Maximilian Salzmann.

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tissue develops is the anterior half of the bases of the ciliary processes.
The interstitial connective tissue of the radial portion of the ciliary
muscle also increases in amount, and the muscle-bundles thereby become
narrower. The interlamellar connective tissue becomes thicker in the
same manner.

In this category should perhaps be placed the senile miosis and es-
pecially the so-called rigidity of the sphincter pupillae, i.e., the resistance
of the pupil to dilatation. It supposedly has its cause in the thickening
of the connective tissue behind the sphincter (Fuchs, 67), if a forma-
tion of hyalin connective tissue at the border of the pupil is not the cause
as in the case of Meller (149) ; this in any case does not any longer belong
in the territory of physiology.

According to Kerschbaumer (117), changes in the vessel system of the
chorioidea are frequent even in the fortieth year and are regular in



THE APPEARANCES OF AGE IN THE EYEBALL 213

senility. These consist especially in clouding and thickening of the
vessel walls, loss of the nuclei, etc. In the choriocapillaris this condition
expresses itself by the loss of the endothelial nuclei, and a greater accentua-
tion of the vessel contours; the whole layer thereby becomes more stiff
and rigid.

The various glands and membranes (cuticular membranes) show a
further and greater tendency to thickening in age and some a tendency
to localized greater thickening or wart formation, as well.

The lens capsule only increases uniformly in thickness (cf. the table on
p. 165); the Descemet's membrane gradually thickens in the center,
but warts appear more and more plainly at the border; the wart zone
broadens (PL IV, i). Very striking, furthermore, is the thickening of
the limitans interna ciliaris, especially its ridges. The results of this
condition upon the ciliary epithelium have been described elsewhere
(p. 122).

Most striking, however, is the tendency to the formation of warts
in the glass membrane of the chorioidea. Since this appearance may
also be a pathologic process, I limit myself to the description of that
form which is found in the eyes of old people without other pathologic
changes.

The senile warts (verrucae of most authors) occur at the periphery of
the glass membrane of the chorioidea as small to medium sized, usually
semispherical elevations (PI. VII, 7). They are seated immediately
upon the glass membrane, so that one can follow both lamellae of the
membrane beneath the warts. When unstained, the warts themselves
(at least in the hardened preparations) consist of a homogeneous, glassy,
transparent substance; this stains only a little more intensely than the
cuticular lamella. Without doubt there can at times be a thin stratum
of ordinary cuticular substance on the surface and in the crevice about
the base of the small warts; this substance stains feebly. Since the
smallest of these structures also set directly on the glass membrane, one
must look upon the warts as a secretion product of the pigment epithelium.
The pigment epithelium courses over the warts, its cells are larger on the
summit and thinner, and the nuclei are flattened.

With the ophthalmoscope the warts, therefore, appear somewhat
lighter than their environment, and, since the pigment epithelium to a
certain extent then appears in profile on the declivity of the warts, and
a thicker layer is presented here (in the line of vision of the observer),
the warts appear to be bordered by a fine, dark seam. The peripheral
situation of the warts makes the ophthalmoscopic proof of them more
difficult, because they are to be seen there only in the less magnified,



2i 4 ANATOMY AND HISTOLOGY OF THE HUMAN EYEBALL

indirect image. One finds them decidedly more often, therefore, on
anatomic than on ophthalmoscopic study.

Variations from this very frequent condition occur in the localization,
the grade of development, and the structure of the warts.

As long as the formation of warts involves only the periphery of the
fundus, it does not damage the function of the eye. At times, however,
they attack the territory of the area centralis (and very extensively), or
they attack it exclusively. They then make themselves manifest by a
lowering of the visual accuity or, indeed, by a central scotoma.

Particularly large warts imbed themselves deeper in the retina,
probably also lead to a total disappearance of the pigment epithelium
over the summit, and thereby to further secondary changes in the
retina. Large warts at times show a stratification about a core which
lies at the base of the wart and is often degenerated; this may resemble
particles of starch.

A calcification is frequently found in these warts, as also in those in
the free portions of the glass membrane (H. Mueller, 156; Kerschbaumer,
117). One then finds numerous, very fine, highly refractile granules
in the glass membrane, which is thereby rendered more clouded and
fragile. These and other depositions likewise bring out a clouding in the
substance of the warts. When the overlying pigment has disappeared,
such warts appear as intensely yellowish-white flecks or show a plain,
decided reflex (Nagel, 163), especially when they contain larger crystals.

