In the inflammatory stage of purulent conjunctivitis, ice compresses will usually be found most valuable, often serving to abort an attack. Ice bags may be used on the eye, or when the weight of the ice bag is complained of, cold may be applied by means of four or five thicknesses of old linen, cut about three inches square and laid upon a large cake of ice; these pads are to be conveyed quickly from the ice to the eye and changed every one or two minutes so that the cold will be constant. Carbolic acid, a 1 to 200 solution, or other disinfectants, can be used in combination with the ice, by having a large piece of ice in a large vessel of the solution.
Caustics are directly efficacious by the irritation of the vascular walls, and indirectly by the contraction that follows a considerable discharge of serum, such as accompanies the shedding of the eschar. A 2 per cent. solution of the nitrate of silver applied once or twice a day is preferable to stronger solutions. The use of Chronic water, Boracic acid and the like is frequently of great service. Astringents, especially a weak solution of nitrate of silver (2 to 5 grains to the ounce) may be required. If the patient is seen shortly after inoculation with gonorrhoeal virus, it may be aborted by one application to the everted lid of a strong solution of nitrate of silver (gr.xxx.ad zi), washing it off with water. Scarification is sometimes needed. The incisions are not to be made deep, but long and parallel to each other, and may be repeated very twenty-four hours, if needed; promote the bleeding by warm water and kneading the lid.
Aqua chlorinii, as an external application, has proved a very valuable remedy in the various forms of purulent Ophthalmia the indicated remedy. The strong solutions is sometimes employed, though we usually dilute it one-half, one-third, or still weaker.
When the cornea becomes ulcerated, some operative measure, paracentesis, or Saemisch’s incision or the use of Atropine or Eserine, may be necessary if the lids are much swollen and very tense to relieve the pressure upon the eyeball and to permit of more through opening of the lids for the purpose of cleansing the eye.
The most important remedies in this disease are Argent. nit., Hepar, Mercurius, Rhus tox., Calcarea hypophos., Aconite, Apis, Chamomilla, Euphras., Nitric ac., Pulsat., Sulphur. For indications see Remedies in Conjunctivitis, Page 214.
Conjunctivitis Diphtheritica is perhaps one of the worst diseases of the eye we have to deal with. It is purulent inflammation, that spreads by infection and the secretion of which is contagious. It may exist alone or with diphtheria of the throat.
PATHOLOGY-It is a fibrinous infiltration throughout the entire thickness of the mucous membrane which seriously interferes with the circulation.
SYMPTOMS- It commences with acute pain (due to strangulation of the nerves and vessels by the infiltration), a feeling of heat and lachrymation. The upper lid becomes very much swollen and sometimes of such a board-like hardness that it is impossible to evert it. The skin of the lid is smooth, shining and of a pale, rosy or livid hue. The upper lid falls down, overlapping the lower, and it is impossible for the patient to raise it. The conjunctiva becomes congested and chemosed, due to an infiltration of coagulated fibrin. There is a dryness of the eye, and on everting the upper lid we find it smooth and yellowish; upon removing a portion of the thickened membrane we find that it has the same appearance all through, due to the infiltration. Owing to a constriction of the blood-vessels, a deep incision will produce no bleeding. The whole lid has a lardaceous appearance in the most severe cases, while in the cases of partial diphtheria we will notice one or two smooth, depressed places of a grayish-yellow color where the exudate is excessive. The conjunctiva between these islands is swollen, red and bleeds easily. Occasionally diphtheritic patches are found on the external angles of the lids. The secretion is sanious and contains flakes of diphtheritic matter.
The disease so far has been one of infiltration, lasting from one to ten days, and is the most dangerous stage on account of corneal complications. Then begins the second stage, that of purulent discharge. The lids lose their hardness and there is set up a copious discharge of fibrinous masses. The vessels reappear at points and the infiltration looks like white patches here and there. The chemosis loses its yellow appearance and stiffness, and the whole disease now looks like an ordinary attack of purulent conjunctivitis. Instead of ending here, it enters a stage of cicatrization, in which there is a slough of the gangrenous portions of the conjunctiva, followed by a granulating surface covered by a new epithelial layer, which, extending from the neighboring conjunctiva, causes a drawing in or contraction of that membrane that results in more or less adhesions between the lid and eyeball, and in some cases ends in xerophthalmia.
