Ophthalmia

“ And it is on this account that we maintain that ophthalmia is a lesser evil than madness, and gout than frenzy. For the person ill in body is aware of it and calls loudly for the doctor, and when he comes allows him to anoint his eye, to open a vein, or to plaster up his head ”

“ Various diseases of the eye, including myopia, strumous and catarrhal ophthalmia, are due to a scrofulous diathesis, and sometimes to a general debility, and can be radically cured only by out-door exercise and a more nutritious diet. ”

“ Sympathetic ophthalmia is the exception in which we too frequently see inflammation of one eye cause severe and often irreparable damage to its fellow. Scattered through ancient and modern surgical works there are many interesting and well-attested cases of impaired vision, some of which should be excluded on account of the want of proper evidence, which is now obtained from testing of the acuity and field of vision and ophthalmoscopic examination. ”

“ Ophthalmia, Infantile, Purulent. This disease very frequently attacks infants of 3 or 4 days old. It is distinguished by redness of the edges of the eyes, the lids of which are often glued together. Upon looking into the eye the lining membrane is seen to be swollen and red. Infantile purulent ophthalmia, although yielding much more readily to proper treatment than that which attacks adults, makes rapid progress if neglected, and may jeopardise the sight of the babe; hence the great importance of calling in efficient medical aid as soon as ever it makes its appearance. ”

“ Hence light is as intolerable in this kind of ophthalmia, as pressure is to the finger in the paronychia. In this disease the patients frequently dream of having their eyes painfully dazzled; hence the idea of strong light is painful as well as the reality. ”

“ Now it is just possible you may have heard of a complaint of the eyes called Ophthalmia, which comes on sometimes in very hot countries, India for instance; and sometimes in travelling across the deserts of Arabia, where the sand gets into the eyes, and irritates them very much; it can very often be cured, but not always, and when it cannot, it ends in blindness. Lady Madeline knew all about the complaint ”

“ The medical officer having under supervision the schools for pauper children in three of the parishes of London reports that, among those admitted, from thirty to forty per cent, are afflicted with ophthalmia in some of its stages, and that bringing the children together in this way concentrates and favors the spread of the disease. ”

“ In adults it often seems to be produced by the action of strong reflected light, as by exposure to intense fires in forges, glasshouses, &c., or by a dependent 280position of the head, accompanied with exposure to light. People advanced in life are most subject to the disease.29 It is not an unfrequent consequence of internal ophthalmia, and almost invariably follows the slightest wound or most delicate puncture of the lens: it often occurs after slight injury of the lens or its capsule, inflicted during attempts to form an artificial pupil. ”

“ The ophthalmia of Egypt leads us through a diversity of symptoms, from slight inflammation and defluxion, to the total and irrecoverable blindness occasioned by opacity of the Cornea. To enumerate them all correctly, and compare them in a variety of cases, must be the task of an oculist long resident on the spot, and accustomed to numerous patients. A transient observer, however diligent in his inquiries, may more easily prove the falsehood of the assigned causes, than trace the real one. ”

“ In ophthalmia, attended with profuse purulent discharge, the structure of the eye is in great danger of being destroyed, from the intensity of the action, and its liability to extend to the deep parts of the organ; the most active practice is required from the first. Copious general depletion, ad deliquium, must be quickly had recourse to; and the patient must be freely purged, and kept in a state of partial nausea for some time, by exhibition of antimonials. ”

“ As a matter of fact, however, the disease may continue to exist, though the symptoms become latent {325} and the patient may infect others when he least suspects it. This form of disease gives rise to many sad complications in family life. Practically all the severe eye diseases of newly born children, the ophthalmia from which so many eyes are lost, is due to this disease. ”

“ If the incited action in the eye do not subside, as it often will not, on removal of the exciting cause, recourse must immediately be had to very active means for its subjugation; for in no other organ does inflammatory action proceed more rapidly to an unfavourable termination. By timely use of antiphlogistic means, those consequences of external ophthalmia, which we have already treated of, may be avoided ”

“ Sometimes, however, the eye alone is diseased: at least, the pathological state which it presents is unattended by any symptoms indicating an affection of the brain or its membranes. Many libertines present only an irritation of the conjunctiva and of the edge of the eyelids. It is a sort of chronic ophthalmia; their eyes are red, watery, fatigued, painful; and they cannot engage in the evening in any occupation, such as reading, which requires the attention to be confined to one object. ”

“ Hydrophthalmia, also, is a disease in which little hope can be entertained of materially benefiting the patient. In the slighter cases, in which no very annoying symptoms accompany the affection, vision may be improved by the use of optical instruments; mercurial preparations may be employed in moderation, with the view of promoting absorption of the superabundant fluid. When the disease has made considerable progress, temporary relief may be obtained from puncturing the cornea at its lower part, so as to discharge the accumulated aqueous humour ”

“ The other fingers rest on the margin of the orbit. All normal eyes have about the same measure of tension and one can use his own eye as a means of comparison. The educated touch is essential. In increased tension, the sense of hardness and resistance, and the indisposition to become indented on pressure is present in the early stages of internal ophthalmias (iritis, choroiditis, retinitis) , phlegmon of the eyeball, glaucoma, hydrophthalmos, and tumors of the bulb. ”

“ The iris is the seat of congestion exudation, thickening, cell proliferation and investment by false membranes. The capsule of the lens is early clouded, may be covered by exudate and is rendered vascular in some cases. The choroid is also the seat of congestion, exudation and discoloration with the covering up at points of its pigmentary layer. The vitreous 394and lens finally become the seat of exudation and opacity which is liable to prove permanent.
Prognosis. The internal ophthalmias are always to be dreaded. ”

