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
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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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    structure of the coujuuctiva, instead, of simply favoring their absorption. I think the crayon of nitrate of silver or sulphate of copper is always to be pre- ferred to the use of collyria, as we can regulate and limit the effect of the cau- terization according to our wish, confining it, if necessary, chiefly or entirely to certain portions of the conjunctiva. If there is considerable swelling of the conjunctiva, especially at the retro-tarsal fold, superficial scarification may be employed with much advantage. After the cauterization, cold compresses should always be applied to the eyelids, in order to diminish the inflamma- tory reaction ; or the cold douche or atomizer may be employed. If the conjunctivitis is so slight as not to produce the absorption of the granula- tions, but rather to encourage their development, it will be necessary to increase the hypersemia and inflammatory swelling of the conjunctiva. The repeated application of suljDhate of copper in substance is very effectual for this purjjose. The same effect may also be pi-oduced by the application of warm compresses over the eyelids. Von Graefe^ has found this treatment very successful, especially in those cases in which the granulations tend to extend deeply into the conjunctiva, and in which there is not a sufficient degree of hypereemia and swelling of this membrane. These warm com- presses should, however, only be applied for a limited period, otherwise they may produce too considerable an inflammation and too great an irritability of the eye. [A useful application in allaying irritation and photophobia may sometimes be found in the balsam of copaiba, applied to the external surface of the lids and forehead.—B.] In treating chronic granulations, it will be necessary occasionally to change the caustic, as it loses its effect after a time, from the conjunctiva becoming accustomed to it. Thus alum, acetate of lead, or tannin, may be substituted with advantage for the nitrate of silver and sulphate of co23per. Some patients are more benefited when the astringent or caustic is applied in the form of an ointment than of a collyrium. If it is, therefore, found in obstinate cases of chronic granulations or chronic ophthalmia that the various collyria are doing but little good, an ointment must be substituted for them, containing sulphate of copper, nitrate of silver, or acetate of lead. The strength of the ointment must vary with the severity of the case, but as a rule it is best to employ it rather w'eak at first, for fear of setting up too much irritation. The following proportions will be found most generally useful: 1. Cupri sulph. gr. j-iv ad Axung. 5j. 2. Argent, nitrat. gr. ss-iij ad 5j. 3. Plumb, acet. gr. iv-xij ad 5j. The glycerine plasma may be substituted for the lard. A small portion (about the size of a split pea) of the ointment should be placed with a probe or the end of a quill on the inner side of the lower lid ; the eye is then to be closed and the lids rubbed over the globe, so that the ointment may come in contact wdth the whole conjunctival surface. [An application which is sometimes found useful is an ointment made of ten grains of the red precipitate of mercury to the drachm of vaseline. Care should be taken that the mercury is thoroughly rubbed up before incorpora- tion with the vaseline.—B.] Great care must be taken never to order any preparation of the salts of lead if there is any abrasion of the epithelium of the cornea or any ulcer of the latter, as it will produce an indelible lead stain. Hairion^ strongly recommends the use of tannin in cases of chronic ophthalmia, etc. etc. He employs it in two forms, as a collyrium, and as a mucilage. The former contains about twelve grains of tannin to f oj of dis- tilled water, and is chiefly indicated in cases of catarrhal ophthalmia. The mucilage is much stronger, and is employed in chronic granulations, chronic 1 A. f. O., vi. 2, 147. 2 French Translation of Mackenzie, i. p. 753.
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