2000 DISEASES OF THE ORGANS OF SPECIAL SENSE 



horizontally outwards from the external canthus. The hyper- 

 trophy of the conjunctiva increases until some indefinite limit is 

 reached, when it ceases and cicatrization sets in; but if the hyper- 

 trophy is excessive, it may last for years, and the cicatrization may 

 develop slowly but surely. 



The cicatrization shows itself at first as whitish striae on the tarsal 

 conjunctivae, which, becoming more numerous, unite into a net- 

 work, the meshes of which are occupied by the hypertrophied con- 

 junctiva, which gradually diminish as cicatrization proceeds, until 

 the conjunctiva becomes pale in colour. In some cases this cica- 

 trization is very slight and hardly noticeable, while in others it may 

 produce serious complications. 



The loss of vision is due to pannus and ulceration of the cornea, 

 the former being a deposit of vesicular gelatinous tissue on the 

 cornea, which becomes uneven and raised in fine projections; while 

 the latter may occur with the pannus or separately. 



The sequelae of trachoma may be classified into: — 



{a) Corneal ulceration and pannus, leading to opacities. 



(b) Cicatrization, leading to (i) Trichiasis, in which the cilia are 

 turned backwards and may touch the cornea; (2) Entropion, in 

 which the border of the lid is turned backward; (3) Ectropion, in 

 which the lid is everted; (4) Symblepharon posterius, in which the 

 fornix is diminished in depth, and the lid is tightly fastened to the 

 eyeball. 



(c) Conjunctival xerosis, in which the conjunctiva, owing to 

 atrophy, loses its secreting powers, and becomes dry and shrunken. 



Treatment. — The acute cases are to be treated with silver prepara- 

 tions, as described for conjunctivitis. 



When the follicles are well developed it is usual to express them 

 by means of a flat Grady's forceps or by the roller forceps of Knapp, 

 but this must be performed under an anaesthetic. The ruptured, 

 surface is then painted with a solution of perchloride of mercury 

 and after one or two days' interval the daily application of solid 

 copper sulphate is commenced, which may be applied pure or as a 

 Ginestou's crayon, which consists of sulphate of copper, i«o gramme; 

 orthoform, 0*5 gramme; holocain hydrochloride, 0'5 gramme; gum 

 tragacanth, o.i gramme; and water as may be required. The 

 above are the quantities required to make a pencil 5 centimetres 

 in length- 



Harston strongly recommends treatment by carbon dioxide snow, 

 which has produced excellent results in many hands, and as it has 

 only to be applied once a fortnight is useful for general out-patient 

 work. It is, however, very painful, and this pain is not prevented 

 by cocaine, which therefore need not be used. 



Hegner and Baumm have advised treatment by quartz light, 

 while other methods are Galezowski's excision of the retrotarsal 

 folds, Kuhnt's removal of the tarsus, while treatment by Merk's 

 extract of abrin, Mayon's X-ray method, and Treacher Collins's 

 radium treatment may be mentioned. 



