Conjunctivitis

“ Notwithstanding the great changes which occur during the progress of a purulent conjunctivitis, there is on recovery a complete restitutio ad integrum so far as the conjunctiva is concerned. Owing to the tendency to severe ulceration of the cornea, more or less serious destructions of that membrane, and consequently more or less interference with sight, may result before the inflammation has passed off. This is a special danger in the case of adults. ”

“ Exposure to cold and wet, to wet and snow storms, to cold drafts and wet lairs must also be accepted as causes of conjunctivitis, the general disorder which they produce affecting the eye, if that happens to be the weakest and most susceptible organ of the body, or if it has been subjected to any special local injury, like dust, irritant gases, or excess of light. ”

“ All forms of severe inflammation of the lids are contagious, especially the variety last considered, and can be conveyed, by means of the discharge, through the agency of towels, handkerchiefs, soap, wash basins, etc., and produce the same or sometimes different types of inflammation in healthy eyes. Therefore, if the severe form of conjunctivitis breaks out among any large number of people, as in schools, prisons, asylums, and almshouses, isolation of the patients should be enforced. ”

“ Dust, cinders, or sand blown into the eyes during transportation frequently cause conjunctivitis.
Symptoms.—A profuse flow of tears, closure of the eyelids from intolerance of light, retraction of the eyeball and corresponding protrusion of the haw, disinclination to move, diminution of milk secretion, etc. On parting the lids the lining membrane is found injected with an excess of blood, giving it a red and swollen appearance; the sclerotic, or white of the eye, is bloodshot and the cornea may be cloudy. If the disease advances, keratitis results, with its train of unfavorable symptoms. ”

“ I thrice met with the snake called the Spitter. On two occasions my dog was struck in both eyes by the liquid projected by the reptile. Immediately (less than two minutes afterwards) , symptoms of conjunctivitis manifested themselves, with considerable swelling of the pupils; the conjunctivitis seemed as though it were going to be very serious, and yielded only after twelve 64 days’ treatment with boracic lotion, aided by a few cauterisations with sulphate of copper. ”

“ The depilation of eyebrows and eyelashes is a backward step, and mars every face subjected to it, and is the cause, naturally enough, of much discomfort, if not of actual disease. At almost every house where we stopped we were called upon to treat cases of severe conjunctivitis, for which we could find no more reasonable cause than that it was due to the irritation caused by the depilation of eyelashes, coupled with bathing in muddy water. ”

“ During this so-called first stage the treatment should be that of an ordinary acute catarrhal conjunctivitis—viz.: iced compresses applied for an hour twice a day if the baby is well and strong; gentle flushing of the conjunctival sac with a warm saturated solution of boric acid. As soon as pus begins to form, the eyes must be cleansed more frequently—every hour during the day and every two hours during the night—and the edges of the lids should be kept constantly anointed with sterile vaselin to prevent their agglutination and the retention of the discharge. ”

“ The Morax-Axenfeld bacillus sets up a conjunctivitis which affects individuals of all ages and conditions and which is contagious. The inflammation is usually chronic, at most subacute. It is often sufficiently characteristic to be recognized without a microscopical examination of the secretions. In typical cases the lid margin, palpebral conjunctiva, and it may be a patch of ocular conjunctiva at the outer or inner angle are alone hyperaemic: the secretion is not copious and is mostly found as a greyish coagulum lying at the inner lid-margin. ”

“ A gesture which seems meaningless and useless to-day becomes intelligible and logical to-morrow, when we learn the reason for it. In the course of an attack of conjunctivitis a patient acquires the habit of winking his eye, and though the inflammation subsides, the habit persists. If we are ignorant of its cause, are we to call the tic convulsive since it appears to us needless? And if we do know its origin; can we say it is co-ordinated when one muscle only is involved in the contraction? ”

“ As the disease advances, the symptoms become more urgent; the conjunctivitis is intensified, the cough becomes incessant, the tongue dries, the lips crack and bleed, and there may be from time to time profuse perspiration. ”

“ A simple conjunctivitis of the globe often will be followed by ulceration of the cornea, giving rise to intense photophobia, and leave behind it opacities of that organ which remain a perpetual evidence of the scrofulous diathesis, if they do not shut out for ever the light from the eye. ”

“ A mild and chronic conjunctivitis often results from exposure to sun-glare after dark rooms and from reading deep into the night with dim oil lamps. The nose is seldom aquiline; the noble and sympathetically advancing outlines of the Mediterranean shores will here be sought for in vain. ”

“ So much is certain at all events, that not only can identically the same clinical appearance result from the actions of quite different pathogenetic organisms, but that various concomitant circumstances may lead to very different clinical signs being set up by one and the same microbe. As regards contagion there is no doubt that the secretion in the case of a true conjunctivitis (i.e. not merely a hyperaemia) is always more or less contagious. The degree of virulence varies not only in different cases, but the effect of contagion from the same source may be different in different individuals. ”

“ The forms of conjunctivitis in which there is an abundant production of pus are usually relatively more inoculable and therefore more liable to pass from animal to animal in a casual manner. Infection takes place through the dried up discharges floating as dust, but more directly by means of the tongue when the animals lick each other, and through posts against which they rub the head. Animals smelling or licking the infected genital organs and then the eyes of their fellows may convey it readily. ”

“ Symptoms.—This form of catarrh conjunctivitis is characterized chiefly by a mucopurulent discharge from the eyes, an intense degree of inflammation of the mucous membrane, accompanied with swelling of the eyelids and an early opacity of the cornea. The flow of tears is mixed with pus, sometimes streaked with blood, and the skin of the face is kept moist and soiled. The eyes are kept continually closed. The implication of the cornea in the disease frequently blinds the animal for a time, and occasionally suppurative keratitis, ulcers of the cornea, or staphyloma supervene. ”

