98 BACTERIOLOGY OF THE EYE 



often greatly changed, and will require some special treatment. Micro- 

 scopic control of the conjunctival secretion is the only method of 

 determining when operative procedure is safe after a sac excision. 

 In those cases where there is a severe blepharo-conjunctivitis, trachoma, 

 or such-like condition as well, the extirpation of the sac will only 

 improve matters ; it will not of itself be sufficient. 



The danger of infection increases with any pathological condition of the con- 

 junctiva, and renders some preliminary treatment necessary before operations. 

 We should pay attention to the Diplobacilli when found in the secretions of such 

 cases. Post-operative infections with this organism have not yet been recorded, 

 but as both the Morax-Axenfeld and the Petit types can cause severe hypopyon- 

 keratitis in the history of which a trauma often occurs, their preliminary cure with 

 zinc is advisable. 



A preparation should be made from the conjunctiva of every patient before 

 an operation on the globe, especially a cataract extraction, even though the 

 conjunctiva be healthy. The loop is passed over the lower fornix and close up 

 to the caruncle ; some moisture, with a few cells, is thus always obtained. If no 

 organisms can be found in this, or should there be merely xerose bacilli or scattered 

 Stapliylococci i.e., small Diplococci there is nothing against an operation ; but if 

 Pneumococci be present and they will be recognized by their elongated shape 

 a delay of a few days for treatment with zinc is necessary, and then the condition 

 controlled until they disappear. L. Miiller 1 and Stedman Bull 2 also treat their 

 cases in this way. 



With regard to the possibility of a wound becoming infected from 

 the lid margins, especially the cilia, it is interesting to note that eye- 

 lashes driven into the interior of the eye have almost never caused a 

 septic reaction. This is clearly shown in the profuse literature 

 concerning the implantation of cilia in the iris and anterior chamber, 

 with cystic formation resulting. L. Miiller planted cilia in the anterior 

 chamber of rabbits, and they always healed in without irritation. 



On the other hand, a few cases are recorded of abscesses in the conjunctiva due to 

 cilia forcibly driven in (Hummelsheim, Zent. f. A., 1895, p. 567 ; Giinsburg, Wjestnik 

 Oftal., 1897 ; Kraisky, ibid., 1902, p. 364, quoted by Saemisch). Logetschnikow, 

 however, found cilia in the conjunctiva without suppuration ; so also did Uhthoff, 

 but in his case a cyst formed. Cilia are often found healed into this structure. 



Schioetz 3 goes too far when he considers it necessary, before opera- 

 tion, to epilate even quite healthy lids, and lays too much weight on 

 the findings of Holth, who cultivated Staphylococci from the cilia. 

 The roots of the hairs do not cause so much danger as he thinks. 

 Experiments have shown that the healthy cilia are quite sufficiently 

 purified, even though the lid margins are not quite sterile, by the 

 more energetic methods of cleaning and disinfection which are still 



1 K. M.f. A., 1901, xxxix., Bd. i., S. 369. 2 Tr. Araer. 0. S., 1904. 



3 Internat. Med. Congress, Section for Ophth., 1900. 



