Having thoroughly removed the crusts, carefully dry the margins of the lids. In fifteen minutes' time wipe dry the edges of the lids and remove the fresh fluid exudation, which, if allowed to remain, dries and forms new crusts, and under these conditions all local remedial ap plications are of little use. This treat ment must be persisted in, and requires the utmost patience. The yellow oint ment of Pagenstecher has stood the test of years, and when this ointment will not effect a "temporary" cure—I use the word temporary advisedly—we must have resort to saturated solutions of nitrate of silver or even the solid nitrate itself. If rubbing a tiny scrap of the unguentum hydrargyri oxidi flavi (1 grain to 1 drachm of vaselin) upon the well-washed and thoroughly dried edges of the eye lid and into the cilia does not effect a cure, we must have resort to the nitrate of silver, brushing a strong solution care fully upon the edges of the lids and around the cilia or actually cauterizing the ulcerated area around the openings through which the cilia project.
As we have said, it is but "temporarily cured." fnless the cause of a blepha ritis be removed, it will return. We have treated the local condition and not removed the cause. This, in our experi ence, is due, in the majority of cases, to a refraction error (usually hyperopia), and is simply an expression of functional strain. A careful refraction worked out under full atropine mydriasis, or by the rapid method when the patient is over 45 years of age, is the best treatment for the simple, acute, and ordinary forms of blepharitis or blepharadenitis that an experience of a quarter of a century now suggests.
The crusts are usually quite adherent, owing to their composition, partly to the sticky secretion of the Meibomian follicles, and partly to a varnish-like substance (serum) which exudes from the hair-follicles. A weak solution of bicarbonate of soda softens and detaches them.
Best results obtained with a solution consisting of hydrogen dioxide and water, equal parts. This accomplishes the de sired result and does not pain the eye. It is to be applied with a bit of ab sorbent cotton, dipped into the dioxide solution and rubbed along the lashes. This should be kept up until the specific oxidizing effect is seen on the scales or crusts, as will be evidenced by the effervescence. The edges of the crusts will begin to separate. They are then to be dried with absorbent cotton.
There is a great advantage in using this remedy in children; it greatly les sens the pain of the treatment. It is
also of special value where ointments of all kinds produce more or less irritation, and sometimes cause an aggravation of the symptoms. S. C. Ayres (Cincinnati Lancet-Clinic, Oct. 23, '97).
Large number of cases of blepharitis treated with picric acid always with good results. Picric acid is used in aqueous solution of strength 5, 8, and 10 parts per 1000, or corresponding strength made with equal parts of water and glycerin. The yellow coloration of the tissue which it causes is not a great inconvenience. It is very necessary before applying the picric-acid solution to the diseased sur faces to soften them well and clear away the crusts which cover the eyelids by means of a hot solution of boric acid or of ichthyol. The applications are re newed every second day. In glandular and ulcerous blepharitis, after having cleansed the ciliary border, opened the little pustules, and extracted the eye lashes most affected, the base of the ulcers are touched with a little pledget of lint soaked in picric-acid solution 10 to 1000; then, after two minutes, the whole of the edge of the eyelid is treated with a weaker solution. Page (Lyon MM., Jan. 9, '98).
A 50-per-cent. ointment of ichthyoL may be applied directly to the mucous membrane as a cure for blepharitis. A. Peters and Darier (Amer. Mcdico-Surg.. Bull., Sept. 10, '98).
During the past year formalin em ployed in all cases of blepharitis. A tooth-pick with a small cotton mop wrapped on the tip so that it does not take up enough solution to run into the conjunctiva is used. The solution is made of the strength of per cent. to 1 per cent., beginning with the weaker. It must be frequently renewed or pre pared at the time of using, in order to insure uniformity of strength. The lid is drawn away from the eyeball. The mop dipped in the solution is rubbed gently along the margin among the lashes until all the scales and crusts are removed and until the surface of any little pustule is rubbed off. A little bland oil may be applied afterward, or the formalin may be used in the oil. The applications are made daily, if possible, by the physician's hands. Otherwise they may be made by the patient at his home. Correction of all refractive errors is of prime importance; likewise the improve ment of local or general conditions which may predispose the margins of the lids. to disease will invariably improve all cases and will cure many of them. H. Moulton (Jour. of Amer. Med. Assoc., Sept. 17, '98).