“ Did you ever see a catarrhal conjunctivitis that acted in this way or a cold in the head in which the patient could be cured and catch a fresh cold twenty times a day? I think you never did. A true inflammation requires time, a few hours, for its development, and when an inflammatory exudate oozes into the meshes of the tissue, it requires some days or at least some hours to be absorbed. This one point of rapid appearance and rapid disappearance would forbid our calling the lesion of hay fever a catarrhal inflammation. ”

“ Many oculists are of the opinion that the serum is entirely without value in acute blenorrhea, even though its use be indicated in metastatic eye disease of gonorrheal origin. Of late, however, at least two men in America have written enthusiastically of serum-therapy in acute gonorrheal conjunctivitis, advocating its employment in the usual manner and also its use locally, i.e., dropped into the conjunctival sac in place of the usual antiseptics. ”

“ In acute cases, indeed, reading is altogether impossible. In all cases of catarrhal conjunctivitis the symptoms are also more marked if the eyes have been tied up, even though this may produce a temporary relief. ”

“ Blepharitis and conjunctivitis may be due to Pediculus capitis.
The means of infection are often very remarkable. Transmission from one individual to another certainly often occurs, but infection may take place in railway carriages and in other ways. A case under the observation of a colleague in Frankfort is a most remarkable one: he diagnosed pediculosis as the cause of a head eczema occurring among the children of one of the best families there. The infection took place through dolls adorned with human hair, in which the presence of nits could be demonstrated. ”

“ Conjunctivitis and keratitis are liable to merge into irido-choroiditis by extension, and above all when owing to perforation of the cornea a direct channel is opened for the easy entrance of infective, pathogenic microbes. A lymphatic constitution, connected with low breeding, or living in a low, damp, cloudy region, or in dark, damp, impure stables, has a strongly predisposing influence. The period of dentition, connected as it usually is with domestication, stabling, grain feeding, and training is often a potent accessory cause. ”

“ For most of these agents, the eye is the most sensitive organ, with pain arising rapidly, accompanied by conjunctivitis, excessive tearing, and uncontrolled blinking. The inside of the mouth and nose experience a stinging or burning sensation, and there is usually excessive discharge of nasal mucus. ”

“ It acts analogous to Æthiops mercurialis, but stronger, and is therefore preferred to it in scrofulous eruptions of the skin, scald, milk-scab, scrofulosis conjunctivitis, keratitis, blepharitis glandulosa, otorrhœa and swellings of the glands. It is especially valuable for children as a mild but nevertheless effective remedy. ”

“ With the stomatitis there are disturbances of the gastro-intestinal tract—nausea and vomiting, pain in the stomach, and diarrhœa alternating with constipation. Conjunctivitis is very common, both in man and animals, from exposure to mercury vapours. The further action of the metal is shown in its profound effects on the nervous system. The patient is changed in his disposition, he is excitable, nervous, or torpid; there are sleeplessness and bad dreams, at the same time headache, noises in the ears, giddiness, faintings, &c. ”

“ Accessory irritants. Symptoms: severe purulent conjunctivitis. Papillary and follicular hypertrophy, uniform redness, protruding head, opacities, erosions, ulcers, photophobia, staphyloma. Treatment: rest, darkness, coolness, elevated head, purgative, diuretics, sedatives; locally solutions of pyoktannin, sublimate, silver nitrate, boric or salicylic acid, atropia, puncture.
Causes. This affection which attacks at once or in rapid succession a large portion or the whole of a herd or flock, is by many held to be infectious while others attribute it to irritant pollen or soil emanation. ”

“ Since there is much danger of contamination from tuberculous sputum, the presence of tubercle bacilli is significant only in proportion to the thoroughness with which the ulcer was cleansed. The diagnosis is certain when the bacilli are found within groups of cells which have not been disassociated in making the smears.
THE EYE
Staphylococci, pneumococci, and streptococci are probably the most common of the bacteria to be found in nonspecific conjunctivitis and keratitis. ”

“ Among the many and indiscriminate diseases of the eye which have been considered to be due to gout are included blepharitis, conjunctivitis, episcleritis, scleritis, orbital cellulitis, neuro-retinitis, retro-bulbar neuritis, optic neuritis, optic atrophy, iritis, cyclitis, choroiditis, glaucoma and retinal hæmorrhage. ”

“ The disease is frequently manifested in the form of indefinite disturbances of the general condition; it commences generally on the sixth day after the presumed infection with rigors, headaches, feeling of weakness, swelling of the lymphatic glands in the loin or in the arm-pits; in the periphery a black dry scab is formed. In addition there is an intense conjunctivitis, and added to symptoms of fever an exanthema resembling measles that lasts from four to seven days. There is frequent delirium and difficulty of hearing which persist for a long while. ”

“ A complete cure of her condition was brought about within a week, and now, after the expiration of six months, there has been no return of her symptoms.
For the benefit of physician readers I should like to add that in treating eye strain, conjunctivitis, sties, granulated lids, and eye conditions generally, pressures made with a blunt probe, (see E Fig. 11) on the muco-cutaneous margins (where the skin joins the mucous membrane in the nostrils) affects the second division of the ophthalmic nerve, and assists materially in bringing about a favorable influence in eye troubles. ”

“ This happens when large masses of false membranes from the bronchi are thrown into the larynx and cannot readily be ejected through the glottis, which has been reduced in size by œdematous infiltration and inflammation.
Percussion is generally useless. The appearance of the eyes is also very significant. These symptoms develop simultaneously with the respiratory disturbance, and are marked by infiltration of the eyelids, œdematous conjunctivitis, and ophthalmia. The cornea becomes whitish, infiltrated, opaque, and sometimes shows ulcerative keratitis ”