DEFINITION. – Inflammation of the conjunctiva-the membrane which covers the posterior surface of the eyelids and the anterior surface of the globe of the eye.
Inflammation of the conjunctiva is met with at all ages, and at all seasons of the year, but some forms are more common in the spring and autumn.
Cases are very frequent in poor, ill-fed children, and very commonly these also suffer from chronic coryza, have sores about the nostrils and lips, eczema of the face, perhaps discharging ears. Good food and cleanliness are here of the first importance. Plenty of fat food-milk, cream, and butter-should be given. The internal administration of cod-liver oil is the best cure for the disease in these cases.
Conjunctivitis may be acute or chronic. An acute conjunctivitis may become chronic.
CAUSES. – Apart from mechanical or chemical irritation, inflammation of the conjunctiva is almost always caused by micro- organisms gaining access to the conjunctival sac; or perhaps in some cases by the sudden development under favourable conditions of those which had been already present in a latent condition. They can easily be detected in the discharge; and are the cause of its infectious nature. Infection takes place by the direct transference of the secretion from person to person, or indirectly by the common use of the same article by different people.
An attack may follow any irritation, such as exposure of the eyes to dust, smoke, heat, accidental splashes of foreign fluids, winds, glare of light, prolonged exertion in using the eyes when there is an error of refraction. The reflex irritation of decayed teeth, gastritis, ingestion of stimulating foods, will produce the same symptoms. When these causes of irritation are repeated or prolonged a chronic form of conjunctivitis results the eyes are always bloodshot, sore, and watery.
SYMPTOMS. – In no disease can the classical features of inflammation-heat, pain, redness, swelling, and alteration of function – be better seen.
Swelling varies from a barely perceptible oedema to a swelling so intense as to render lid and eyeballs immobile, and the skin may be swollen and glassy-looking.
Pain is always present in acute cases. It is peculiar that patients complain of the presence of sand or grit in the eye, even, sometimes, of a feeling as if broken pieces of glass were rolling under the lids. The membrane is sensitive to cold air.
Excluding cases where the eyes are closed by oedema of the lids, there is even in slight cases some blurring of vision.
Tears are excessive and a secretion of mucus or muco-pus glues the lids together in the morning.
There is bright redness of the conjunctiva and frequently extreme intolerance of light.
TREATMENT. – Bathe the eyes several times daily with warm boracic lotion. If there is muco-purulent discharge use instead a lotion of Calendula O 5 drops, to a wineglassful of warm water. After bathing instill Boracic or Calendula ointment within the lower eyelid, – while the patient looks up, draw down the skin of the lower lid, and with a clean glass rod or spatula place a piece of ointment the size of a match-head on the exposed conjunctiva lining the lower lid. If the lids are agglutinated in the morning they should not be opened without being first moistened with lotion, but any gumming of them together is prevented by smearing the edges at night, or better still, instilling within the lower lid, a little ointment.
Exposure to currents of cold and damp air should be avoided, and if the weather be inclement the patient should remain in a room of uniform temperature. As long as the eyes remain sensitive they may be protected by a shade, or by plain blue or smoke- coloured glasses. They should be used with extreme moderation, and an impure atmosphere avoided.
The food should be simple, nourishing, and digestible.
It is important to remember that many forms are highly contagious, the infection being not unfrequently transmitted by towels, sponges, water, etc. Those articles which will stand boiling in a little washing soda may be disinfected by that process.
PURULENT OPHTHALMIA is a severe and dangerous form of conjunctivitis, due in nearly all cases to contagion from gonorrhoeal discharges.
It is most commonly seen in infants infected by vaginal discharge at birth, and it makes its appearance about the third day after the confinement. The lids become red and swollen and their edges stick together; on opening them yellowish pus exudes. If the disease be neglected there is great risk to the cornea from ulceration and sloughing with consequent incurable blindness. In the L.C.C. Blind Schools 37 per cent. of the children are blinded by this one cause.
The disease is preventable (1) by curing the leucorrhoea of the mother during pregnancy; (2) by instilling a 1 per cent. solution of silver nitrate, or a 15,000 perchloride of mercury solution into the conjunctival sac as soon after birth as possible in order to kill the gonococcus should it have gained access to the conjunctiva. In the child’s first toilet, the face should be washed in separate water and dried with a separate towel to that used for the body, and at no time should the mother’s towels be used for the baby.
