LOCAL DLSEASES OF THE EYE 513 



ETIOLOGY. 



IVachoma is found among- the poorer classes. Certain races seem 

 predisposed to it, as the Jews from Russia, the Germans, Austrians 

 and the poorer population of the Balkan States. 



Some affirm that the causative organism is a fungus, Microsporon 

 trachomatosum, others affirm that it arises from chronic urethritis and 

 vaginitis, the organisms being carried by towels, hands, &c., to the 

 eyes. Cell inclusions of a chlamyzoan nature have been found in these 

 discharges and also in the trachomatous nodules. The disease is 

 important because of its disastrous complications and sequelas. 



DEFINITION. 



An acute or chronic inflammation of long duration, accompanied 

 by hypertrophy of the conjunctivae and the formation of " granules " 

 with subsequent cicatricial changes. 



SYMPTOMATOLOGY. 



Photophobia, lachrymation, itching and burning sensation, pain, 

 visual disturbance, swelling of the eyelids, narrowing of the palpebral 

 fissure, drooping of the upper lid from weight, swelling and stiffness; 

 muco-purulent discharge, marked in recent, scantv in chronic cases. 

 The conjunctiva of the larsus and fornix is reddened, thickened and 

 uneven on account of the hypertrophy and granules. These granules 

 are rounded collections of lymph corpuscles in a connective tissue 

 reticulum. Papillar}-, granular and a mixed form are recognized. 

 Cicatrical changes occur Axhich ma\' cure the trachoma but which 

 unfortunately give rise to the sequelae. The disease often manifests 

 intermissions and exacerbations. Relapses are common and treatment 

 is often discontinued too soon. 



COMPLICATIONS AND SEQUELAE. 



Pannus is common. It consists of a newly-formed vascular tissue 

 often covering the upper part of the cornea, the vessels springing from 

 the conjunctival vessels at the limbus. The entire cornea mav be 

 covered. The condition is not merely due to mechanical irritation but 

 also to changes like those of the conjunctiva. Iritis and corneal ulcers 

 may be present, the latter having opacities interfering with the vision. 



Corneal opacities when chronic leave a permanent layer of con- 

 nective tissue causing the opacity. 



Cicatrization leads to : — 



Trichiasis : the cilia are turned backwards and mav touch the 

 cornea. 



3^A 



