In the treatment of iritis the action of atropine is often augmented by the use of the Turkish bath. Claiborne (N.
C. Med. Jour., '92).
As a general rule, the treatment of axial myopia without glasses will im prove the vision to that previously ob tained with glasses. I use atropine, with local bathing with hot water, and leeches to the temple. Dark glasses are worn to protect the eyes from light, and astrin gents are applied to the conjunctiva. Bates (Med. Record, Jan. 27, '04).
In penetrating wounds of ciliary re gion and lens, even where tion is gone and where usually enuclea tion is performed, removal of lens will often be followed by recovery of com paratively useful vision; operation to be performed during first week of injury. Irritating solutions to be avoided. After treatment: atropine, 1 per cent., every four hours, and compress bandage. Ran dolph (N. Y. Med. Jour., Feb. 23, '95).
The inflammatory conditions necessi tating the use of atropine are confined to the eye itself; it is not indicated in inflammations of the appendages. &led tis and episeleritis will generally yield to appropriate treatment, without myd riasis, also. In keratitis, atropine is indicated because it paralyzes accommo dation, thereby relieving the cornea from any action the ciliary muscles may in directly have on it, and because it acts as an anesthetic to a limited degree. I have never seen glaucomatous symp toms arise from the use of atropine in keratitis, but conjunctival irritation in this connection is not uncommon.
In iritis atropine is indicated at once, and the sooner the iris is brought fully under its influence, the better: and espe cially is this true of the plastic variety. In serous iritis, without plastic exuda tion, mydriatics act by dilating the iris, thereby relieving pain. In the plastic variety, not only is this the ease, but they also overcome the danger, if used in the onset of the disease, of adhesions being formed between the iris and the anterior capsule of the lens, constituting what is know as posterior syneehia. In inflammation of the ciliary body, cyclitis, atropine is indicated as an antiphlogistic and analgesic. In inflammations of the deeper structures of the eye, as in hya litis, retinitis, choroiditis, and even Mem orrhage, I believe atropine has a place.
There is a difference of opinion here, some holding that the enlargement of the pupil from atropine allows more light to enter the eye than is good for the in flamed structures, which is a fact; but the paralyzing of the accommodation, it seems to toe, is beneficial, especially when one can exclude the light by means of very dark glasses. The greatest fear to be entertained from the use of atropine— and, in fact, of all mydriatics—is increase of tension; but this should be a desir able aid in case of hemorrhage from the retinal vessels. In simple optic neuritis
atropine is not beneficial.
The contra-indications for the use of atropine can be inferred from what I have already said, but the greatest fear, and one which even the most experi enced feels, is the possibility of precip itating an attack of acute glaucoma. Van Fleet (Med. News, Feb. 5, '96).
Clinical study of action of mydriatics and myoties on 12 eases of total oculom otor palsy shows that atropine widened the pupil an additional 1 millimetre to I millimetres, which is attributed to the action of the mvdriatic on nerve ends and fibres that were not completely paralyzed, rather than to its influence on the sympathetic nerve. Sprio (Centralb. f. prakt. Augenh., Mar., 'OS).
Atropine should not be used in con junctival troubles, in glaucoma or in creased intra-ocu]ar tension, or as a mvd riatic in patients over forty. It is indi cated in iritis, keratitis, and corneal ulcer and may be used diagnostically to dilate the pupil and to relax accommodations in persons under thirty or thirty-five years. Marple (Phila. Poly.: Post-grad., May. '9S).
In ocular therapeutics the greatest in dication is in iritis. whether rheumatic. traumatic. syphilitic, or idiopathic. In adults 1 drop of a 1-per-cent. solution usually suffices to dilate the pupil fully if instilled every two or three hours. In children of one to five years.
cent. solution should be used. Intoler ance of the drug is shown by: (1) toxic symptoms. as dry throat. nausea: 1'21 the production of catarrh [this usually follows long-continued use]: (3) redness and swelling of the lids. It is indicated in all traumatisms of the eye when iritic or cyclitic involvement is suspected, in corneal inflammations, ulcer of the cor nea, and to dilate the pupil for ophthal moscopic examination. Among the abuses cited are its uselessness or even positively injurious effects in simple un complicated conjunctivitis, not only be cause it possibly may increase the con junctival inflammation, but because of the unnecessary inconvenience of disturbed vision. It should never be used simply to dilate the pupil tem porarily in patients beyond forty-five years of age, the glaucomatous tendency being more marked at this time, and its instillation can readily so occlude Fon tana's spaces as to precipitate an attack of acute glaucoma. Under no circum stances should it be used in glaucoma. A. D. MeConachie (Maryland Med. Jour., No. 13, p. 195, '99).