New Observation on a Primary Ocular Reaction to Shwartzman Toxins

Abstract

This report deals with a marked reaction in the eye of the rabbit following the intravenous injection of Shwartzman toxins.∗ It consists of miosis, photophobia, lacrimation, congestion of the iris and conjunctiva with a marked pericorneal ring of dilated capillaries and in some instances with gross conjunctival hemorrhages. Ophthalmoscopical examination is rendered difficult by the turbidity of the dioptic media although a marked congestion of the fundus may be revealed. The ciliary bodies show enhanced permeability to fluorescein injected intravenously. The aqueous humor of the anterior chamber is usually under high pressure and coagulates immediately upon removal. The fluid is clear in appearance although numerous fibrin-threads, crystals, and epithelial cells may be seen microscopically. The reaction reaches its maximal intensity within 2 hours following the intravenous injection of potent toxins but it completely disappears 24 hours later. The toxins may be given intravenously and intraäbdominally, the cutaneous route is only successful when a vascularized area of the skin is used (the upper third of the ear). Microscopically, severe reactions show massive conjunctival hemorrhage with dilatation and engorgement of blood vessels of the recti muscles. No lesions have been seen in the iris, retina, cornea, and ciliary bodies.

Incidentally, other primary toxic effects following the intravenous injection of the Shwartzman filtrates may be noted, i. e., severe diarrhea, enhanced fragility of the capillaries of the skin, serous fibrinous exudation in the joints, some enhanced permeability of the choroid plexus to fluorescein and a high mortality-rate. These effects may be considerably diminished by a previous local preparation of rabbits to the Shwartzman phenomenon (observed on about 50 animals). No similar protection is afforded by local preparation with chemical irritants and inflammatory agents devoid of Shwartzman principles (cantharidin plaster, turpentine, diphtheric toxin, etc.).