PART III.

DISEASES OF THE EYE.

SPECIAL DISEASES—DISEASES OF THE LIDS.

BLEPHARITIS.

Synonyms.-Blepharitis Marginalis; Ophthalmia Tarsi; Tinea Tarsi ; Sycosis Tarsi; Blepharo-Adenitis; Blepharitis Ciliaris.

Definition.-Inflammation and oedema of the border of the lids. Causes.-I. Sequelae of Conjunctivitis, Keratitis, etc.; II. Uncorrected Am.; III. Inflammation and Degeneration of the roots of the cilia; IV. Idiopathic, or as consequence of strumous diathesis.

Symptoms. Swollen and angry lid edges, accompanied by itching and soreness; a gummy exudation sticks the lids together during sleep, or dries in scales or crusts along the edges. In extreme cases the lashes may fall out (Lippitudo).

Prognosis.-Very favorable.

Treatment. If the incrustations are not easily removable by the hand soften them with F. 22, and remove also with the epilation forceps those cilia which are plainly diseased. Order F. 20 or 21, once, twice or thrice daily, carefully applied along the borders. If a refractive error exists, the blepharitis, as well as other disorders, may be its result, and not subside till proper spectacles are prescribed.

Sequelae. In severe and chronic cases may produce distichiasis, trichiasis, even entropion or ectropion, and by closing the puncta, also result in epiphora and diseases of the lachrymal duct.

HORDEOLUM (STYE).

Definition. A furuncular or phlegmonous inflammation located near the hair follicles of the margin of the lid.

Causes. Constitutional derangements, uncorrected Am., exposure to cold, etc., or the diseased root of cilia.

Treatment. Besides the general preventive measures relating to the general health and correction of refractive errors, which are especially advis.

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able, as these troublesome visitors come "in crops," special means are found in astringent and antiphlogistic lotions, as F. 6. If the offending lash is seen, pluck it out. Poulticing may give relief and aid the stye to point, when it may be opened.

CHALAZION.

Synonyms. Meibomian cyst, tarsal cyst, tarsal tumor.

Definition. A small tumor arising from the inflammation or closing of the duct of a meibomian gland.

Character. It is generally about the size of a small pea, points, usually, toward the palpebral conjunctiva, producing irritation and considerable discomfort.

Diagnosis.-Eversion of the lid shows a pinkish or dusky patch over the swelling, though the latter may not always be pronounced enough to notice.

Treatment.-Remove. (See Operations.) F. 2, or 4.

ENTROPION.

Definition. Inversion of the eyelid against the globe.

Causes.-I. Result of the cicatrizations following trachoma; II. Consequent upon blepharitis; III. From traumatic origin, burns, etc. IV. Blepharospasm.

Varieties.-I. Distichiasis, a double row or excessive number of cilia; II. Trichiasis, the eyelashes only inverted; III. The lid itself turned inentropion proper.

Treatment.-Epilation should be repeatedly tried for distichiasis and trichiasis before trying the surgical operations. (See Operations.)

ECTROPION.

Definition.-Eversion and conjunctival exposure of the lid.

Causes.—I. Relaxation of the tissues, as in old people; II. Cicatricial changes consequent upon injuries, burns, etc.; III. Sequelæ of conjunctivitis, blepharitis, etc.

Treatment. In the mildest forms, styptic lotions, e.g., F. I, or 3, and measures to reduce the conjunctivitis, may succeed in giving greater tone to the flabby parts. If not, surgical operation must be advised. (See Operations.) For severe forms nothing else suffices.

DISEASES OF THE LIDS AND LACHRYMAL APPARATUS.

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Sequelæ. An almost invariable result of ectropion is eversion of the puncta, and consequent epiphora and conjunctival irritation and hyperæmia. For this condition, slitting the canaliculi may give relief. (See Operations.)

MISCELLANEOUS AFFECTIONS OF THE LIDS. Xanthelasma are yellowish patches, perhaps slightly elevating the skin, and situated beneath it. They are objectionable only from a cosmetic point of view. They may be cut out with scissors, if desired.

Horny and wart-like formations are prone to grow from the lids, and should be removed.

Rodent Ulcers are the more frequent of carcinoma of the lids. They should be wholly removed.

Syphilitic Ulcers and Gummata upon the eyelids are the same in character and treatment as upon other parts of the body.

Molluscum Contagiosum, Naevi, Fibroma, etc., may also occur upon

the lids.

Crab Lice (pediculus pubes) may find a lodging on the lashes.

DISEASES OF THE LACHRYMAL APPARATUS.

DACRYO-ADENITIS.

Causes.-Inflammation of the lachrymal gland, of rare occurrence, arises from sympathetic irritation from neighboring tissues, from traumatic origin, from cold, compression, etc.

