Ophthalmoscope, 33-35.
  3. Amalric, "The Galezowski tradition," 105-6.
  4. Roper-Hall, "Historical Vignette," 127-128, 130; Ouvrir, "Henri Parinaud," 1571-2.
  5. Goetz, Bonduelle, and Gelfand, Charcot, 139.
  6. See Keller, "The Ophthalmoscope in the Lifetime of Hermann von Helmholtz."
  7. Bellan, "The Evolution of Cataract Surgery."
  8. Amalric, "Galezowski tradition," 108

Bibliography

    • Amalric, Pierre M. "The Galezowski tradition in Paris." Documenta Ophthalmologica 98.1 (1999): 105-113.
    • Bellan, Lorne. "The Evolutuion of Cataract Surgery: The Most Common Eye Procedure in Older Adults." Geriatrics and Aging 11.6 (2008): 328-332.
    • Goetz, Christopher G., Michel Bonduelle, and Toby Gelfand. Charcot: Constructing Neurology. Oxford University Press, 1995.
    • Keeler, C. Richard. "The Ophthalmoscope in the Lifetime of Hermann von Helmholtz." Archives of Ophthalmology 120.2 (2002): 194-201. DOI: 10.1001/archopht.120.2.194.
    • Ouvrir, Robert. "Henri Parinaud (1844-1905)." Journal of Neurology 258.8 (2011): 1571-1572.
    • Roper-Hall, Gill. "Historical Vignette: Henri Parinaud (1844-1905): French Ophthalmologist and Pioneer in Neuroophthalmology." American Orthoptic Journal 64.1 (2014): 126-133. DOI: 10.3368/aoj.64.1.126.
    • Timberlake, George T. and Michael Kennedy. "The Direct Ophthalmoscope: How it Works and How to Use it." University of Kansas, 2005. http://web.media.mit.edu/~raskar/Eye/TheDirectOphthalmoscope.pdf.
    • Zander, Adolf. The Ophthalmoscope: its varieties and its use. Translated by Bert Brudenell Carter. London: Robert Hardwicke, 1864. Google Books.