“ Celsus recommends this collyrium also for the psorophthalmia, which he describes by the name of scabri oculi. For this last-mentioned affection he recommends various stimulant applications; and, when other remedies are not at hand, directs us to apply bread pounded in wine. The psorophthalmia is the prurigo oculi of Haly Abbas, for which, among other things, he recommends a composition containing pepper, sal ammoniac, saffron, spikenard, camphor, &c. He describes sclerophthalmia by the name of durities oculi, and recommends for it bleeding, gentle purgatives, emollient collyria, &c. ”

“ A careful focal illumination of the eye will enable the operator to see and remove the smallest particles without injury. Subsequent treatment is that of wounds.
ACUTE KERATITIS. INFLAMMATION OF THE CORNEA. Extension from conjunctivitis, wounds, foreign bodies, bites, stings, blows, infections, filaria. Symptoms: eye tender, closed, epiphora, red, pannus, photophobia, congested sclera, opaque or ramified red cornea, or diffuse red, exudation, suppuration, corneal abscess, ulcer, perforation, prolapsus iris, panophthalmia. Focal illumination. Recovery. Permanent 379cicatrix or opacity. ”

“ It is by the aid of the ophthalmoscope that many obscure diseases are diagnosed, and while it is impossible for every young man who obtains a diploma to become thoroughly proficient in the use of this instrument, yet the eye shows to him many conditions which guide him to the road of successful treatment. Think of a case of optic neuritis—inflammation of the optic nerve—going to an optician and fitting one set of glasses after another until the patient suddenly discovers that blindness is inevitable. ”

“ But human beings are often called to still greater trials—to total loss of sight—in other words, to perfect blindness. This calamity results from many causes; for example, the cornea may become so opaque as to be incapable of transmitting rays of light into the interior chamber of the eye; or the crystalline lens, also, may become opaque (cataract;) disease of the iris, attended by closure of the pupil, will produce blindness, as will also paralysis, or loss of energy, in the retina or optic nerve, (Amaurosis or Gutta serena.) ”

“ The early pain may be ascribed (1) to injury to the nerves of the ciliary body and iris, especially when the laceration of those structures is considerable, as our clinical experience and our specimens alike show it sometimes is; (2) to hæmorrhage from the vessels of the ciliary body, the iris, the choroid or the retina: such hæmorrhage may produce pain in two ways— (a) by dissecting up sensitive structures, and (b) by increasing the tension of the eye; and (3) to the rapid production of early glaucoma. There are several ways in which we may conceive that such a glaucoma might be produced. ”

“ This curious circumstance cannot be owing to the action of light on the inflamed vessels of the cornea; it therefore shews, that the extremity of the optic nerve or retina is also rendered more exquisitely sensible to light, by partaking of the inflammation; and I have been told, that red colours are in these cases sometimes painfully perceived even in perfect darkness. This shews that the retina is excited into motion by the stimulus of light; and that, when it is inflamed, these motions give great pain, like those of other inflamed parts, as the muscles, or membranes. ”

“ When the eye is inflamed, great light becomes eminently painful, owing to the increased irritative motions of the retina, and the consequent increased sensation. Thus when the eye is dazzled with sudden light, the pain is not owing to the motion of the iris; for it is the contraction of the iris, which relieves the pain from sudden light; but to the too violent contractions of the moving fibres, which constitute the extremities of the optic nerve. ”

“ 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. ”

“ The chief lymph stream flows from the posterior chamber past the margin of the lens, through the zonula of Zinn, beneath the iris, through the pupil into the anterior chamber, thence through the tissue at the junction of the iris and sclera into the circular canal of Schlemm and from this space into the external lymph channels. Obstruction to the steady escape of the intra-ocular fluids at any point in this drainage system or any undue increase of the fluids themselves may [Pg 103] produce glaucoma. ”

“ In a few hours violent inflammation supervened, and continued several weeks, in spite of the most vigorous and energetic treatment, its principal seat being the optic nerve, and subsequently the iris. The inflammation was at length overcome, but vision was not restored; and the irritability in both eyes was so great as to render it absolutely necessary not only to avoid all attempts to use them, but also to exclude them from the light. The sight of the right eye was entirely, and, as I feared, irrecoverably gone; its pupil contracted almost to the size of a pin's point, and immoveable. ”

“ The commonest visual defects are, first, inflammation of the cornea, or imperfections of the lens—the cornea is often so scarred as to make vision imperfect; second, myopia, or progressive shortsightedness, a condition in which the axis of the eye gradually grows longer. This lengthening is accompanied by stretching of the eyeball, and such children always run the risk of the inner and most important part of the wall of the eye, the retina or nerve layer, being torn away, and blindness resulting. ”

“ A characteristic of this condition is increase of the intra-ocular tension, which has a deleterious effect on the optic nerve end and its ramifications in the retina. The cause of the rise of tension is partly congestive, partly mechanical. The effect of glaucoma, when untreated, is to cause ever-increasing loss of sight, although the time occupied by the process before it leads to complete blindness varies within such extraordinary wide limits as from a few hours to many years. ”

“ With the left eye he could just distinguish light in the outer upper field of vision. With the ophthalmoscope only the lower fundus of the left eye could be made out, where the retinal vessels were seen up to the lower edge of the optic disk. The disk itself could not be made out, but above it a bulging, detached retina was prominent, with a hemorrhagic spot at its inner margin. In the upper outer fundus another separate bulging detachment of the retina could be plainly seen. ”