326 INFECTIONS OF THE OCULAR REGION 



The pneumococcus is a fairly common cause of serpiginous corneal ulcerations. 

 Active treatment is necessary. 



It is now recognized as advisable to make an examination for the 

 pneumococcus before perfoiming operations on the eye as serious 

 results may follow if the pneumococcus be present. It is the organism 

 frequently found in dacryocystitis and, in the case of traumatism, may 

 bring about panophthalmitis. . 



Corneal ulcerations are not apt to appear even with a pneumococcal conjunc- 

 tivitis unless there be an injury of the epithelium. 



The B. xerosis is possibly a harmless organism and must not be accepted as ex- 

 plaining an infection unless other factors have been eliminated. The true diph- 

 theria bacillus, which the xerosis so much resembles, may cause a pseudomembran- 

 ous inflammation. 



The B. pyocyaneus may cause severe purulent keratitis as well as conjunctivitis. 

 The pyocyaneus toxin appears to be a factor. 



The gonococcus and the Koch-Weeks bacillus are usually responsible for the 

 very acute cases of conjunctivitis. Both these organisms are characteristically 

 intracellular and are Gram negative. 



Conjunctivitis in the course of epidemic cerebrospinal meningitis has been 

 found to be due to the meningococcus. 



The diplobacillus of Morax and Axenfeld is more common in chronic, rather 

 dry affections of the conjunctiva, chiefly involving the internal angle and showing 

 a morning accumulation of the secretion. The bacilli are found in twos, more 

 rarely in short chains. They are generally free but may be found in phagocytic 

 cells. They resemble Friedlander's bacillus morphologically but do not have 

 capsules. 



In cases of ozena with involvement of the nasal ducts Friedlander's bacillus 

 may be found. 



Even in cases without ozena, capsulated, Gram negative bacilli of the Fried- 

 lander group have been frequently reported in conjunctival inflammation and in 

 dacryocystitis as well. 



The nodules of the eye-brows give the most convenient area to take 

 material from in the diagnosis of leprosyf either the fluid expressed 

 after scraping or a piece of tissue cut into sections. Conjunctival ul- 

 ceration in leprosy may show abundant bacilli as is also true of corneal 

 ulceration. 



Ordinarily it is impossible to find tubercle bacilli in tuberculous conjunctival 

 discharges. 



The discharge from a tuberculous dacryocystitis may show them satisfactorily. 

 Animal inoculation is preferable in the diagnosis of ocular T. B. The pneumo- 

 coccus is, however, the most important organism in dacryocystitis rarely the B. 

 coli. 



