344 BACTERIOLOGY OF THE EYE 



As the cornea is avascular, it cannot be primarily attacked ; but 

 according as the bacilli pass in. from the deep or the superficial 

 vessels, a form of pannus or an interstitial change will occur. 



Primary nodules often occur at the limbus of the conjunctiva ; they 

 agree in all particulars with those in the conjunctiva (vide supra). 

 Lie considered that the nodes which occurred in the cornea or sclera. 

 secondary to these conjunctival ones, consisted entirely of leucocytes, 

 as he never found karyokinetic figures in the fixed corneal cells. The 

 epithelium of the cornea remains intact for a long time, and when 

 changes do occur, they so resemble those of the conjunctiva that Lie 

 leans to the opinion that the peculiar corneal nodules which result 

 consist of conjunctival or episcleral tissue which has invaded the part. 

 E. Meyer and Berger record a case which shows what remarkable 

 tumour-like growths are possible in the cornea (A. f. 0., 1888, xxxiv., 

 p. 4). The leprous tumour was taken to be a sarcoma until Leber 

 stained it for the lepra bacillus. 



Besides growths of this form, the bacilli can spread in the lymph 

 spaces of the cornea, where they are found in small masses between the 

 lamellae ; they often lie in small clusters cut off from their original point 

 of entrance. Lie thought that the bacilli in this situation had been 

 taken up by the cornea cells. Jeanselme and Morax have given 

 similar records. Ulenhuth, Westphal, and Greef found large numbers 

 of bacilli throughout the cornea, although no changes could be demon- 

 strated in it except a slight granulation at the corneo-scleral margin. 

 From this we must conclude that the bacilli can lie in tissues which 

 clinically are still transparent. The reaction which finally results at 

 these points produces the flecks in various layers of the cornea, even 

 where it is not thickened. Meller's case, resembling a keratitis 

 punctata superficialis, belongs to this class. The bacilli lay in small 

 clusters immediately under Bowman's membrane. This form of 

 leprous infiltration can occur in those eyes which show no sign of a 

 marginal leproma. 



The corneal lamellae resist the action of the leprous nodules for a 

 time ; in the end they are destroyed, but only in the immediate 

 neighbourhood of the nodule. This accounts for the disappearance of 

 the flecks, without leaving any marked opacity. 



Lie considers that the bacillary clusters can disappear without 

 leaving any trace and without any destruction of the tissues around. 



Descemet's membrane resists still longer. The nodules which are 

 found in the anterior chamber are derived from the uvea through the 

 angle of the chamber. 



