The treatment of chronic granular conjunctivitis in the early stages must be non-irritating; but, so soon as the discharge becomes marked, silver nitrate becomes the sovereign remedy. When the acute stage has moderated and the discharge is less marked, the silver salt should be replaced by other caustics: copper, alum, zinc, etc. These drugs must be continued months and perhaps even years, until every trace of hyper trophy has gone and the conjunctiva has become perfectly smooth and clean.
The nitrate-of-silver solution should be applied but once daily, and at times when there are marked signs of irrita tion, must be wholly withdrawn for a few days, while these are combated with atro pine and milder antiseptics.
The prognosis is quite favorable. It should be treated by applications of ni trate of silver of the strength of 1 to 40 or 1 to 50, weaker solutions being less effective. The bacilli found were de void of movement. Inoculation of a cult ure on the human conjunctiva produced a typical attack. Victor Morax and G. W. Beach (Arch. of Oplithal., vol. xxv, .No. 1).
As it is necessary that the local treat ment shall be continued for such a long time during the stage of cicatrization, to prevent relapses, an ointment of 1 grain of tannin to 1 drachm of vaselin may be ordered and may be applied by the pa tient himself. Copper may be applied in the same strength.
Instillation of 1- to 2-per-cent. solution of ereolin recommended in trachoma. E. Nesse (Centralb. f. prakt. Augenh., Mar., '98).
In trachoma during the early vascular sta.ges the lids should be penciled three times a week with the following: Ich thyol, 50 grains; distilled water, 40 grains; glycerin, 10 grains; to be dis continued as soon as the vascularity has subsided. Eberson (Centralb. f. prakt. Augenh., Apr., TS).
After an experience with 3000 cases of trachoma the medicinal management of trachoma is advocated, surgery being re served for those cases (probably 40 per cent.) rebellious to medicines. H. Kuhnt (Klin. Monats. f. Augenb., Mar., '98).
In trachoma. iodine dissolved in a petroleum preparation, as recommended by Nesnamoff, is of value. Slight eases of granular lids may be cured in two or three weeks, while severe cases may re quire as niany months, but the pannus begins to improve markedly in the first week or two. For mild cases the 1-per
cent. solution is applied every other day; in more severe cases a 2-per-cent. solu tion. H. H. Seabrook (N. I'. Eye and Ear Infirmary Reports, Jan., 1900).
The writer pointed out some years ago that the essentials of any treatment likely to prove effective were fairly well afforded by ichtliyol. These essentials he laid down thus: The application must constrict the dilated vessels, re move the infiltration and thickening of the conjunctiva, and alleviate the vari ous subjective symptoms, particularly the pain, the lacrymation, and the pho tophobia. He found that iehtliyolate of ammonia, in 50-per-cent. solution, met these requirements better than any other application he had yet employed. Jacovides also, and Darier, have spoken highly of ichthyol in trachoma. The latter used it undiluted; but this does not seem to be a wise example to fol low-. The former employed the drug in a great number of different affections of conjunctiva and cornea, and found that its action on the pannus of trachoma was specially marked and beneficial. Denti, too, used ichthyol in trachoma. In his experience the :tenter forms were much more favorably influenced by it than the more chronic; its action was specially valuable in cases showing su perficial ulceration along with pannu.s. Bialetti speaks strain:1y in favor of a lotion of ichthyol (50 per cent.) painted on the everted upper lid and then washed oft' with distilled water. The first effect of application is a slight burning sensation, which quickly passes oil% and is succeeded by relief from pho tophobia, blepbarospasm, and pain, and this relief is not merely transitory. The vessels of the pannus shrivel up tinder its use, and the corneal opacity clears. Eberson Ocul., Palermo, June, 1901; Edinburgh Med. Jour., .June, 1002).
Numerous surgical procedures have been proposed for the excision of the granulations, and some observers advise the excision of the entire fornix of the conjunctiva. It is probable, however, that the resultant cicatrices cause more mischief than those which would result if the disease were allowed to take its course. This form of treatment has, therefore, met with but little favor from the more conservative clinicians.