Page:The American Cyclopædia (1879) Volume XII.djvu/659

OPHTHALMIA 645 papillae being separated into groups by furrows and fissures, or tuberculated and sarcomatous looking, like a mulberry." (Jones, " Ophthal- mic Medicine and Surgery.") In the severer forms of the disease the eyelids are tense, livid, and often enormously swollen, the upper over- hanging the lower one; on separating them they often become everted, from the congested and swollen state of the palpebral conjunctiva. The conjunctiva lining the globe, red and swol- len, soon becomes raised like a wall around the cornea (chemosis)', a copious secretion of muco-purulent matter is poured out, runs down on the cheek, and bursts forth when the swol- len lids are pressed asunder. The patient is unable to bear the light ; there is burning pain in the eye, with pain around the orbit and in the temple, increasing at night. During the violence of the disease fever is present, though commonly moderate. The inflammation is not confined to the conjunctiva, but extends to the sclerotic and the cornea; the latter becomes vascular, opaque, and often ulcerated; some- times it bursts, discharging the aqueous hu- mor. The disease was first attributed solely to contagion imported by the British troops from Egypt, but it is now certain that it arises sporadically, and that under favoring circum- stances, such as overcrowding, innutritious diet, or want of cleanliness, it becomes highly contagious. Purulent ophthalmia even in its milder forms requires prompt and decided treat- ment, both because the disease may at any time suddenly assume a violent and intractable form, and because of its tendency to produce thick- ening and granulation of the conjunctiva of the lids. When the disease is severe, or when it occurs in a strumous constitution, there is always great risk of permanent injury to the eye ; in the worst cases the eye is sometimes destroyed in from 24 to 36 hours. In the se- verer forms of the disease recourse must be had to bloodletting, either general or by means of leeches or cupping glasses in the commence- ment ; afterward the lids may be pencilled once a day with a solution of nitrate of silver, or brushed over with the lunar caustic in sub- stance, and the eyes should be cleansed fre- quently with warm water or with a weak warm solution of alum or bichloride of mercury (alum gr. xvi., water viii., solve ; or bichloride of mercury gr. i., hydrochlorate of ammonia gr. vi., water f viii.). To relieve the congestion and swelling of the conjunctiva of the lid, it should be freely scarified, and when great chemosis is present recourse must be had to incision of the ocular conjunctiva. When the inflammation extends to the iris, as evinced by the irregularity and contraction of the pupil and by the change of color in the iris, mercury combined with opium may be cautiously ad- ministered, while the pupil should be dilated by the application of extract of belladonna around the eye. On the subsidence of active inflammation the diet should be improved, and iron, bitter tonics, and quinine may be neces- sary. Gonorrhceal ophthalmia closely resem- bles the severest and most intractable forms of Egyptian ophthalmia, and is to be treated in a manner precisely similar. Its only cause is the direct application to the eye of gonorrhceal virus. 3. Ophthalmia Neonatorum. New-born infants are subject within a week or two of birth to a disease closely resembling catarrhal ophthalmia. The infant is first observed to have the lids glued together after sleep, their edges are red and slightly swollen, and the eyes themselves are weak and watery. The inflammation is at first mainly confined to the lids ; as the disease advances they become swol- len, tense, red, and shining; on being separa- ted, a thick, yellow muco-puriform discharge bursts forth, the lids often become everted, and their conjunctival surface is seen to be velvety and dark red ; the sclerotic conjunctiva is at the same time seen to be injected, and more or less chemosis is present. In the worst cases the cornea may become ulcerated and the eye destroyed ; but if treated early enough the disease is easily subdued. In mild cases bathing and cleansing the eye several times a day with warm water, or with a weak colly- rium of alum water, may be all that is neces- sary. In severe cases the nitrate of silver so- lution may be applied to the eye daily, while the eye is cleansed three or four times a day with the alum or bichloride of mercury solu- tion. Sometimes it may be necessary to scar- ify the conjunctiva of the lids. 4. Scrofulous or Strumous Ophthalmia Phlyctcenular Oph- thalmia. Strumous ophthalmia is eminently a disease of childhood, and, excluding ophthal- mia neonatorum, before 12 years of age inflam- mation of the eye assumes this form in nine cases out of ten. While it is most common in children presenting other evidences of the strumous diathesis, it sometimes occurs in those whose constitutions are apparently without taint. It is early marked by great intolerance of light ; the child seeks the shade, shelters the eye with the hand, bends down the head, and keeps the eyelids nearly closed. Any attempt to open the eye is resisted by a spasmodic clo- sure of the eyelids, which the child even if in- clined is unable to resist. On forcing them open there is often little appearance of inflammation, merely a faint blush of redness, with perhaps a few vessels running from the angles of the eye toward the cornea. As the disease ad- vances, one or more phlyctsenulse form upon the cornea, and these bursting leave small ul- cers. There is commonly little suffering except from the intolerance of light, and from the excoriation caused by the tears running down the cheek. The child is fretful, the appetite irregular, and the digestive organs disordered. The disease is apt to be obstinate, with a great tendency to relapse. When ulceration of the cornea occurs, a permanent cicatrix (leucoma) is apt to be left. In bad cases the ulceration may penetrate deeply, the cornea be pierced, the aque- ous humor discharged, and prolapse of the iris