A less harmful method, and one which is frequently employed by the ophthal mologists of this country at least, con sists in the expression of the granula tions by means of forceps. Knapp has devised a roller-forceps especially for this purpose. The reaction following this procedure is at times quite severe; so that it is advisable to employ ice-com presses for some time afterward; to pre vent a recurrence of the granulations it is always well to follow the expression by applications of silver nitrate.
The amount of benefit obtained from the expression method is, in general, pro portioned to the quantity of exudate in and beneath the conjunctiva; where there ha.d been a considerable amount of exudation, the cure is immediate and apparently permanent. Jackson (Med. a.nd Surg. Reporter, Aug. 20, '92).
(a) In the first stage of trachoma the most efficient mode of surgical interfer ence is that of expression, combined with superficial scarification and the introduc tion of a gertnicide by the use of a brush. (b) In the second stage, where surgical interference is advisable, the treatment known as "graftage" should be combined with expression in some cases. Can thotomy or canthoplasty, if necessary, gives the most satisfactory results. (c) The operations, as above advised, con vert a, contagious into a nan-contagious condition, and the patient may be ad mitted to wards for ordinary surgical eases without fear of infection. Weeks (Jour. Amer. Med. Assoc., Sept. 3, '92).
The procedure of Darier and Abadie used in seventy-five cases; but one grave complication resulting from its use wit nessed: a case of total symblepharon due to neglect in the dressing. If a radical cure of the disease could be ob tained by this method of treatment, the pain and great local reaction following the operation might be atoned for, but a single instance of permanent cure was never seen. Trousseau (Archives d'Oph tal., Apr., '93).
Conclusion from the results obtained hy the treatment of two hundred cases: Rapid, perfect, and permanent recovery by expression alone, or expression fol lowed by mild caustic treatment, takes place in the majority of cases, especially of the purely follicular type. Imperfect recovery—i.e., disappearance of tra choma, leaving more or less shrinkage of the conjunctiva—results, as a rule, in old neglected cases of inflammatory tra choma. Relapses that are cured by a
second or third operation occur in both the simple and inflammatory forms. The operation itself has never injured an eye. Knapp (Archives of OpMimi., Jan., '93).
Knapp's roller-forceps the most expedi tious and surest method of treatment, particularly applicable where the fornix and palpebral conjunctiva are covered with large follicles. Gepner (Centralb. f. prakt. Augenheilk., Oct., '92).
Study of 161 cases of trachoma; ex pression-treatment as practiced with Knapp's roller-forceps favored. U. Hell gren (Mittheil. a. d. Augen. d. Carolin. med.-chir. Inst., Stockhohn, '9S).
The greatest emphasis must be laid upon the necessity of placing the sub jects under the best hygienic conditions. In the case of patients confined to hos pitals, asylums, etc., the utmost pains should be taken to secure good ventila tion, nourishing food, and perfect clean liness, personal as well as general.
When pannus has occurred and the thickening of the conjunctiva subsides, the corneal disease will usually abate pari passu; so that the treatment of pannus and of ulcers of the cornea re solves itself into that of the conjunctiva.
Atropine should be instilled to combat any existing iritis.
If the pannus is unusually dense and is partly made up of connective tissue, further absorption may be obtained by exciting a violent inflammation of the conjunctiva. An infusion of jequirity is frequently employed for this p.urpose. This is prepared by steeping the ground jequirity-bean for twenty-four hours in cold water. With this infusion, the con junctiv-a of the everted lids is painted thoroughly two or three times daily. A croupo-purulent conjunctivitis is excited and is combated in the same manner as already described under this disease. When the inflammation has run its course, the cornea is frequently found to have regained, in a measure, its former transparency.
Jequirity beneficial in those cases of granular conjunctivitis where there is superficial vascularity of the cornea. Also used the drug with advantage in the fibrous condition which often follows. Emerson (N. Y. Med. Jour., Feb.11, '93).