OCULAR COMPLICATIONS.
The ocular complications of gonorrhoea necessarily come under the province of the ophthalmologist, yet inasmuch as they are apt to be primarily presented to the general practitioner, it is proper to devote a little attention to them. There are two forms of ocular complica tion occurring in the course of gonorrhoea, one of which is due to local infection of the conjunctiva and the other to the same constitu tional impression that gives rise to gonorrhoeal rheumatism.
As regards the prognosis of the two affections there exists the widest difference, the local infection resulting in a large proportion of cases in destruction of the eye, while the constitutional difficulty is rarely productive of serious results.
Gonorrhoeal ophthalmia, or the form due to the constitutional im pression of a gonorrhoea, is of a distinctly rheumatic type. It is well known that persons affected with the ordinary form of rheuma tism, or those who are afflicted with the rheumatic diathesis, are peculiarly predisposed to inflammation of the conjunctival mucous membrane, and very often of the iris. In this respect gonorrhoeal rheumatism is like the ordinary form. Rarely, however, does defi nite iritis occur, and in several cases which have come under the author's observation the implication of the iris seem to be a coinci dence rather than a condition secondary to the gonorrhoea.
According to some authorities gonorrhoeal ophthalmia is most often associated with involvement of the joints, particularly when polyarticular. As far as the author's experience goes, however, the ocular complication have appeared to occur in the majority of in stances independently of rheumatic symptoms in other situations. The inflammation may attack the conjunctiva, but more often affects the membrane of Descemet, producing the condition known as descemetitis or aquocapsulitis. This is characterized by its insidiousness of onset, the pain at the beginning being comparatively trifling. Later on, however, as a consequence of mechanical disten tion of the anterior chamber of the eye, there may be considerable pain, varying with the amount of increase in the aqueous humor. In several instances coming under the author's observation there was more or less involvement of the iris, assuming the form of serous iritis, in which the effusion was extensive, giving rise to intolerable pain relieved only by paracentesis. The conjunctiva is usually only mod
erately reddened, lachrymation being considerably increased. The function of the eye is disturbed but slightly, objects having a some what cloudy or smoky appearance. Hemorrhagic effusion in the anterior chamber has been described. As a consequence of serous effusion, the cornea becomes bulging and prominent, and pari passe with the increase in this corneal bulging the pain becomes more severe.
A form of catarrhal conjunctivitis, secondary to urethritis, is de scribed by Fournier, and is supposed by him to occur independently of contagion. It is probable that such cases occasionally occur, al though it would be difficult to exclude the possibility of mild infec tion. Reasoning from the effects of ordinary rheumatism upon the conjunctiva, it is reasonable to suppose that a similar catarrhal condi tion of the mucous membrane might result from gonorrhoeal rheuma tism. It is easily conceivable that the contraction of a coryza during the existence of rheumatic irritation of the structures of the eye in the course of a urethritis might readily result in the production of gonorrhoeal conjunctivitis.
Both eyes may be attacked in gonorrhoeal ophthalmia, usually consecutively, simultaneous involvement being the exception rather than the rule. The prognosis is generally favorable, although, when iritis is a prominent factor in the case, synechie, with conse quent disturbance of the functions of the iris, may result. It is possible, moreover, that complete occlusion of the pupil by in flammatory lymph may occur.
Ganorrhceal conjunctivitis is a far more serious condition than that which has just been considered, and is due to infection of the conjunctiva with the irritating products of a virulent urethritis. It is in no way different from ordinary purulent ophthalmia of a non venereal type, unless, perhaps, it be more serious upon the average and more highly infectious. Its prognosis in the majority of in stances is unfavorable. As the disease belongs more properly to the department of ophthalmology, it is unnecessary to do more than to allude to it as one of the possible and lamentable complications of urethritis. The danger of conveying infection to the eye by towels or the fingers should be impressed upon the patient by his medical adviser.