Endogenous Infections of the Conjunctiva 



(Cf. section 'Conjunctivitis, General,'' p. 108). 



Endogenous Infections of the Cornea. 



THE avascular cornea can only be reached by the pyogenic organisms 

 from the blood-stream indirectly. An isolated corneal metastatic 

 abscess, in the sense that such an irritant can settle down and show 

 activity in the transparent cornea away from the margin, is impossible ; 

 the organism produces its irritation at the spot where it leaves the 

 walls of the vessels. It cannot spread into the avascular tissue of the 

 cornea, and then form an abscess at some distance. 



On the other hand, it is quite possible that the cornea may sup- 

 purate from a septic embolism of a marginal vessel, as in the case of 

 streptococcal sepsis anatomically examined by Leber and Wagen- 

 rnann. 1 Michel reports a similar case. A suppuration of the cornea 

 is also possible as the final event in a panophthalmitis resulting from 

 metastatic infection of the interior of the eye. A ring abscess of the 

 cornea may develop, even when the bacteria are not in the anterior 

 chamber, if the site of the suppuration is deep, and the toxic action is 

 conveyed by the aqueous. I have seen a case of commencing suppura- 

 tion of the cornea, due to a remote agency, in which an anatomical 

 investigation showed that the Pneumococci were restricted to the 

 vitreous and the parts behind it. In other cases (and this is always 

 the case in actual suppuration) the pyogenic bacteria are active in the 

 anterior chamber ; this occurs at an earlier stage when septic meta- 

 stases have taken place in the iris or ciliary body (c/. Morax's pneurno- 

 coccal case). Saltini's 2 anatomical examination shows that the 

 organisms can finally destroy Descemet's membrane, and penetrate 

 into the substance of the cornea. 



1 A.f. 0., 1888, xxxiv., 4, p. 251. 2 Rassegna di Scienze Med., 1894. 



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