LEADING INDICATIONS FOR SOME OPHTHALMIC MEDICINES
Belladonna. – Pain, redness, and swelling; throbbing pains in the temples; flushed cheeks, glistening eyes, and great intolerance of light. A dozen drops of the tincture may be mixed with a half a dozen tablespoonfuls of water, and a spoonful given during the acute stage every hour, and afterwards every three to six hours. Aconite is often required in alternation with Belladonna when there are general feverish symptoms; or two doses of Aconite may precede Belladonna
Aconitum. – Conjunctivitis, with quick pulse, dry skin, thirst, and when arising from cold. The early administration of this remedy, with the local use of Calendula or Boracic lotion bath, will generally promptly relieve and cure Catarrhal Ophthalmia.
Mercurius Sol. – Conjunctivitis marked at first by a copious discharge of watery fluid, which afterwards changes to mucus and pus; agglutination of the lids; smarting heat and pressure, with aggravation of the pains when moving or touching the eyes. There is not much fever present, but considerable itching and irritation.
Euphrasia. – Catarrhal Conjunctivitis, with profuse secretion of tears, sensitiveness to light, and catarrhal Inflammation of the frontal sinuses and of the lining of the nose. In simple Catarrhal Inflammation, profuse lachrymation being the chief symptom, it often cures without the aid of any other remedy.
Mercurius Cor. – In the most violent forms of Acute Conjunctivitis with extreme dread of light, or in chemosis the 1x or 2x of this remedy will often cut short the attack.
Argentum Nit. – This remedy is especially valuable in the Purulent Ophthalmia of children, which it cures rapidly and completely, without the local use of the nitrate. It is also valuable in Chronic Conjunctivitis.
Phytolacca. – Itching in the eyes, aggravated by gaslight; chronic conjunctivitis with rheumatic pains; reddish-blue swelling of the lids.
Gelsemium. – Squinting; desire for light; Orbital Neuralgia.
Pulsatilla Nuttalliana. – Eyelids agglutinated; increased secretion of tears; neuralgic pains in the eye-balls.
Arsenicum. – Obstinate Ophthalmia in weak, nervous patients, particularly if the secretion be acrid, with burning, tearing, or stinging pains in the globe and lids, aggravated by light.
Phosphorus. – Chronic and obstinate cases which have resisted the usual remedies, with sensitiveness to light, heat, and itching of the eyes, sudden attacks of blindness, black spots floating before the eyes, and secretion of viscid mucus.
Ac.-Nit.-Purulent Conjunctivitis; swelling and redness of the mucous membrane and lids; secretion of viscid mucus or pus; burning and smarting in the eyes; Photophobia; nightly agglutination; and pains in the bones and parts around the eyes. Ac.-Nit. is required in cases originating in Syphilis, or aggravated by mercurial preparations.
Hepar Sulph. – Similar cases to Ac.-Nit., which it may follow if necessary.
Arnica.-Inflammations affecting either the mucous membrane, or the deeper structures of the eyes, from mechanical injuries. In addition to its administration, the eye should be bathed with a lotion of Arnica O (five drops to four tablespoonful of water). After well bathing the eyes, a piece of lint or linen should be saturated with the lotion, applied to the eye, covered with oil- silk, and secured by a hand-kerchief.
Other remedies-Sulph., Silicea, Pulsatilla, Lycopodium, Aurum, Rhus, Spigelia
ACCESSORY MEASURES. – In the treatment of the various forms of Conjunctivitis, and weak and imperfect vision generally, the causes of the disease should be correctly ascertained, so that they may, as far as possible, be removed and guarded against. Patients in crowded and unhealthy towns should remove to the country, at least for a time, where they may take daily out-of- door exercise, and enjoy a pure, bracing air. Frequent careful tepid washing of the eyes to prevent accumulations of matter; a spacious well-ventilated apartment; and avoidance of all causes likely to keep up the inflammatory process, are all necessary precautions. The food should be plain and nourishing, coffee and fermented drinks being excluded; the habits early and regular and frequent bathing should be practised.
115. – Iritis.
DEFINITION.-Inflammation of the iris. The iris is the coloured membrane which lies in the space between the cornea and crystalline lens. In its centre is the circular aperture called the pupil. By the contractile power of the iris the size of the pupil is varied, and thereby the amount of light admitted into the eye through the pupil is regulated. When children are born they have blue eyes, but as pigment is developed in the substance of the iris they may become brown.
Inflammation of the iris is acute or chronic; again, Iritis may be primary in the iris, or secondary, from extension of the inflammation from a neighbouring diseased structure.
By far the most common cause of acute primary Iritis is Syphilis, probably fifty per cent. of all cases being due to it. Other causes are gonorrhoea, tuberculosis, rheumatism, gout, diabetes, enteric fever, pneumonia, influenza, etc.
SYMPTOMS. – There are burning pains of a neuralgic character in the eye and severe aching in the forehead which come on in paroxysms and are aggravated at night. The iris changes its colour and becomes blurred. The pupil is sluggish in action, small and irregular in shape, and if the disease be neglected or mistreated closed or obstructed-the rays of light being thus intercepted in their passage to the retina, sight is prevented. Marked congestion of the eye, and especially a radiating zone of vascular redness surround the cornea. No matter forms.
