tension, which shortly falls to the normal and sometimes
below it, the tension being high as long as the primary narrowing of the
pupil is maintained, but more than one author, particularly A. Senn,
holds an opposite view and reports acute glaucoma following its
instillation into a chronic glaucomatous eye. He believes that dionin
not only does not reduce the tension but hinders the filtration through
the anterior lymph channels by the pressure of the edema which is
produced on the veins and by the increased secretion of the ciliary
processes. In spite of this statement, most of us must agree with Karl
Grossman's observations that certainly in acute and particularly in
chronic secondary glaucoma, this is a most valuable agent, especially if
it is combined with holocain, which Paul Knapp in his well-known
research has proved can reduce the tension even of the normal eye. I
cannot think that anybody who has systematically used dionin with
holocain, the former in gradually increasing strength, beginning with 2
per cent and going up to 8 per cent, in various types of acute glaucoma,
particularly of the secondary variety, can fail to have noted a
favorable influence.

Many authors, for example, Darier, Grandclement and others, are strong
in their recommendation of adrenalin, particularly if this drug is added
to the various myotic mixtures, and yet adrenalin is certainly not
without danger in the treatment of glaucoma. McCallan has seen a number
of instances of striking increase of intra-ocular tension following this
instillation in the conjunctival sac. Harmon has had a similar
experience, as also has Senn. It is possible that in these circumstances
the solution was too strong. Should the rise of tension occur, and I
have seen it myself, it is doubtless due to the fact that this drug
dilates the pupil, which would be especially dangerous if the dilatation
should occur before contraction of the ciliary vessels; also the
narrowing of the ciliary veins by the adrenalin might by virtue of this
narrowing obstruct the gate of outflow. I have never been able to
persuade myself that, except as an adjuvant to operative work, there was
any real therapeutic value in the instillation of adrenalin.

A word in regard to the effect of general narcosis on intra-ocular
tension. Thus, Neuschuler has observed that narcosis causes an elevation
of the intra-ocular tension of from 2 to 6 degrees as measured with
Fick's tonometer. These observat