A treatise on the diseases of the eye / By J. Soelberg Wells... Together with selections from the test-types of Prof. E. Jaeger and Prof. H. Snellen.

  • Wells, J. Soelberg (John Soelberg), -1879
Date:
1883
Catalogue details

Licence: Public Domain Mark

Credit: A treatise on the diseases of the eye / By J. Soelberg Wells... Together with selections from the test-types of Prof. E. Jaeger and Prof. H. Snellen. Source: Wellcome Collection.

Provider: This material has been provided by the Harvey Cushing/John Hay Whitney Medical Library at Yale University, through the Medical Heritage Library. The original may be consulted at the Harvey Cushing/John Hay Whitney Medical Library at Yale University.

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    carefully kept apart, and not employed for any other purpose. Some authors have expressed a doubt as to the contagiousness of catarrhal ophthalmia, but in out-patient practice, we have very frequent opportunities of seeing several members of the same family affected consecutively with the disease. Con- stitutional treatment will hardly be required; the bowels should be kept freely open, and, if the patient is feeble and out of health, tonics should be administered. 3.—PUKULENT OPHTHALMIA. (Syn. Egyptian ophthalmia, contagious ophthalmia, military ophthalmia.) [The disease represented by these three terms is far oftener a granular con- junctivitis than a suppurative process. Purulent conjunctivitis would be a better synonym. Conjunctival blennorrhcea.—B.] We cannot draw a sharp line of demarcation between acute catarrhal and purulent ophthalmia. The latter may indeed be regarded as a more severe form of catarrhal ophthalmia, in which all the symptoms of this affection are intensified in degree. The lids are more oedematous, hot, and red, the palpebral and ocular conjunctiva more injected and swollen, and the papillae more turgid and prominent. The chemosis is also more considerable, and the discharge is thicker, more copious, and more contagious. The inflam- mation is, moreover, not confined to the conjunctiva, but extends deeper, and involves also the subconjunctival tissue; so that there is not only a secre- tion of muco-purulent discharge upon the free surface of the conjunctiva, but also an infiltration of sero-plastic lymph into the substance of this mem- brane. The cornea is, moreover, far more frequently and more seriously implicated than in catarrhal ophthalmia. At the commencement, the patient experiences a sensation of heat and itching in the eye, as if a foreign body, more especially sand or grit, were lodged beneath the eyelids. The edges of the latter become slightly glued together, and small beads of matter collect and harden on the lashes and at the corners of the eye. On eversion of the lids, their lining membrane is found to be very vascular, swollen, and of a uniform redness, so that the Meibomian glands can no longer be distinguished. The retro-tarsal fold, the caruncle, semilunar fold, and ocular conjunctiva are also abnormally red and swollen. The eyelids are red, glistening, and perhaps somewhat puffy. At first, there is only considei^able lachrymation, but the discharge soon assumes a muco-purulent character, having yellow flakes of pus and broken-down epithelial cells suspended in it. Up to this point, all these symptoms are only those of catarrhal ophthalmia; but, as the disease advances, they soon become more severe in character. The patient often experiences great pain in and around the eye, which may even extend to the corresponding half of the head, especially if the inflam- mation be of a sthenic character, in which case marked febrile symptoms may also present themselves. Generally, the pain diminishes as soon as the discharge becomes purulent. It may, however, again increase in severity if the cornea becomes affected, and especially if the iris or other tissues of the ^lobe should become involved in the inflammatiou. In general inflammation of the eyeball (panophthalmitis) the pain is often excruciating. The lachrymation and photophobia increase, the lids become very swollen, so that the upper hangs down in a thick heavy fold, and they can only be opened or everted with difficulty. [Fig. 60.] They are red, glistening, and cedematous, and, if deeply pressed, somewhat tender. [The tenderness and
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