PANOPHTHALMITIS.
General suppurative inflammation of eye. Experimental cases. From traumas. Diagnosis; foul wound, violent eye inflammation, yellow purulent appearance, high fever, involves second eye. Treatment: antiseptic, enucleation.
This term has been applied to a general purulent inflammation of the eye resulting from infection with pus germs entering from without through traumatic injuries, or by reason of inflamed tissues, or on the other hand, reaching the eye as a general infection through the blood. It may begin therefore, as conjunctivitis, scleritis, or keratitis, and gradually extend to active infection of the iris, choroid, and ciliary body.
Möller produced an experimental case in a foal by the injection of the staphylococcus pyogenes aureus into the anterior chamber. In 24 hours there was violent inflammation: the eyelids were closed, the conjunctiva dark red, and a mass of glairy pus under the eyelid. The cornea was cloudy throughout, though still dimly transparent so that the accumulating pus in the anterior chamber could be seen. The iris was strongly dilated and the eyeball abnormally tense. The second day the bulb was visibly enlarged, the eyelids greatly swollen, the conjunctiva infiltrated so as to cause chemosis, and the cornea completely opaque. The infiltration of the orbit caused the eyeball to protrude from its sheath. A high fever set in and on the fifth day the foal died.
Cases in the lower animals are usually the result of direct infection through some traumatic lesion of the eye.
The special feature of the disease is the rapid and abundant production in all parts of the eye of pus cells until the whole organ has become a bag of pus.
The chief diagnostic symptoms are the presence of a foul wound, the rapid advance of the phlegmonous inflammation of the conjunctiva and lids, the yellowish opacity of the cornea, and, if visible, of the aqueous humor, the prominence of the entire eyeball, the high attendant fever and the early destruction of the eye. In the domestic animals the sympathetic irritation of the second eye has not been observed so commonly as in man. If the patient survives, the pus makes its way slowly to the surface, and escapes, and the cavity granulates and heals with contraction of the eye into a small nodular mass.
The treatment of the condition is essentially antiseptic and should be made preventive if possible, as there is little hope of saving the eye if the suppurative inflammation has been already established. The wound should be treated at the earliest moment with antiseptic lotions, sublimate solution (1 ∶ 5000) or potassium permanganate solution (1 ∶ 100) or pyoktannin (1 ∶ 1000), or creolin (1 ∶ 100). When inflammation has actually set in, these should be used still more assiduously by frequent injection under the lids, or by inserting antiseptic cotton between these and the bulb.
Enucleation. When the eye has become a virtual abscess the quickest and most perfect relief is secured by the complete extirpation of the eyeball. The patient is narcotized by ether or chloroform, and a thread or hook being passed through the cornea, the globe is quickly dissected out by curved scissors. Bleeding may be checked by pressure with cotton wool steeped in tincture of the muriate of iron, and later the wound may be dressed with stupes wet with a mixture in equal parts of standard solution of sulphurous acid, glycerine and water.