A grave mistake into which the uninitiated often fail is to take a case of iritis to be one of conjunctivitis scleritis. The appearance of the iris itself is the most valuable guide.
TREATMENT. – Atropine (g. iv…i) instilled into the eye every two hours for the first day or two, less frequently afterwards. Dry heat applied over the eye. Dark glasses.
In the gonorrhoeal rheumatic forms, the attacks are very liable to recur even after an interval of years.
EPITOME OF TREATMENT.- 1. Traumatic Iritis. – Arnica (both internally and externally); Aconite (febrile symptoms); Belladonna
2. Rheumatic.-Aconite, Mercurius, Belladonna, Cocc., Coloc., Spigelia, Sulphur
3. Syphilitic. – Mercurius-S., Cinnabar, Clem., Merc-Iodium, Belladonna, Aurum
See Leading Indications for Ophthalmic Medicines.
DEFINITION. – A convenient expression which may be taken as meaning that the eyes cannot be used as they should be in a state of health, without entailing a strain upon the muscles of the eye, which in its turn betrays its presence by local or general discomfort.
CAUSES. – Some often unsuspected, error of refraction, or deficiency in the focusing system (accommodation), or in muscular action, of the eye. Slight degrees of hypermetropia (longsight), with or without astigmatism, is the commonest cause of eyestrain. Other things being equal, it is the small error of refraction and not the large which is usually responsible for the symptoms.
Eyestrain is more likely to show itself among the cultivated than among the uncultivated members of society-the small error of refraction that would pass unnoticed in a labourer might produce marked discomfort in hard-worked literary man.
An error of refraction is naturally more likely to cause headache if the patient is debilitated. It is far from uncommon for the discomfort to make its appearance for the first time under such circumstances, even although the underlying ocular defect may have existed from childhood.
SYMPTOMS. – It is most important to bear in mind that the suffers from eyestrain rarely complain of any defect of vision. Indeed, they not infrequently warmly repudiate any suggestion that the eyes are at fault by asserting that they have a very good sight – and so they often have; but how do they obtain it? At the expense of a strain upon the eyes, or otherwise?
Headache is the commonest manifestation of eye-strain. It has been estimated that from eighty to ninety per cent. of all headaches are of this origin. Whenever headache, neuralgia, giddiness or other symptom is induced or made worse by use of the eyes and relieved by rest, it may be assumed to be due to eyestrain. That supposition is strengthened if the patient possesses sight which when estimated by test types is found to be normal or better than normal.
It is a suspicious circumstances if headache is complained of after a visit to a theatre or a picture gallery, or a journey by train, tram or car. There is nothing peculiarly characteristic about the headache except that the sufferer rarely suspects that his eyes are at fault.
The local evidences of eyestrain, which are sometimes present, assume the form of aching, tenderness, fatigue, throbbing, watering, and redness of the eyes. A frequent complaint is that lines of print becomes misty, and cannot be read again until the eyes have been closed for a few seconds. An outbreak of small styes is often a sign; so is frequent blinking.
That those who suffer from ocular headache sometimes suffer also from disordered general health can scarcely be looked upon as extraordinary. Such complaints as sleeplessness, confusion of thought, inability to fix attention, irritability of temper, and gastric disturbance are not rare, and these symptoms, like the headache may often be relieved by suitable glasses.
Eyestrain should always be thought of as a possible cause in all patients with insomnia, who use the eyes much.
TREATMENT. – Appropriate glasses prescribed after testing with ophthalmoscope and retinoscope by a competent ophthalmic surgeon.
The effects of eyestrain can often be relieved for a time at all events by medicinal treatment, and the leading of an outdoor and active life.
Many highly organized people experience considerable difficulty in becoming used to glasses; while some, alas will not preserve long enough to obtain any sensible relief. If the glasses are correct-not always an easy thing to make a patient believe-the only remedy is time. The uncomfortable feelings gradually become less and less marked, until in the course of a few weeks they are no longer experienced.
117. – Foreign Bodies.
Foreign bodies lodged in the conjunctival sac, unless embedded, are usually found under the upper lid. If the lids be everted they are easily removed with a clean spud, needle, etc. If necessary a drop of four per cent. Cocaine solution may be first instilled into the eye, in which case the eye should be subsequently bandaged for a few hours until the effect of the Cocaine has passed off.
