DISORDERS IN RELATION TO THE EYE 799 



Phlyctenular affections of the conjunctiva and cornea were always 

 associated by clinical observers with disorders of metabolism in specially 

 predisposed subjects. The frequent association in scrofulous children with 

 eczema, either local (ocular) or general and interpreted less as part of 

 a skin affection than as a parallel manifestation of a diathesis, variously 

 characterized as arthritic, lymphatic, or exudative, is well known. 



Phlyctenular Keratitis and Conjunctivitis. Clinically a manifesta- 

 tion of lymphatism. Helped, empirically, by cleaning out intestine, re- 

 lieving toxemia, eliminating tea, coffee, pickles, sweets, etc., from dietary, 

 administering alteratives, rhubarb and iron, iodides and, moreover, in- 

 sisting on fresh air and hygienic mode of Irving. Diagnosis, scrofula, seen 

 with glands of the neck, pasty skin, eczema, exudative diathesis, chronic 

 intestinal intoxication. The tuberculosis theory of the etiology of phlyc- 

 tenular affections brings in all of these factors as links in the causal chain. 

 The good effect of calomel locally and per os, of the yellow oxid of mer- 

 cury as an eye-salve, is largely due to stimulation of processes of repair. 



KeratHis ex Acne Rosacea. This is a form which is clinically very 

 similar to phlyctenular keratitis, but appears in adults as an expression of a 

 severe and long standing disturbance of metabolism. It begins with in- 

 filtrations at the limbus which become ulcerated and afterwards acquire 

 a serpiginous character, with tendency to invade the center of the cornea. 

 The arrangement of inflammatoy blood-vessels in leashes running to the 

 ulcers, later faint leucomas, is typical of this fascicular keratitis. In 

 some cases hyperemia of the iris or mild iritis has been noted, and oc- 

 casionally there is a development of inflammatory nodules or papules 

 in the sclera which generally undergo absorption and disappear without 

 any sequelae. Simple rosacea is never attended by ocular complications. 

 Gastrohepatic and intestinal, as well as menstrual, disturbances are com- 

 mon etiological factors in the anamnesis. The combination of trophic 

 disturbance, and general toxemia with an irritating infectious agent is 

 probable (Uribe^Troncoso). An angioneurotic element in the etiology 

 and clinical course connects these cases again with the exudative di- 

 athesis, Quincke's edema, and other dyscrinoid, probably hypothyroid, 

 states. 



Lymphatic States. The conjunctiva shows follicular hypertrophy 

 often diagnosed as trachoma, but which never runs the severe course of 

 that disease, and is Benign in its outcome. Often seen in children with 

 adenoids, "buck teeth," and constant colds. 



(Good effects of C. L. 0. Fe. lodin Adrenalin.) 



Other forms of conjunctiva!, ocular, lymphoid hyperplasia seen in 

 Parinaud's conjunctivitis, and in involvement of lachrymal gland and con- 

 junctival follicles in Mikulicz's disease and epidemic dacryo-adenitis 