When extensive atrophic processes are at the same time present in the retina,
when the capillaries of the chorioidea are destroyed, a newly built connective tissue or
bone lies beneath the warts, and one has a pathologic form of warts to deal with. Such
changes are not the result but the cause of the wart formation, i.e., a proliferation of the
pigment epithelium and an abnormal secretion of cuticular substance. The stratified
concrements arising primarily in the cerebral layer of the retina or in the non-
medullated section of the optic nerve have, in general, nothing to do with the pigment
epithelium and are pathologic formations throughout.

The pigment epithelium in the eye of the aged is often subject to a
certain amount of atrophy. This appears partly in a diffused form, and
thereby brings out the tessellation of the fundus very much more plainly,
partly in a circumscribed form. The latter occurs in the immediate
neighborhood of the optic-nerve entrance and leads to conus or halo-like
figures.

Such atrophic conditions are often found in the pigment epithelium
in the neighborhood of the border of the retina and the border portions
of the retina are frequently fixed thereby. It is, however, questionable
whether these appearances are not in the territory of the pathologic.



THE APPEARANCES OF AGE IN THE EYEBALL 215

Concerning the development of cystoid degeneration there has already
been extended discussion (p. 84, etc.).

The irregularities appearing in the ciliary epithelium and their
supposed cause have also been referred to elsewhere. However, actual
growths of the ciliary epithelium may also come about; these lead to
tufted or nodular excrescences. They appear on the crests of the ciliary
processes. In connection with the more marked development of the
connective tissue of the substratum, they bring about the plump appear-
ance of the ciliary processes in the eye of the aged, especially, however, the
nodular and racimose appearance of the ridges (Kerschbaumer, 117; Hess,
101), and, according to the latter author, also the greater extent of the
whitish coloration. The individual excrescence is formed by the ciliary
epithelium alone, and projects over the surface like half a sphere (PL
VII, 2).

It is conceivable that not only the ciliary valleys but also the entire
ciliary ring is thereby narrowed, and since, too, the lens is at the same
time larger, a complete closure of the circumlental space can come about
in the eye of the aged.

The border layer of the vitreous thickens and becomes condensed
in age; at the same time the structure of the nucleus becomes spaced up,
and large cavities filled with fluid appear (liquefaction of the vitreous,
synchisis). The zonula fibers are also greatly thickened in age.

The lens increases in size up to the very greatest age, and although
the rapidity of its growth is very much less than that in youth, a much
longer time is allowed for it. Accurate statements concerning the growth
of the equatorial diameter have been made by Priestley-Smith (173).
In the third decade of life it has an average of 8.67 mm, in the eighth
decade 9.64 mm. Along with this there is always a further individual
play of at least o. 75 mm.

According to the same author, such senile lenses may be 5 to 6 mm
or more thick. The ophthalmometric measurements of Saunte (pub-
lished by Tscherning, 228) present a continuous increase of the thickness
of the lens from 3 . 6 mm, in persons under 20, up to 4 . 5 mm in persons
over 50 years of age.

From all this it is evident that at this period of life the lens increases
uniformly in all diameters. According to Priestley-Smith, one can,
therefore, deduce the form of the senile lens from that of the youthful
lens if one thinks of it as surrounded by a shell some o . 5 mm thick. The
margin of the senile lens is, therefore, much more strongly rounded.

The yellow coloring of the lens often attains such a height in great



216 ANATOMY AND HISTOLOGY OF THE HUMAN EYEBALL

age that the color perception, especially that for blue, becomes markedly
disturbed (Hess, 98).

Corresponding to the slight growth of the lens fibers in age, the nuclear
bow of the lens shows only a few transitional divisions from epithelium
to lens substance, and the nuclear bow bends sharply and often very
irregularly forward (PL IX, 3).

It is very difficult to decide to what extent opacifications should be accredited as
senile appearances. It is, indeed, true that one practically never sees an eye in the
aged in which the lens is completely free from clouding. Yet this clouding does not
progress in all people to a complete formation of cataract. The senile cataract and all
its initial stages, frequent as they are, had, therefore, better be treated as pathologic
appearances.

One result of the enlargement of the lens, in part also of the defective
secretion of aqueous, is the lessened depth of the anterior chamber. That
the free space of the posterior chamber is also narrowed, and in a still
higher degree, is shown by the enlargement and thickening of the ciliary
processes, the lens, and the zonula fibers.



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217



218 ANATOMY AND HISTOLOGY OF THE HUMAN EYEBALL

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LITERATURE CITATIONS 219



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LITERATURE CITATIONS 221

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