To evert the upper lid, make the patient look strongly down; seize the eyelashes of the upper lid with the thumb and forefinger of the left hand; push down with the thumb of the right hand the skin of the upper lid, three-eighths of an inch above the lid margin, then evert by pulling the lid upwards against the point of the thumb
Many foreign bodies are dislodged by simply using the eye-bath with warm water.,
Lime frequently gets into the conjunctival sac and produces a caustic effect. Water must never be applied to these cases, but a strong solution of sugar, which will form with the lime an insoluble lime salt; or a few drops of oil may be placed between the lids.
Defect in distant vision is the commonest symptom, and if the short sight be more than a very moderate degree it will be found that the patient hold print nearer than normal to the eye.
Myopia is due to stretching of the globe of the eye, so that the eyeball is longer than normal. It may often be suspected by the prominence of the eye.
Myopia tends to increase, but the increase does not occur as a rule after twenty-five year of age. Any severe illness, and especially congestion of the eyes brought about by excessive strain in near vision, and stooping over books, etc., favours its progress.
City or town residence by the constant self-adaptation of the eyes to short distances, is a powerful predisposing cause. It cannot but make a vast difference in the condition of the eye in the course of years, whether it is daily employed in looking at walls a few feet distant, or as in the country, at mountains and forests, which often are in view miles distant.
TREATMENT. – In the majority of cases no medical treatment is required, but only the choice of suitable glasses. These should not be purchased at random, but under the guidance of a competent ophthalmic surgeon.
DEFINITION. – Opacity of the crystalline lens, or its capsule, causing obscuration or total loss of vision.
Cataract may be present at birth (congenital cataract) or acquired. It may be partial or complete, and it may be stationary or progressive.
SYMPTOMS. – The symptoms produced depend on the density and position of the cataract or the defect of vision caused thereby. A very thin cataract may cause practically no defect of vision.
The opacity comes on in a gradual manner, first affecting one eye, afterwards both, and is often discovered by accident only. Objects appear to the patient as if seen through a mist or gauze, and a flame is observed surrounded by a halo. Vision is less affected in a weak light, such as twilight, or when the patient has his back to the window, under such circumstances the pupil dilates and the light enters at the circumference of the lens. For the same reason Atropine, which dilates the pupil, improves vision. The patient may also see better in an oblique than in a straight direction. The patient does not become so blind but that he can distinguish day from night, the position of the window, the shadow of passing objects, and is able to find his way about his own house with little difficulty.
CAUSES- The cause of many of the forms of cataract is at present unknown. It is not infrequently found to occur in several members of the same family.
EPITOME OF TREATMENT- Beneficial results have resulted from the following remedies- Belladonna, Cann., Calcarea, Sulphur, Silicea, Coni., Euphr., Phosphorus, etc.
Cataract should be extracted when the patient’s vision has failed so that he us unable to follow his occupation satisfactorily.
120. – Strabismus – Squinting.
DEFINITION. – A condition in which the axis of one eye is not parallel with that of the other.
If the squint is directed towards the mesial line, it is called convergent; if outwards, divergent. Concomitant indicates that the two eyes move together in distinction to the one-eyed movement seen in paralytic squint. Inward or convergent squint is the most common.
When a child is born the eyes move independently of each other, and thus new-born children often appear to squint. As they begin to take notice of surrounding objects they develop the power of fusion – the two images which fall on the two retinae are fused by the fusion centre of the brain. If one eye is defective from any cause, or the balance of muscles unequal, binocular vision does not develop and a squint may result.
CAUSES. – If the fusion faculty be weak, relatively small troubles may cause squint. The most common causes are hypermetropia (longsightedness), inequality of the eyes in refraction or muscle control, opacities on the cornea from former inflammation, etc. The disturbance of an acute fever, measles, or whooping-cough, or a fall may determine the onset of squint. High degree of myopia (shortsight) causes divergent squint.
If the squinting eye is not used it becomes amblyopic, and after a time fixation may be lost. The vision of this eye may be improved if the patient is treated sufficiently early, by covering up the sound eye.
EPITOME OF TREATMENT. – Belladonna, Stramonium, Hyoscyamus, Sulphur, Gelsemium, Cina., Spigelia, Phosphorus
An attempt should be made to correct the deformity and educate the squinting eye by covering the unaffected one for periods during the day. If an error or refraction be present the appropriate correcting glasses are essential. A surgical operation may be necessary.
121. – Amblyopia.
DEFINITION. – Defective vision in which there is no evidence of any ocular condition which might account for the visual defect. The term is not employed where there is any obvious lesion of the eye.
Amblyopia may be congenital; it may arise from non-use of a squinting eye; certain toxins such as tobacco, alcohol, quinine, lead poisoning, etc., produce it.
When it is toxic in origin, both eyes are as a rule equally affected, and recovery is usually complete on abandoning the use of the poison, unless it be of long standing.