Treatise on the diseases of the eye, including the anatomy of the organ / by Carl Stellwag von Carion ; translated from the fourth German edition and edited by D.B. St John Roosa, Charles S. Bull, and Charles E. Hackney.
- Date:
- 1873
Licence: Public Domain Mark
Credit: Treatise on the diseases of the eye, including the anatomy of the organ / by Carl Stellwag von Carion ; translated from the fourth German edition and edited by D.B. St John Roosa, Charles S. Bull, and Charles E. Hackney. Source: Wellcome Collection.
Provider: This material has been provided by the Royal College of Physicians of Edinburgh. The original may be consulted at the Royal College of Physicians of Edinburgh.
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![are moderate, as well as in cases where the nervous character of the process is evident from the disproportionate severity of photophobia or pain, and relatively slight vascular symptoms, careful and antiphlogistic regimen and instillations of solution of atropine, repeated two or three times daily, together with a protective bandage, are most serviceable. Where the inflammation is more intense, particularly when the vascular symptoms are prominent, leeches may be used; and if the local temperature is much increased, cold compresses may be carefully applied for short periods. If unbearable pain or excessive photophobia, with great spasm of the lids, render a treatment of symptoms absolutely necessary to counteract general or local danger, hypodermic injections of morphia are better than the internal use of opium. In cases where the nervous symptoms have a particular type, the use of quinine and morphia in suitable doses is recommended. In such cases the nervous symptoms are often intense, and readily tempt the inexperienced practitioner to use antiphlogistics, especially leeches. This should be carefully avoided. This treatment is particularly injurious in debilitated persons, women, and delicate children. On account of its effect on the constitution, it not unfrequently increases the nervous symptoms. Sometimes the result of treatment does not appear at once. The disease often resists all reme- dies. Then nothing is so injurious as the popular “feeling around in the medicine chest ” for specifics. It increases the sufferings of the patient and lessens his confidence in the surgeon. We should make a careful prognosis, then carefully and patiently carry out the treatment once recognized as indicated. 2. If, in spite of the cessation of the symptoms of irritation, the clearing up of the cornea is delayed, or if the keratitis becomes chronic, finely-powdered calomel should be dusted on the eye with a camel’s-hair brush. If this be followed by great irritation, its use must be delayed for a time ; but if well borne it may be used once or twice daily, and after a time changed for the more active yellow oxide of mercury salve. 3. In trachomatous keratitis special treatment is not required. After subduing the more prominent symptoms of irritation, direct treatment of the trachoma by caustics is the most serviceable. If nothing else interferes, the corneal cloudiness disappears under their use much sooner than the trachoma itself. [In the treatment of the various forms of keratitis, more especially, however, of trachomatous inflammation of the cornea and herpes, or phlyctenular keratitis, as well as of pannus, there is often great value in the operation of dividing the exter- nal canthus, the so-called canthoplasty. Its effects in pannus and phlyctenular keratitis and conjunctivitis, where there is great photophobia, are usually very marked. The operation consists in the free division of the conjunctiva and integu- ment of the external canthus with a pair of strong scissors or a scalpel, and the union of the divided membrane to the skin by two or three fine sutures. A free dissection of the conjunctiva from the integument, or of the orbital connective tis- sue, is unnecessary and not without danger, while the simple division of the exter- nal commissure “may be considered a perfectly safe procedure. It is an operation which, when performed in the above-named class of cases, has been found to be a powerful adjuvant in their treatment, by at once lessening the prominent symptoms of irritation.]](https://iiif.wellcomecollection.org/image/b21987634_0089.jp2/full/800%2C/0/default.jpg)
