generally accepted in Germany. The disease undoubtedly occurs in individuals absolutely free from syphilis.
Hutchinson refers to a certain abnormal development of the teeth as nearly constantly associated with the disease, but this, too, is absent in many cases. The peculiarity of this abnormity is that the middle of the cutting edge of the incisors, which should be the most prominent part, crumbles down and assumes, especially in the two upper front teeth, a concave form.
Keratitis parenchymatosa is most frequent from the sixth to the twentieth year. After that it is rarer, and its course, when it occurs, is milder.
In making the prognosis, we have to consider the length of the process and the remaining opacities. These last are generally so much the greater the higher the inflammation and the more extensive the vascularization of the cornea has been.
The treatment of this form of keratitis cannot be a very active one. Improvement of the hygienic surroundings, attention to constitutional disturbances, protection of the eyes from injurious influences of all kinds, and patience on the part of the physician and patient, are the principal points in the therapeutic programme. Iodide of potassium and preparations of iron are generally to be recommended. The local treatment should be such as to diminish as much as possible the irritability. For this purpose warm fomentations and atropine are best. All irritants are to be avoided. Hasner[1] recommends the paracentesis of the cornea for all cases which are free from complications, and in which the cornea, although considerably clouded, is but little or not at all vascularized, while the hyperæmia of the sclera and the ciliary neuralgia are but slight. It is especially in recent cases of this kind, in which the affection has lasted but a few weeks, that favorable results have been observed to follow paracentesis.
Keratitis punctata is a quite rare affection, and one always complicated with iritis; it ought not, however, for that reason to be confounded with certain cases of iritis, which are characterized by a precipitate upon the membrane of Descemet. With inflammatory symptoms, and the corresponding irritability, there develop in the parenchyma of the cornea, isolated, circumscribed, white
- ↑ Klinische Vorträge über Augenheilkunde, pag. 163.
