CONJUNCTIVA, DISEASES OF THE. —The conjunctiva is more frequently flamed than any other ocular tissue; it is not only exposed to invasion by hosts of bacteria, but it offers a favorable nidus for their development. The pathogenic micro-organisms may be carried into its folds in many different ways: through the medium of the hands, towels, kerchiefs, etc., through the lacrymal sages, and from the nasal mucous brane by direct continuity of structure. Tears have the power of diminishing the number of the staphylococcus °genes aureus and the bacillus subtilis.
Their virulence, however, is not affected. The gonococcus and micrococcus pro digiosus were unchanged. Bernheim (Corres. f. schweizer Aerzte, .Aug. 1, '93).
Investigations of one hundred healthy eyes. The normal conjunctiva always contains bacteria, among which the staphylococcus epidermis albus is found with such frequency that it must be regarded as a regular inhabitant of the conjunctival cia-de-sac. This coecus, though but slightly pathogenic ordi narily, may, under certain conditions, be come harmful. Neither irrigation with distilled water nor instillation of a 1 to 5000 solution produces sterility of the conjunctiva. R. Randolph (Arch. of Ophth., July, '97).
Hypermmia of the Conjunctiva.—Con junctival hypermia may either be pas sive or active. Passive hyperamiia exists after paralysis of the cervical sympa thetic, or as a result of some interference with the proper circulation of blood in the membrane, or it may be associated with disorders of the general systemic condition, especially gout.
Active hyperaemia is a prelude to all inflammatory conditions of the conjunc tiva, but may be occasioned by the pres ence of a foreign body or a misplaced cilia, or by the irritative action of dust and smoke. It is a frequent exponent of some error of refraction or of muscular insufficiency, and is often associated with a catarrhal condition of the nose and throat and with disease of the lacrymal passages.
The conjunctival congestions described by Jonathan Hutchinson as characteris tic of masked gout are usually confined to one eye. The conjunctiva becomes
rcd, and the eyeball feels hot and pricks as if it contained sand. The attack- may come on within half an hour of the meal which has disagreed, and it may last for a few hours or a day or two. The fuga cious periodical episcleritis of Fuchs is the same disorder. In this the conges tions come on rather suddenly and pre sent themselves in the form of patches of hyperfemia of the sclera and over lying. conjunctiva. They may have a violet hue, and are associated with burn ing and itching. These symptoms are personally thought to be the indication of vascular changes deep in the ocular coats, which in their turn are significant of wide-spread arterial changes through out the body. G. E. de Schweinitz (Maryland -Med. Jour., June, 1900).
Symptoms.—There is a smarting, burning, and itching sensation in the eyes, the lids feel heavy, and there is a disinclination to prolonged near and fine work. On eversion of the eyelids the mucous membrane is found to be abnor mally red and perhaps a little swelled, while the Meibomian glands, imbedded in the tarsus, are rendered indistinct by dilated meshes of blood-vessels. The in jection of the vascular supply may be limited to the conjunctiva of the lids or involve that of the globe also. There may be a slight increase in the flow of tears, but there is never any discharge.
Treatment.—Treatment of hypermmia of the conjunctiva resolves itself into the removal of the cause. If of passive origin, the removal of the obstruction to the circulation will be followed by the rapid subsidence in the undue vascu larity. If of active, the correction of any existing anomaly of refraction or of muscle-balance, or the removal of any foreign body, will accomplish the same result. Dark glasses should be given to protect the eyes from irritating rays of light, and from dust and smoke, and a boric wash or some other mild antiseptic or astringent lotion will, with cold com presses, be sufficient to reduce the ves sels to their normal size.