Characteristics.-Usually, a chronic swelling, which may be mistaken for a tumor, or vice versâ, in the upper and outer margin of the orbit. It is generally painless and not tender to the touch, though in acute stages may be excessively so.

Treatment. The usual antiphlogistic remedies may be tried. Free incisions, to allow escape of pus, if suppuration threatens, are to be recommended. The danger of an obstinate fistula should be borne in mind. In chronic hypertrophy, or inflammation of the gland, its excision may have to be decided upon.

EPIPHORA.

Definition.-Overflow of tears upon the cheek.

Causes and Varieties :—

I. From excessive secretion, caused by inflammation of the gland, or from the reflex action of neighboring irritations.

II. From eversion of the puncta in ectropion.

III. From obstruction of the puncta or canaliculi.

IV. From obstruction or stricture of the sac or duct.

The Puncta and Canaliculi may be closed or clogged by lodgment of foreign bodies or the products of inflammatory exudations, by the cicatricial tissue following trachoma, or wounds, by the oedema of blepharitis, etc.

Treatment.-Slit up the canaliculus. (See Operations.)

DACRYO-CYSTITIS.

Synonyms. Mucocele; Blennorrhoea; Swelling of the Lachrymal

Sac.

Definition.—A phlegmonous inflammation of the lachrymal sac.

Causes. This disease is preceded by a period of œdema and irritation, caused by obstruction and constriction of the sac or duct, and may be noticeable only by its effect in producing epiphora. If not relieved, a tumor becomes perceptible in the neighborhood of the sac, which, upon pressure, throws up its contents, colorless or pus-like, according to the length of time the breaking down has been going on.

Various causes may produce the constriction; catarrhal inflammation, injuries to the nasal bones, periostitis, etc.

The adjacent tissues of nose and cheek may take up the inflammatory processes in a way to deceive one in the diagnosis, and cause intense pain and trouble to the patient.

Treatment. The lower canaliculus must be slit up and the duct opened with a probe. (See Operations.)

The probe should be passed at intervals of every one, two or three days, according to necessity, for several weeks. When the duct shows a persistent determination to close up, a style will have to be worn for a longer or shorter period, till this habit is overcome.

Sequela.-There is usually conjunctivitis, by extension of the inflammation, and possibly blepharitis. When the dacryo-cystitis has produced abscess of the sac, free exit should be given the pus by slitting the canaliculus, and external puncture. So soon as the condition of the tisssue will permit, the duct should be probed, and an injection of an astringent and soothing character used (F. 1), by means of a syringe. The abscess should be speedily healed, to avoid the danger of a permanent fistula.

DISEASES OF THE CONJUNCTIVA.

DISEASES OF THE CONJUNCTIVA.

PALPEBRAL CONJUNCTIVITIS.

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Synonyms. Simple Conjunctivitis; Hyperæmia of the Conjunctiva. Definition. Inflammation and congestion of the capillaries of the palpebral folds of the conjunctiva.

Causes.-I. Long continuance of near work and strain of the ocular muscles; II. Uncorrected errors of refraction; III. Exposure to colds, winds, etc.; IV. Dust or foreign bodies.

Symptoms. The patient complains of a gritty feeling, as if sand were in the eye, smarting and itching.

Diagnosis. Upon everting the lids, the injected capillaries are seen; there may be some hyperæmia. We must make a thorough examination, as foreign bodies lodged in the folds create quite the same subjective symptoms.

Prognosis. Unless of very long standing, it will yield to treatment in a few days, or, at most, weeks.

Treatment.-F. No. 1 is especially recommended t.d., though Nos. 2, 3, or 4 are good, and to be used for a change or under special circumstances.

MUCO-PURULENT CONJUNCTIVITIS.

Synonyms. Simple Conjunctivitis; Conjunctivitis; Catarrhal Ophthalmia; Catarrhal Conjunctivitis.

Definition. A contagious inflammation of the conjunctiva, accompanied by a muco-purulent discharge.

Causes. The various causes producing palpebral conjunctivitis may, it seems, also bring about this more severe one. Chronic palpebral conjunctivitis may also degenerate into this. But the chief cause is, doubtless, contagion. Caution about the use of towels, etc., must always be urged upon parents and those afflicted.

Symptoms. The palpebral folds are hyperemic, the capillaries injected; the lids are stuck together in the morning by the drying of the discharge. In severer cases, the ocular conjunctiva participates in the congestion.

Diagnosis.—In severe forms, it passes, by insensible gradations, into purulent conjunctivitis, from which, as well as from the palpebral form, it seems to be distinguishable largely, perhaps only, in degree.