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

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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$junctivitis or corneitis, more especially if the latter are accompanied by a great discharge of hot scalding tears, which constantly moisten and excoriate the edges of the lids. But it occurs also as a primary disease, and is then generally due to prolonged exposure to wind, cold, bright glare, or to an im- pure smoky atmosphere. Its intensity is much aggravated by dirt and want, and it is, therefore, most frequently met with amongst the poorer classes, and especially amongst those nationalities in which habits of cleanliness do not prevail. It occurs most frequently amongst children, but it is also met with in adults, and is especially prone to attack persons of a delicate, feeble, and scrofulous constitution, or who sutFer from impairment of the digestion; in such, it proves especially obstinate and apt to recur. Dr. McCall Anderson considers that this disease is neither more nor less than a pustular eczema (impetigo) attacking the edges of the lids.' [In a considerable proportion of the patients affected, the disease is associated with some error of refrac- tion or muscular defect, which renders the ordinary treatment of little or no value. Therefore, it is well always to test the refractive and muscular con- ditions of such eyes, and where any error is discovered, correct it by the necessary glasses before using local remedies. Often the disease will disap- pear without any local treatment when the refractive or muscular error has been corrected.—B.] In the treatment of this disease, the greatest attention must be paid to the most scrupulous cleanliness. In mild cases, the eye should be frequently washed with tepid water, or warm milk and water, so as to remove the crusts from the lashes, and when this has been done, a little of the weak nitrate of mercury ointment should be applied to the roots of the lashes with a fine camel's-hair brush. [A better application is a solution of sodic bicarbonate in the proportion of grs. xv-xx to the ounce of hot water, to soften the crusts.—B.] If this prove too irritating, we should diminish the strength of this ointment by an admixture of one or two parts of lard. If the crusts are thick and firm, and the edges of the lids very swollen and red, mere ab- lution with warm Avater will not sufiice, but compresses, steeped in hot Avater, should be applied for ten or twenty minutes, and frequently changed during this period. This should be repeated three or four times a day, or hot bread and water or linseed-meal poultices may be applied instead of the compresses. This will greatly alleviate the inflammation, and the crusts will be so thor- oughly soaked and softened, that they will either become detached spon- taneously, or can be removed without difticulty or injury to the lid. The hot compresses or poultices will be found especially useful in the morning, when the crusts are thick, and the lids firmly glued together by the noc- turnal discharge. After the removal of the crusts, the lids may be bathed with tepid water, and then some astringent ointment or lotion should be applied. Before doing so, any diseased or stunted eyelashes should be ex- tracted with the cilia forceps, as this favors the growth of the new ones, and renders the application of the topical remedy more easy. Indeed, if the disease is severe, and implicates the greater portion of the lid, it will be well to remove the greater part of the lashes, or, as suggested by Mr. 8treatfield, to cut them down quite close to the margin. Malposition, or a faulty shed- ding of the lashes, is a not unfrequent cause of a very obstinate, though per- haps mild, form of blepharitis. In such cases, we find that on passing the lashes lightly through our finger and thumb, many of them come out at once, their root being often black. Great benefit is derived from careful and repeated epilation of the affected lashes. A great number of ointments ^ A Practical Treatise upon Eczema,' by Dr. McCall Andci-son, p. 197.$