Encyclopaedia Britannica, 11th Edition, "Evangelical Church Conference" to "Fairbairn, Sir William" / Volume 10, Slice 1

by Various

In new-born children (ophthalmia neonatorum) infection takes place from the maternal passages during birth. Notwithstanding the great changes which occur during the progress of a purulent conjunctivitis, there is on recovery a complete restitutio ad integrum so far as the conjunctiva is concerned. Owing to the tendency to severe ulceration of the cornea, more or less serious destructions of that membrane, and consequently more or less interference with sight, may result before the inflammation has passed off. This is a special danger in the case of adults. For this reason when only one eye is affected the first point to be attended to in the treatment is to secure the second eye from contagion by efficient occlusion. The appliance known as Buller’s shield, a watch-glass strapped down by plaster, is the best for this purpose. It not only admits of the patient seeing with the sound eye, but allows the other to remain under direct observation. The treatment otherwise consists in frequent removal of the secretions from the affected eye, and the use of nitrate of silver solution as a bactericide applied directly to the conjunctival surface; sometimes it is necessary to cut away the chemotic conjunctiva immediately surrounding the cornea. When the cornea has become affected efforts may be made with the thermo-cautery or otherwise to limit the area of destruction and thus admit of something being done to improve the vision after all inflammation has subsided. The greatest cleanliness as well as proper antiseptic precautions should of course be observed by every one in any way connected with the treatment of such cases.

Phlyctenular conjunctivitis is an acute inflammation of the ocular conjunctiva, in which little blebs or phlyctenules form, more particularly in the vicinity of the corneal margin, as well as on the epithelial continuation of the conjunctiva which covers the cornea. The inflammation is characterized by being distributed in little circumscribed foci and not diffused as in all other forms of conjunctivitis. In it the conjunctival secretion is not altered, unless there should exist at the same time a complication with some other form of conjunctivitis. This condition is most frequent in children, particularly such as are ill-nourished or are recovering from some illness, e.g. measles. The susceptibility occurs in fact mainly where there exists what used to be called a “strumous” diathesis. In many cases, therefore, there is some kind of tubercular basis for the manifestations. This basis has to do with the susceptibility only, at all events to begin with. The local changes are not tuberculous; their exact origin has not been clearly established. They are in all probability produced by staphylococci.

Many children suffering from phlyctenular conjunctivitis get after a short time an eczematous excoriation of the skin of the nostrils. This excoriated, scabby area contains crowds of staphylococci which find a nidus here, where the copious tear-flow down the nostrils has excoriated and irritated the skin. Lacrymation is indeed a very common concomitant of phlyctenular conjunctivitis. Another frequently distressing symptom is a pronounced dread of light (photophobia), which often leads to convulsive and very persistent closing of the lids (blepharospasm). Indeed the relief of the photophobia is often the most important point to be considered in the treatment of phlyctenular conjunctivitis. The photophobia may be very severe when the local changes are slight. The eyes should be shaded but not bandaged. Cocain may be freely used. The best local application is the yellow oxide of mercury used as an ointment.

Phlyctenular conjunctivitis, and the corneal complications with which it is so often associated, constitute a large proportion (from ¼ to 1⁄3) of all eye affections with which the surgeon has to deal.

Granular Conjunctivitis.—This disease, which also goes by the name of trachoma, is characterized by an inflammatory infiltration of the adenoid tissue of the conjunctiva. The inflammation is accompanied by the formation of so-called granules, and at the same time by a hyperplasia of the papillae. The changes further lead in the course of time to cicatricial transformations, so that a gradual and progressive atrophy of the conjunctiva results. The disease takes its origin most frequently in the conjunctival fold of the upper lid, but eventually as a rule involves the corna and the deeper tissues of the lid, particularly the tarsus.

The etiology of trachoma is unknown. Though a perfectly distinctive affection when fully established, the differential diagnosis from other forms of conjunctivitis, particularly those associated with much follicular enlargement or which have begun as purulent inflammation, may be difficult. Trachoma is mostly chronic. When occurring in an acute form it is more amenable to treatment and less likely to end in cicatricial changes. Fully half the cases of trachoma which occur are complicated by pannus, which is the name given to the affection when it has spread to the cornea. Pannus is a superficial vascularized infiltration of the cornea. The veiling which it produces causes more or less defect of sight.

Various methods of treatment are in use for trachoma. Expression by means of roller-forceps or repeated grattage are amongst the more effective means of surgical treatment, while local applications of copper sulphate or of alum are certainly useful in suitable cases.

Diphtheritic conjunctivitis is characterized by an infiltration into the conjunctival tissues which, owing to great coagulability, rapidly interferes with the nutrition of the invaded area and thus leads to necrosis of the diphtheritic membrane. Conjunctival diphtheria may or may not be associated with diphtheria of the throat. It is essentially a disease of early childhood, not more than 10% of all cases occurring after the age of four. The cornea is exposed to great risk, more particularly during the first few days, and may be lost by necrosis. Subsequent ulceration is not uncommon, but may often be arrested before complete destruction has taken place. The disease is generally confined to one eye, and complicated by swelling of the preauricular glands of that side. It may prove fatal. In true conjunctival diphtheria the exciting cause is the Klebs-Löffler bacillus. The inflammation occurs in very varying degrees of severity. The secretion is at first thin and scant, afterwards purulent and more copious. In severe cases there is great chemosis with much tense swelling of the lids, which are often of an ashy-grey colour. A streptococcus infection produces somewhat similar and often quite as disastrous results.

The treatment must be both general with antitoxin and local with antiseptics. Of rarer forms of conjunctivitis may be mentioned Parinaud’s conjunctivitis and the so-called spring catarrh.

Non-inflammatory Conjunctival Affections.—These are of less importance than conjunctivitis, either on account of their comparative infrequency or because of their harmlessness. The following conditions may be shortly referred to.