140 A. f. O., xii., 2, p. 138.
141 Behandlung der Amaurosen, pp. 24-30.
SCARLATINA.—In scarlatina we have usually a hyperæmia of the conjunctiva coincident with the skin eruption. Inflammatory affections of this membrane and of the cornea are much less frequent than in measles. Martini142 remarks that only in one case in twenty is there any inflammation of the eye. Beer143 informs us that the tears are more irritating than in morbillous ophthalmia, and that the photophobia is more persistent. When ichorous ulcers form, they attack not only the cornea, but also the white of the eye, and spread much more rapidly in this situation than in the conjunctival leaflet of the cornea. Kerato-malacia occurs more frequently than in rubeola. Bonman144 relates that in a severe epidemic of scarlet fever five boys in one family were taken sick, and that two of them lost their sight from sloughing of the cornea within a week of their seizure. Of these, one died, and the other was brought to him with a shrunken globe and without light-perception. The eyes of the other three children were not affected. Arlt in the first volume of his work on diseases of the eye145 has given us a clinical description of this form of kerato-malacia. The patient, a boy of four and a half years, was first seen by him on the eighth day of the disease. The child was very pallid, with a burning-hot skin, hoarse voice, slight diarrhoea, and flat abdomen. The right cornea was evenly clouded throughout, swollen, and softened, while the left had lost its brilliancy and was slightly clouded, presenting the appearance of an eye thirty-six hours after death. The conjunctivæ of both eyes were white, with a few vessels and ecchymotic spots in their lower parts. On the tenth day, the right cornea was converted into a mass as soft as schmeer-käse, and was beginning to be thrown off on the centre, where there was a hernia of the hitherto unaffected membrane of Descemet. Both eyes eventually had the cornea completely destroyed, and the patient died on the seventeenth day. Iritis is more frequent than after measles.
142 Von dem Einflusse des Secretions Flussigkeiten, vol. ii. pp. 267, 268.
143 Lehre von dem Augenkrankheiten, Bd. i. pp. 536, 537.
144 Lectures on the Parts concerned in the Operations in the Eye, London, 1870, p. 110.
145 Krankheiten des Auges, vol. i. pp. 211-213.
Considering the frequency of acute nephritis in this disease, the retinal lesions are comparatively rare. Schreiber146 gives two interesting plates of chorio-retinitis after scarlatina. Ebert147 at a meeting of the Berlin Medical Society in 1867 called attention to some cases of transient blindness in the course of scarlatina without ophthalmoscopic changes; and Graefe, who presided at the meeting, remarked that in all these cases of absolute blindness there was still reaction of the pupil to the light, and that therefore there could be no neuritis or decided lesion between the corpora quadrigemina. He considered the prognosis favorable so long as there was pupillary reaction, and not necessarily bad where it was wanting. Although this is the rule, the prognosis is certainly more favorable when the pupil reacts promptly and to moderate light. Hirschberg148 has recorded a case of blindness following meningitis, where light-perception failed to return, although the pupillary reaction lasted several weeks.
146 Veränderungen des Augenhinter-grundes, Plates iii. and iv., Figs. 7 and 8.
147 Berliner klin. Wochenschrift, Jan. 15, 1868, pp. 21-23.