OPHT H 
Can be derived with refpeft to the prognosis. It is occa- 
fionally an unfavourable event, when an acute ophthalmy 
becomes chronic, while in other inftances the change from 
the chronic to the acute form of the complaint is equally 
bad. Although chronic ophthalmies are generally not 
attended with much danger of the fight being deftroyed, 
yet they are ordinarily more difficult of cure than acute 
cafes, becaule their caufes are for the moft part exceed¬ 
ingly complicated, inveterate, and not eafily detefted. 
Ophthalmies are likewife diftinguilhed into feveral 
kinds, by a variety of external appearances. The in¬ 
flamed eye is fometimes fo dry, that the cornea is quite 
hard and ficaly, and the eye and eye-lids cannot be moved 
without pain. Sometimes an extraordinary quantity of 
tears is difcharged from the inflamed eye. The tears 
alfo may be very acrid and irritating, or entirely free from 
all hurtful qualities. The ftimulus of gentle inflamma¬ 
tion, operating upon fecreting organs, increafesthe fecre- 
tion, by increaiing the aftion of the veflels ; but the fti- 
mulus of violent inflammation puts a flop to fecretion, 
probably by producing a fpafmodic conitriftion of the 
fecerning arteries. Hence dry ophthalmies ar.e always 
more fevere than fuch as are termed humid. It is con- 
ftantly a fign of mildnefs, when the fecretion of the tears 
is neither increafed nor leflened. Ophthalmies of the 
dry kind are moft apt to bring on fuppuration of the eye ; 
while fuch cafes as are accompanied with an efl'ulion of 
acrid irritating tears, are moft liable to occafion ulcera¬ 
tion of the tranfparent cornea, or of the margins of the 
eye-lids. Sometimes the inflamed eye is covered with 
thick purulent matter, which, in the night-time, glues 
the eye-lids together, a part of it becoming hard, and ad¬ 
hering to the eye-la(hes. 
In the treatment of ophthalmy, there are feveral indi¬ 
cations to be fulfilled. The moft important one is 
founded upon the caufe of the complaint : all the others 
are of inferior confequence. When the caufes are nu¬ 
merous, the curative indications may alfo be fo. The 
fecond moft material indication is that arifing from the 
character of the diforder, which, being inflammatory, of 
courfe demands antiphlogiftic treatment. Befides thefe 
two principal indications, which the furgeon mull care¬ 
fully and conftantly attend to in the cure of ophthalmy, 
there are others of a collateral nature, depending upon 
the different appearances of the complaint, the various 
degrees of violence, the differences in the fituation of 
the inflammation, the patient’s conftitution, &c. Al¬ 
though thefe laft fliould not interfere with the chief 
means of cure, they often point out ufeful auxiliary 
meafures. 
With the exception of the humid ophthalmy, attended 
with an effufion of acrid tears, and chronic cafes unac¬ 
companied with pain, every inflamed eye ihould be kept 
from the light and air, which aft as ftimuli, fo as to in- 
creafe the inflammation, and prove particularly detri¬ 
mental, the light producing alfo a great deal of pain. 
The ufual bandage, confifting of a comprefs laid over 
the eye, and faftened with a fillet, fulfils the intention ; 
but yet it is apt to comprefs and irritate the eye. The 
comprefs foon becomes wet with the tears that are dif¬ 
charged, and the eye and adjacent parts are kept conti¬ 
nually in amoift ftate, which, in certain ophthalmies, ef- 
pecially the acrid humid cafe, is very hurtful. Richter 
thinks the propofal of putting over the eye a foft bit of 
fponge, inltead of a comprefs, altogether ufelefs : it is 
true that the fponge will not make inconvenient preffure 
on the eye, but the organ will be, as it were, in a kind of 
warm-bath. In a majority of inftances, it is unneceffary 
to lay a comprefs upon the eye itfelf; for, when the in¬ 
flammation is of any importance, the edgesof the eye-lids 
very quickly become adherent together. In this circum- 
ftance, it is always preferable to put the comprefs on the 
forehead, and let it hang down over the eye, care being 
taken to fallen it with a band, or elfe to pin it to the pa¬ 
tient’s cap. When the eye-lids are not clofed, a com- 
Vol. XVII. No. 1195. 
