Diseases of the eye and ophthalmoscopy : a handbook for physicians and students / by A. Eugen Fick ; authorized translation by Albert B. Hale.

Adolf Gaston Eugen Fick

Date:: 1896

Credit: Diseases of the eye and ophthalmoscopy : a handbook for physicians and students / by A. Eugen Fick ; authorized translation by Albert B. Hale. Source: Wellcome Collection.

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$(c) Keratitis parenchymatosa circumscripta is a rare inflammation of the cornea that has many signs in common with keratitis ]iarencliymalosa. It begins as a grayisli opacity at the center of the cornea, rather in the middle layers. The opacity extends to the epithelium and to the posterior surface of the cornea. The marginal portions of the cornea remain free. After several weeks or even montlis have passed, the opacity be- gins to clear, but this process is seldom completed, and there is apt to be left an incura- ble corneal deposit exactly in front of tlie pupil. The irritation is slight, and may be so completely absent that at the first inspection no inflammation is seen, and one thinks to have found a large leukoma on the cornea. Vascularization does not take place, or if it does, it is very much less than in keratitis parenchymatosa. In severe cases the cloudy cornea is insensitive; if sensation returns, however, it is an indication of a speedy im- provement. The disease is unilateral, and usually attacks elderly persons, men twice as often as women. The opacity is said to depend not on round-cell infiltrations, but on cloudiness and disintegration of the fixed corneal cells and on swelling and relaxation of the fibers. Little is known of the cause of the disease. Egger thinks that a weak physical condition with impairment of the general nutrition must be an important factor. The prognosis, considering the length of the disease, the fact that incurable opacities are almost always left, and that the iris shows a tendency to be sympathetically affected, must be considered unfavorable. Treatment should seek to improve the general con- dition by a proper regimen ; locally, the persistent use of moist applications may stimu- late vascularization, and atropin should be applied in order to assure the preservation of the iris ; when the irritation has completely subsided, massage with yellow ointment should be begun. Caution must be observed in resorting to operative interference, as iridectomy, for example ; the eye seems to resent this, as I can confirm from unfortunate experience in the matter, and the opacity progresses rapidly into the hitherto peripheral portion of the cornea lying in front of the artificial pupil. This new cloudiness will probably clear up in a few weeks, but the patient does not relisli the experience. {d) Keratitis Scleroticans.—This disease is characterized by an involvement of the cornea in an inflammation of the sclera. The corneal opacity is of a somewhat triangu- lar shape, its base lying toward the portion of the cornea already inflamed, its apex extending more or less into the cornea. The disease is usually chronic, with very little or no irritation, with very little or no vascularization, and without ulceration. So long as the clouded area does not extend its apex into the region of the pupil, the disease may go on without comment. The opacity recedes, also with equal slowness, but a complete clearance takes place only at the central edge of the clouded area. The marginal portions remain opaque, retaining an appearance as if the sclera had in this place grown into the cornea itself The prognosis is favorable if, as is usually the case, the disease is restricted to the edge of the cornea. It may last for months or years. Treatment should be directed to the cure of the inflammation of the sclera 262) ; atropin and moist heat have been advised, but stimulants and operations should be avoided. {e) Keratitis Punctata Profunda.—Just as the iris is sympa- thetically affected in severe corneal inflammation, so may an inflam- mation of the iris leave its mark upon the cornea. This is quite a usual result in iritis serosa {p.2'jf) \ indeed, keratitis punctata profunda itself is often the only sign of such an iritis. The chann-es on the cornea consist in minute points sometimes infre-$