Internal Ophthalmia. 395 



When viewed with the ophthalmoscope properly focused the 

 choroid may show a lack of its normal lustre and an uneven- 

 ness due to the formation of small rounded elevations in con- 

 nection with congestion, or exudation, and patches of yellowish 

 red or whitish discoloration together with lines of the same color 

 following the course of the blood-vessels. It may also reveal 

 dark spots of opacity in the lens {cataract) or clouds in the an- 

 terior region of the vitreous, the result of exudations. The 

 blood-vessels may appear enlarged and tortuous. 



In some cases the exudate may form a false membrane which • 

 completely closes the pupil. 



A special tenderness around the margin of the cornea is sug- 

 gestive of cyclitis. Internal ophthalmia is usually accompanied 

 by a variable amount of fever. 



Diagnosis. From simple keratitis, it is distinguished by the 

 thickening, discoloration and sluggishness of the iris, by the ab- 

 sence, in many cases, of corneal opacity, and of free lachryma- 

 tion, and in some instances by increased tension of the eyeball. 



Recurring ophthalmia, which is usually also an internal in- 

 flammation, appears more abruptly and often at first with greater 

 severity, and accompanied by more hyperthermia. There is 

 almost always a bluish white opacity around the margin of the 

 cornea, the eye is retracted in its sheath so as to appear smaller 

 and the upper lid usually shows a marked angle between its inner 

 and middle thirds in place of the evenly curved arch of the 

 healthy palpebra. It usually appears for the first time in the 

 young and in those that have inherited the susceptibility and 

 have been kept on damp soils, in cloudy districts, or dark 

 buildings. 



Lesions. These are necessarily varied according as the inflam- 

 mation is concentrated on particular parts of the interior of the 

 eye. The secreting membrane of the aqueous humor is nearly 

 always inflamed giving rise to an exudate and a milky opacity 

 of the aqueous humor. The iris is the seat of congestion exudar 

 tion, thickening, cell proliferation and investment by false mem- 

 branes. The capsule of the lens is early clouded, may be covered 

 by exudate and is rendered vascular in some cases. The choroid 

 is also the seat of congestion, exudation and discoloration with 

 the covering up at points of its pigmentary layer. The vitreous 