The great danger in this disease is the liability of corneal complications, due to the infiltration of the conjunctiva shutting off the nutrition of the cornea.
CAUSES-Contagion is the principal cause, yet the disease must be looked upon as an expression of the general condition, for we find diphtheritic affections of other parts at the same time and we may have the general symptoms of fever, exacerbations, weakness, loss of appetite, etc. The good eye, though protected, will often become affected. It is most frequently found from the second to the eighth years of life, and is rarely seen in adults.
PROGNOSIS depends upon the amount of infiltration, grayish chemosis and stiffness of the lids. It is always serious and as a rule, more serious in adults than in children. The earlier the cornea is affected the more serious is the prognosis. There is not only the probability of the loss of vision, but in addition the danger of the loss of life. Cases caused by direct contagion are always much more serious.
TREATMENT-See Conjunctivitis Crouposa.
Conjunctivitis Crouposa (Conjunctivitis Membranacea)-This disease is characterized by an exudate on the surface of the tissue where it hardens into a membrane, while in diphtheria the exudate is within the tissue itself. In this disease there is the formation of a membrane, which may be thrown off as a cast of the sac. The membrane may be peeled off and leaves a bleeding surface underneath, while in diphtheria the membrane cannot be peeled off. the swelling and injection is less than that of purulent ophthalmia. The membrane has an special affinity for the cul-de-sac, while the tarsus and globe are least affected. The lids, while red and swollen, are soft. The upper lid hangs down over the lower. There is at first a watery secretion mixed with mucus which later becomes more purulent. The membrane is similar microscopically to that of tracheal croup. The disease is always acute, and the formation of a fibrinous layer is the essential feature, which is cast off with a slight purulent discharge and cure rapidly follows. It occurs particularly in the spring and autumn, when there is apt to be an epidemic form of diphtheria, and is found especially among children.
TREATMENT-Although these two forms of inflammation are wholly distinct from each other, they will be considered under the same section, as the treatment is not dissimilar in many points. If only one eye is involved, endeavor to prevent the extension of the disease to the other eye by hermetically closing it, for the discharge is very contagious, though extension may take place though the general dyscrasia. Cleanliness is of the greatest importance, as in purulent conjunctivitis. It is better not to exercise any force in removing the false membrane, as it only leaves a raw surface, upon which a new membrane forms, thus doing more harm than good; though all loose shreds should be carefully removed whenever the eyes are washed.
The application of caustic or strong astringents, especially in diphtheritic conjunctivitis, is always injurious except in the purulent stage, and then must be used very guardedly. Hot applications are better than cold, which serve to still further constrict the blood-vessels, and may be used especially in the purulent stage. A solution of alcohol and water (zj ad zj) has been employed locally with some benefit in diphtheritic inflammation; also a one percent solution of Carbolic acid. Solutions of both lactic and acetic acid have been used locally with benefit. Lemon juice brushed over the surface of the conjunctiva every six hours is highly recommended by a number of physicians. In croupous inflammation chlorine water has been useful as an external application. Corneal complications require special attention. In the cicatricial stage palliate the desiccation of the eye by instillations of milk, boroglycerine, or the carbonate of soda, gr.xxx.ad zj.
The most serviceable remedies are Acetic acid, Kali bich., Apis, Mercurius prot., Argent. nit., Arsen. Hepar, Lachesis, Phytolacca, etc. See Remedies in Conjunctivitis, page 214.
Professor of Ophthalmology in the College of the New York Ophthalmic Hospital; Surgeon to the New York Ophthalmic Hospital. Visiting Oculist to the Laura Franklin Free Hospital for Children; Ex-President American Homoeopathic Ophthalmological, Otological and Laryngological Society. First Vice-President American Institute of Homoeopathy : President Homoeopathic Medical Society of the State of New York ; Editor Homoeopathic Eye. Ear and Throat Journal : Associate Editor. Department of Ophthalmology, North American Journal of Homoeopathy, etc.