EYE COMPLICATIONS OF TROPICAL DISEASES 2005 



branched ulcer with grey margins. The ulcer then becomes clean, 

 and heals after one to three months, leaving a branched opacity of 

 the cornea. This is one form of corneal ulcer to which the name 

 ' serpiginous ' is given, but it equally applies to ulcus rodens and 

 keratitis marginalis superficialis, which, as far as we know, have 

 never been stated to be of malarial origin. Keratitis dendritica 

 was first described by Kipp in America, who stated that nine out 

 of every ten cases were malarial. 



The treatment must be that described for malaria, as well as con- 

 stitutional, and it is usual to recommend that the ulcers be treated 

 by a piece of blue stone whittled to a fine point, and carried carefully 

 along the furrow made by the ulcer, or by careful cauterization by 

 the actual cautery. 



Keratitis Profunda — Synonyms. — Keratitis parenchymatosa cir- 

 cumscripta, or Central parenchymatous infiltration of the cornea. 



This is said by Arlt, among other causes, to be brought about by 

 chronic malarial cachexia. It begins with a grey opacity, situate 

 in the middle and deep layers of the centre of the cornea, and over 

 which the corneal surface is grey and punctate. Seen with a 

 magnifying-glass, the opacity resolves into dots and maculae, or grey 

 interlacing striae. After remaining four to eight weeks, it slowly 

 abates without ulceration. The iris may be hyperaemic, and there 

 may or may not be symptoms of inflammation of the cornea, which 

 may recover completely, or with some opacity. The treatment 

 would be the same as for malaria, but it must be definitely stated 

 that the cause is unknown. 



Iritis. — Secondary iritis is said to be very rarely caused by 

 malaria, but even this is open to doubt. 



Vitreous Opacities. — Haemorrhage and serous effusion have been 

 described. 



Amaurosis. — Malarial amaurosis is described in Chapter XL., 

 p. 1181, under the term ' Amaurotic Pernicious Fever,' but may 

 occur, not merely during an attack of malaria, but as a sequel, 

 and as such was described by Jacobi in 1868, and later by Chiarini. 

 It is due to atrophy of the optic nerve. 



Retino-choroiditis. — This was first described by Poucet as occur- 

 ring in chronic malaria, but it is also found in the acute and in the 

 chronic forms. In the acute affection the vessels of the retina are 

 filled with corpuscles, many of which contain malarial parasites. 

 In the choroid the larger vessels contain pigmented leucocytes, many 

 of which contain red corpuscles with malarial parasites. The retina 

 is hazy, the papilla is obscured, and there are retinal haemorrhages. 



The amblyopia may be temporary or permanent. In the chronic 

 condition there is atrophy of the capillaries of the choroid. The 

 macular region shows small whitish dots, in the centre of which 

 retinal pigment can be seen. These changes extend to the periphery. 

 Pathologically, they are coloid masses in Bruch's membrane. 



Suppurative Uveitis. — Suppurative choroiditis, leading to destruc- 

 tion of the eye, has only been described by Pemnoff. 