A L M I A. 52-9 
prefs mull be carefully kept on the eye. To this prac¬ 
tice, however, there are a few cafes forming exceptions. 
Befides guarding the eye from the light and air, it is alfo 
proper to prevent all motion of the eye and eye-lids, as 
fuch motion would evidently irritate the inflamed par;. 
On this account, Richterconceives, that a comprefs, which 
is merely allowed to hang down over the eye, does not 
do in every cafe what ought to be done. 
Both eyes, even though one only may be inflamed, 
ought always to be covered in one of the foregoing man¬ 
ners. The ftimulus of the light uponthefound eye alfo 
affefts the difeafed one, and the latter generally moves 
together with the former. The comprefs Ihould be fre¬ 
quently changed, becauJ'e the difcharge would foon ren¬ 
der it hard and ftiff, in which Hate it would prove oft'en- 
iive to the eye. Sometimes the eye-lids adhere fo clofely 
together, that the tears cannot efcape, fo that they accu¬ 
mulate under thefe parts, which become prodigiously dif- 
tended, and hang down in the form of a pouch. This 
cafe is not of frequent occurrence ; but it does occafion- 
ally happen, and may be miftaken by an incautious fur¬ 
geon for an cedematous l'welling of the eye-lids. If the 
eye-lids be fepsrated a little from each other at the inter¬ 
nal angle, the confined tears will flow out in a ftnall ftream, 
and the l'welling of the eye-lids immediately fubfide. 
This expedient mull be adopted every day, and even re¬ 
peatedly, elpecially when the tears are lharp and irri¬ 
tating. 
Befides the means of cure required by the foregoing 
indications, in cafes of ophthalmy, external topical ap¬ 
plications may be employed with advantage. Thefe are 
bell in the form of an eye-water, orcollyrium. Powders, 
blown or fprinkled into the eye, always produce irrita¬ 
tion. Salves will not readily remain in contaft with the 
eye, which is moftly furrounded with aqueous fecretions : 
they only remain applied to the eye-lafhes and Ikin of 
the eve-lids ; and they are attended with the inconveni¬ 
ence of being liable, unlefs quite recently prepared, to 
produce rednefs, pain, and heat. Earthy indiffoluble 
ingredients, alfo, Ihould never be put into collyria ; for 
they remain in the eye afterwards, and always occafion a 
degree of irritation. It appears to Richter, that the or¬ 
dinary mode of uling lotions for the eye- by wetting cora- 
preffes, and laying thefe over the ftiot eye-lids, is inef¬ 
fectual and hurtful. Ineffectual, becaufe, fays this wri¬ 
ter, how can the operation of a collyrium extend to the 
globe of the' eye through the eye-lids, which are fre¬ 
quently very much thickened and fwelled ? Hurtful, be¬ 
caufe the wet comprefs fooh becomes warm, and warm 
moill applications do harm to feveral kinds of ophthalmy. 
Whenever the comprefs becomes dry, it is rendered hard 
and ftiff, and in this ftate it irritates and difturbs the eye. 
The bed plan is to infinuate a few drops of the collyrium 
into the inner angle of the eye, while the patient lies 
upon his back. Thus, the application not only comes 
into contaft with the parts on which it is to aft, for it 
fpreads over the whole eye-ball towards the external an¬ 
gle, efpecially when the patient moves the eye-lids, and 
turns his head iideways ; but it alfo continues a certain 
time upon the affefted parts, if the patient be kept upon 
his back, and a few frelh drops be every now and then 
introduced. 
As Richter obferves, there are cafes in which the fur¬ 
geon forefees the diforder, and, by timely prophylactic 
meafures, has it in his power to prevent, or at all events 
leffen, it. Such inftances particularly occur in fnrgical 
operations upon the eyes. Here inflammation is always 
to be expefted, and it not unfrequently proves a caufe of 
the ill fuccefs of the operation. The foie defign of all 
preparatory treatment adopted before the latter proceed¬ 
ing, is to leffen and prevent the apprehended inflamma¬ 
tion. With this view, it was once the cuftom to keep 
the patient a certain time on a low debilitating diet, to 
hinder him from taking the. air, to exhibit weakening 
aperient neutral falts, and even to have recourfe to vene- 
6 T feftion. 
