OPHTHALMIA. 



OPHTHALMIA. 



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OPHTHALMIA ( from opktkalmos, o^a^os, the " eye" ) is an 

 inflammation of the eye. General ophthalmia, or an inflammation of 

 the whole globe of the eye, is a very rare occurrence. Cases however 

 do occur, from severe injuries or other causes, in which the signs of all 

 the special forms of ophthalmia are combined, and they are the most 

 formidable affections to which the eye is liable. Unless met by the 

 most active antiphlogistic treatment, they usually terminate in com- 

 plete destruction of the organ. 



In the large majority of inflammations of the eye, one part of it is 

 alone or especially affected. Hence there have been described nume- 

 rous varieties of ophthalmia, a distinct name being formed for the 

 inflammation of each part or tissue by appending the termination 

 itii to its anatomical name; as conjunctivitis, iritis, and corneitis, for 

 the inflammations of the conjunctiva, iris, and cornea. [EYE, in NAT. 

 HIST. Div.] 



Of all the varieties of ophthalmia, slight inflammation of the con- 

 junctiva is the most frequent. It is the common result of all slightly 

 irritating bodies being introduced between the eyelids, and of the 

 application of cold, in which case it is often called catarrhal ophthalmia. 

 Its symptoms are redness, varying from a pale-pink to a scarlet colour, 

 of the external membrane of the eye and of the lining of the eyelids, 

 the blood-vessels (which are naturally invisible) appearing swollen and 

 tortuous, and making the front of the eye what is commonly called 

 blood-shot ; swelling of the eyelids and increased thickness and puffi- 

 ness of the conjunctiva of the ball ; and an increased secretion of 

 opaque white or yellow tenacious mucus which agglutinates the eyelids. 

 The pain is seldom acute, except in severe cases, in which it has a 

 peculiar character, as if there were dust or fine sand rubbing between 

 the eyelids. There is rarely any intolerance of light or any constitu- 

 tional affection, and the vision is not at all affected, except by the 

 swelling uf the eyelids and the accumulated mucus. 



In this, the common inflammation of the eyes, no active means need 

 be employed. In severe cases, blood has been taken from the arm ; 

 but in general, the application of leeches, cooling lotions applied to the 

 eyes, and mild purgatives or sweating medicines, are sufficient for the 

 removal of the inflammation, which, as it does not affect a part directly 

 important to vision, nor spread beyond the tissue first affected, rarely 

 leaves any inconvenience behind. In the mild cases of this kind, a 

 lntiiin composed of two grains of sulphate of zinc to the ounce of 

 water is the best, and generally a sufficient remedy ; the eyes should be 

 washed with it three times a day. 



That which is commonly called purulent ophthalmia is a much more 

 serious form of inflammation of the conjunctiva. It was observed in 

 its greatest severity in the European armies engaged in Napoleon's 

 campaign in Egypt, and is therefore sometimes called Egyptian 

 ophthalmia ; and from its appearing to spread from one individual to 

 another by the contact of the purulent matter secreted by the inflamed 

 eyes, it has also received the name of contagious ophthalmia. In this 

 form, which has often appeared as an epidemic, and is generally 

 acknowledged to be liable to spread by contagion, all the symptoms of 

 tin' preceding are greatly aggravated. The conjunctiva is intensely 

 red, and so swollen that it is raised in a deep ring round the cornea, 

 whose edges it overlaps so as almost totally to obstruct the sight. The 

 conjunctiva of the eyelids is at the same time excessively inflamed, and 

 by effusion into their loose cellular tissue they often become so dis- 

 tended that they completely cover the front of the eye. A considerable 

 quantity of acrid yellow purulent discharge constantly flows between the 

 eyelids, producing excoriations of them and of the cheeks. The pain is 

 often extremely acute, vividly smarting, or hot and burning, and it is 

 accompanied by some intolerance of light. From the conjunctiva, 

 which it at first affects, the purulent ophthalmia often spreads rapidly 

 to the other tissues of the eye ; producing ulceration and sloughing, or 

 excessive opacity of the cornea, and all the worst results of inflamma- 

 tion of the several tissues, even to suppuration and destruction of the 

 whole of one or birth eye-balk. 



The treatment of this form of ophthalmia must be active in propor- 

 tion to the rapidity of its destructive effects when unchecked. 

 I'lfi-'ling, both general and local, may be employed, and purgatives and 

 the various other antiphlogistic means should be administered, as in 

 t)i'- treatment of any other acute inflammation. When the innamnia- 

 somewhat checked, the greatest benefit is derived from the 

 application of powerful astringents to the eye, a mode of treatment 

 which may 1* adopted with equal advantage in these and in the severer 

 cases of catarrhal ophthalmia. The best material is a solution of from 

 two to four grains of lunar causticjto the ounce of water ; of which one 

 or two drops should be let fall into the eyes once or twice a day, 

 according to the severity of the inflammation. This remedy produces 

 considerable pain for a short time after its application, but is generally 

 five of the most beneficial results. 



One of the most common effects of the purulent ophthalmia, when 

 prevented by active treatment from producing ita worst results, is a 

 thickening and roughness of the inflamed lining of the eyelids, to 

 which the name of granular conjunctiva is given. The affected sur- 

 face looks like that of a florid ulcer, and the friction of its irregularities 

 upon the front of the eye-ball keeps up a constant slight inflammation, 

 of which the common consequence is a complete opacity of the cornea. 

