EYE DISEASES PROPER 



2003 



Cornea. 



Phlyctenular keratitis is common as a sequela to conjunctivitis 

 phlyctenulosa. both of which act as common predisposing causes to 

 pterygium, which, according to Harston, is extremely common 

 among the Chinese. 



Ulcus Serpens Cornese. 



This appears as a greyish-white or yellowish slightly depressed 

 disc near the centre of the cornea, the rest of which is clouded. It 

 is associated with iritis and turbidity of the vitreous, hypopyon, 

 and more or less oedema of the lids, with conjunctivitis, cyclitis, 

 photophobia, and pain, except in the so-called ' torpid ' cases. The 

 ulcers increase in depth and extent; perforation occurs into the 

 anterior chamber, which contains sterile pus, which now escapes, and 

 at the same time prolapse of the iris may occur. The inflammation 

 now comes to an end, but panophthalmia may occur. The most 

 common cause in the tropics is the pneumococcus, which may often 

 be found in the nose of the same patient. The prognosis is serious. 



Treatment. — The cauterization of the ulcer and apparently clear 

 border with the actual cautery is an imperative immediate treat- 

 ment, followed by application of atropine, iodoform, or orthoform 

 powder, or i per cent, xeroform ointment, or callaryol ointment 

 3 per cent., and moist and warm compresses. Harston recommends 

 douching with hydrogen peroxide as an adjuvant to the usual 

 treatment, while i in 40 formalin solution is also recommended, but 

 must be preceded by cocaine, as it is very painful. Perforated ulcers 

 are best treated by iridectomy on each side of the synechia. Har- 

 ston operates on the worst eye of the two when both are involved, 

 as operative interference is apt to set up a severe irido-cyclitis in 

 the poorly-nourished Chinese coolie, with eventual loss of sight in 

 the eye. The nasal infection must also be treated by antiseptic 

 douches. 



Ins. 



Diseases of the iris are as common in the tropics as in the Tem- 

 perate Zone. Those which are specially connected with tropical 

 disease will be mentioned below, but it is well to remember that in 

 native races the stroma of the iris is laden with pigment, which 

 probably accounts for its slow reaction to mydriatics. 



Cataract. 



This disease is said to be on the wane in the Temperate Zone, but 

 is very rife in the tropics. In fact, its home is said to be in India, 

 the ophthalmic surgeons of which have a great reputation. Colonel 

 Smith, of Jullundur, has perfected a complicated but most successful 

 operation for intracapsular extraction. 



Sometimes in the tropics it is impossible to wait until the cataract 

 ripens, and operations may have to be performed on immature 

 cataracts. To meet this difficulty, Nell has devised a modification 

 of the usual procedure, which consists in performing a zonulotomy 



