Blepharitis ciliaris (eczematous) occurs as a concomitant of eczema, seborrhoea, and other skin affections, and as a com plication of vaccinia, syphilis, and other infectious processes, or may be parasitic, and is to be treated according to the rules of therapy in dermatology. Pediculi palpebrarum looks like a lid with a double row of cilia and readily yields to applications of uuiguentnm hydrargyri.
Case of vaccination ulcer on the upper lid of a female adult, probably inoculated while washing a child, which had re cently been vaccinated. Hirschberg (Centralb. f. prak. Augen., Jan., '92).
Case of vaccine blepharitis. Lower lid showed two ulcerating patches at the ciliary margin, close to the external canthus. Infection probably occurred from contact with a vaccine pustule on the arm of a sister. C. Zimmerman (Archives of Ophthal., Apr., '92).
Case of accidental vaccinia of the eye lids; latter oedematous and painful, their edges at both outer canthi exhibiting a purulent ulcer with indurated margins. Thompson (London Lancet, July 23, '92).
Blepharitis ciliaris (furunculous) is a variety peculiar to no local or reflex con dition, but is caused, as a rule, by an infection. Such inflammations follow the usual course of furuncular inflam mations and abscesses, and the secretion from the localized slough furnishes the typical "furuncle bacillus." For this reason alone the boils, or tummies, not necessarily "styes," recur, and acute autoinfection through the mouths of the Meibomian follicles occur and recur, unless severe antiseptic precautions are rigidly enforced. Hot fomentations with boiled water, followed by drenchings with borated or weak sublimate solutions (1 to 3000) are best. When furunculous abscesses are evacuated spontaneously or by the knife, a focus of infection is established, and we must use dilute listerin, Dobell's solution, Seiler's solu tion (tablets), electrozone, or dioxide of hydrogen, until complete healing has taken place. Fomentations are best made while the patient reclines. Squares of "spongiopilin" or pledgets of absorb ent cotton covered with "oil-silk" are most convenient. Following hot fomen tations, the eye should be lightly covered and protected from draughts.
Half-grain doses of sulphide of calcium in pill form two or three times a day after meals are recommended as a pre ventive for styes. Sympson (Brit. Med. Jour., Nov. 24, '88).
Hydrogen dioxide of special value in the treatment of blepharitis marginalis. After the eye has been cocainized the drug is applied to the lid upon a cotton tampon. Daily sitting. Ayres (Amer. Jour. of Oph., Feb., '94).
Successfully employed the above treat ment for the past two years. Essad (Recueil d'Ophtal., Apr., '94).
Loss of cilia caused by destruction of glands is seldom seen, but such loss of cilia robs the eye of its protection against light. Cilia generally grow again unless the edges of the lids are sclerosed and deformed with cicatrices from neglected ulcerations abort the mouths of the hair follicles.
Closure of the puncta lacrymalia is a most serious complication. All careful operators take great pains to cleanse the cilia, especially the superior ones in any case. It is unsafe to operate with bleph aritis present, as the secretion would in fect the wound.
In phlegmonous, or erysipelatous, blepharitis ciliaris with abscess of the upper lids, and in cases of ecchymosis or other swellings, these should be evacu ated, the eyeball being cut into.
A fact worth noting is that blepharitis ciliaris is seldom. found accompanying myopia.
If blepharitis ciliaris is a symptom of functional strain of reflex eye origin, headaches arc seldom present. If, on contrary, headaches are the one symp tom, blepharitis, or blepharadenitis, generally conspicuous by its absence.
If one eye be used more than the other, or if one eye be not used at all. more or less blepharitis ciliaris will likely indicate the amount of strain. Blepharadenitis is only an aggravated subacute or chronic form of blepharitis ciliaris. in which the mouths of the Meibomian follicles have become closed and the lining membrane of the glands has become subacutely or chronically inflamed. Retention-cysts and abscesses with pyogenic membranes secrete pus from granulating sacs and deform the lid.
every particle of diseased gland with its pyogenic membrane be carefully removed, recurrence will take place, and injury to the tarsal cartilage will cause deformity. Epiphora, entropium, and ectropium will ensile, and with them what is best described as "wrinkled lid" will remain as a permanent source of trouble, and rub its irregular surfaces over a cornea doomed to destruction from irritation and ulceration.
We can recall the time spent years ago in fighting blepharitis and blepha radenitis until its true case was recog nized and understood. At present, and in the light of modern ophthalmic surgery, we recognize in blepharitis, or blepharadenitis, only a symptom which in a general way promptly yields to treatment when we remove the cause. The elimination of the latter as promptly brings relief in other directions: not only by improving the vision, but also by curing life-long headaches and other neuroses.