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.

    164/898 page 170
    subsided, our chief object is to obtain, if possible, the absorption of the gran- uhitions by keeping up a certain amount of inflammation of tlie conjunctiva. The degree of the latter should just suffice to promote this absorption, but should never be allowed to l^ecome so considerable as to arrest or retard it. If there is much photophobia, lachrymation, and ciliary irritation, the greatest care must be taken to avoid all stimulating applications. Atropine drops (gr. ij ad t'sj) should be applied three or four times daily. If they are, however, found to keep up or increase the irritability, they should be at once exchanged for a belladonna coUyrium (Ext. bellad. 3ss ad aq. destill. foj), which should be api)lied somewhat more frequently, and in larger quantity. [Solutions of the other mydriatics, such as duboisia, hyoscyamia, and hydrobromate of homatropine, will sometimes be found useful, where atropine increases the irritability.—B.] At the same time, the compound belladonna ointment should be rubbed into the forehead every four or six hours, until a slight papular eruption is produced. If the pain in and around the eye is very severe, of a pulsating, throbbing character, and in- creases much toward night, a few leeches should be applied to the temple. Cold compresses are also of much benefit in subduing the irritation and relieving the pain. They must, however, be applied with circumspection, and their eflect watched. If the cold is disagreeable to the patient, warm poppy or belladonna fomentations should be substituted. If the conjunctiva is much swollen, more especially in the retro-tarsal region, it may be lightly scarified, care being taken to make the incisions very superficial, so that no cicatrices may be left. Much benefit and comfort are often experienced from the application of a bandage, for this keeps the eye quiet, aud prevents the irritation caused by the constant movements of the lids. When the symptoms of irritability subside, and the disease assumes the character of purulent ophthalmia, it must be treated on the same principles as that attection. The same rules as to the choice and mode of application of caustics apply as in the latter disease ; the only difference being, that the cauterization must not be repeated so frequently, as we must remember that it is desirable to maintain a certain degree of inflammation in order to favor the absorption of the granulations. But care must be taken not to commence the use of caustics too early, whilst there is still considerable irritability of the eye, otherwise this will be greatly increased, and infiltrations, or even ulcers, of the cornea may be produced. In those cases in which we are in doubt as to whether the irritability of the eye is not still too great for the application of the nitrate of silver or sulphate of copper, it is always wiser to feel our way with some milder application. For this purpose we may try a weak solution (gr. vi-x ad f3j) of [alum—B.], a little of which should be painted over the granulations with a brush, and at once washed off with warm water; and if this is well borne, and causes a subsidence of the in- flammatory symptoms, we may, in the course of a day or two, pass over to the use of the stronger caustics. Von Graefe' strongly recommends chlorine water for the purpose of paving the way for the use of stronger caustics in acute granulations. When the crayon of nitrate of silver and potash is applied, it should be at once neutralized by the application of salt and water. As a rule, the cauterization should not be repeated more frequently than every forty-eight hours. Great care must be taken if any ulcers of the cornea exist, for they may be easily aggravated by too free a use of the nitrate of silver. If there is a great deal of irritation, I often apply atropine drops in the interval of 1 A. f. O., X. 2, 197.
    digitised image 1
    digitised image 2
    digitised image 3