Lacrymal Fistula on the Right Side; Ectasia of the Lacrymal Sac on the Left; Bilateral Epicanthus. (Haab.)
FIG. 2
Dacrocystitis. (Haab.)
THE CONJUNCTIVAL SAC.
The mucous membrane lining the conjunctival sac is perhaps the most exposed to irritation and even infection of all mucous surfaces. It is not strange then that conjunctivitis is the most common of all eye affections. Whether irritated by constant exposure to dust and dirt, or raw and cold winds, or by the heat of a blast furnace, by the dazzling brilliancy of electric lights, or contact with bacteria, it displays a surprising degree of accommodation and resistance. It has peculiar susceptibilities, particularly to the germs of gonorrhea and diphtheria. To these it is peculiarly sensitive, and under their influence it may quickly succumb. The harm done in either of these conditions is by no means limited to the conjunctiva, but may extend in such a way as to eventually cause loss of vision.
Nowhere else may the phenomenon of hyperemia be so easily studied as by watching the ocular conjunctiva for a few moments after the occurrence of irritation. The rapidity with which the vessels dilate and become visible, the occurrence of the consequent redness and swelling, and the reflex phenomena attending it become appreciable within a short time. In the chronic conditions the tissues become thickened and less mobile. A chronic conjunctivitis is the constant condition in certain laborers whose eyes are exposed in their occupation.
A peculiar granulomatous condition of the conjunctiva, especially the palpebral, is that known as trachoma, which appears to be due to a specific form of infection that leads to exudation, organization and thickening, intensified in punctate areas, and giving the surface the appearance of an ordinary granulation. This condition has assumed such importance as to be sufficient for the exclusion of aliens and immigrants.
The milder conditions of acute or subacute conjunctivitis subside under cold applications and mild antiseptic and astringent eye-washes or collyria. These should be frequently instilled, beneath the lid whenever this area is involved as a complication of injuries to the head or face. In acute cases of the infectious type, such as the gonorrheal or diphtheritic, atropine should be used locally, so that the iris may be drawn out of harm’s way and the pupil left free should resolution and recovery ensue. Individuals suffering from either gonorrhea or diphtheria should be cautioned and protected from possibility of conjunctival infection. The eyes of the newborn are not infrequently infected during the process of parturition. The parturient canal of women suspected of having an infectious lesion of this kind should be cleansed before the passage of the fetal head, and in all suspicious cases instant and constant attention should be given to the eyes of the newborn infant.