 Tin: granular conjunctiva may be treated by the application of power- 

 ful aHtriiiKimta or caustics; the most efficient, though a severe remedy, 



ARTS AHD SCI. DIV. VOL. VI. 



is to touch the rough surface with a piece of sulphate of copper, 

 taking care after its application that no considerable portion of it comes 

 in contact with the front of the eye. 



Infants of three or four days old are often the subjects of a very 

 severe form of inflammation of the conjunctiva, to which the name of' 

 the ophthalmia of new-born children has been given. Its course and 

 effects are similar to those just described, and it sometimes produces 

 entire destruction of the eye before it attracts proper attention, for the 

 eyelids are commonly agglutinated together by the discharge, and are 

 so swollen that they obscure the front of the eye. Its severest form 

 may be suspected when the upper eyelid is much swollen and is exter- 

 nally of a bright red colour. The treatment must be similar in its 

 principles to that for the corresponding disease in the adult ; in severe 

 cases a leech should be applied to the temples, and purgatives should 

 be administered in all; and when the inflammation is somewhat 

 relieved, or from the first, if it be not very severe, astringent lotions 

 should be dropped into the eyes. The best form is composed of from 

 two to ten grains of alum in an ounce of water, beginning with the 

 smaller quantity and gradually increasing the strength. 



Another form of inflammation of the conjunctiva is that called 

 strumous ophthalmia. It occurs in children of scrofulous habit, and 

 is chiefly remarkable for the extreme intolerance of light by which it 

 is accompanied. The patient cannot be induced to open the eyes, or 

 even to raise them to the light, but keeps his head down, with the 

 eyelids pressed together upon the ball of the eye, and carefully 

 covered with his hands or his clothes. The degree of inflammation is 

 by no means proportionate to the severity of this symptom ; the con- 

 junctiva is usually only a little reddened, but in many cases little 

 pustular elevations form upon the edges of the cornea. The treat- 

 ment of these cases should be chiefly that adapted for the constitutional 

 disorder on which their peculiarities depend. [SCROFULA.] Pure air 

 and exercise, mild aperients and tonics, and especially bark, iodine, and 

 iron should be administered, and the general health should be carefully 

 attended to-. In the earlier stages a few leeches may be applied, but 

 afterwards counter-irritation by blisters placed behind the ears, or by 

 tartar-emetic ointment rubbed on the same parts, is most useful. 

 Slightly astringent lotions may also be applied to the eyes, and the 

 ulcers or little pustules on the cornea touched with the solid nitrate of 

 silver (lunar caustic). 



The characters of inflammation of the sclerotica are very different 

 from those of inflammation of the conjunctiva, but very often the two 

 affections are coincident, so that the appearances belonging to each are 

 confounded. In sclerotitis, as this form of ophthalmia is sometimes 

 called, the redness of the eye has a rose-pink or violet tinge, rather 

 than the scarlet hue which is seen in the preceding form ; for the dis- 

 tended vessels are fewer and smaller, and are to a certain extent 

 obscured by the conjunctiva, beneath which they lie. This redness is 

 most intense in a zone around the cornea, at which the enlarged vessels 

 are concentrated like rays, and from whose outer border the redness 

 diminishes in brightness till it is nearly lost at the angles of the eye ; 

 and by this circumstance sclerotitis is further distinguished from in- 

 flammation of the conjunctiva, in which the redness increases with the 

 distance from the cornea. In sclerotitis there is always considerable 

 pain of a dull heavy kind, which often extends all round the orbit, or 

 over the forehead and head, and is accompanied by intolerance of light 

 and a profuse secretion, not of mucus or pus, as in the preceding cases, 

 but of hot tears. The pain is very often aggravated in the evening, or 

 throughout the night. 



The treatment of inflammation of the sclerotica must, as far as 

 general means are concerned, be the same as for acute inflammation of 

 the conjunctiva. The application of astringents or stimulants is use- 

 leal, and sometimes injurious; the vapour of hot water and other 

 warm fomentations are the local means which are most agreeable to 

 the patient. The moderate use of mercury is generally useful. In 

 rheumatic and gouty conditions of the system, with which this form 

 of ophthalmia is often connected, and is then called rheumatic or 

 arthritic ophthalmia, the treatment adapted to the general disorder 

 should, as far as possible, be combined with those means which are 

 proper for the local disease. [GoCT ; RHEUMATISM.] 



Inflammation of the cornea, corneitis, or keratitis, is very generally 

 connected with some degree of the preceding. Its signs are those which 

 are common to the inflammations of all the deep-seated tissues, namely, 

 dull pain, intolerance of light, and profuse discharge of hot burning 

 tears ; at the same tune a few vessels passing inward from the red 

 zone around the cornea become visible upon its surface ; it loses its 

 transparency and becomes hazy, or assumes a grayish and often opaque 

 chalky-white hue, from the deposition of lymph between its laminae. 

 [LECOOMA.] In very severe cases suppuration takes place in the 

 cornea, and it acquires a yellow colour and ulcerates ; or matter is 

 poured into the anterior chamber [HvporiUM], or the cornea is per- 

 forated by ulcers and the iris protrudes ; or it sloughs and becomes soft 

 and weak, so that staphyloma is produced. 



The treatment of corneitis in its active state is the same as that for 

 inflammation of the sclerotica. After the inflammation is subdued, its 

 effects (which the situation of the cornea renders peculiarly important) 

 admit of but little useful treatment. The opacity which remains, 

 when it is superficial, is usually gradually removed, and that process 

 be in some degree assisted by the application of a weak solution of 



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