Pannus successfully treated with anti pyrine. As the insufflations are painful, cocaine should be used at first, and ap plication made daily or every third day, according to the gravity of the case and the effect desired. The violent reaction that follows should be treated by fre quently-changed, hot, antiseptic com presses. This method is not applicable to symptomatic pannus. in which the primary condition should be first reme died. Vignes (Recueil d'Oplital., Aug., '92).
The operations of peritomy, which consists in the destruction of the vessels supplying the pannus, has also been much vaunted for the cure of this condi tion. After a ring of conjunctival tissue about five millimetres from the margin of the cornea is excised by scissors, the underlying connective tissue is dissected off the sclera-, which is then laid bare.
Xerosis admits of palliation only by emollients--such as glycerin, olive-oil, or vaselin—applied freely several tiraes daily.
The distortion of the lids, with the resultant trichiasis and entropion and ectropion which it occasions, only yields to operative measures.
Phlyctenular Conjunctivitis (Lym phatic, or Strumous, Conjunctivitis).
Definition.—Phlyctenular conjunctivi tis is a frequent form of inflammation of the conjunctiva characterized by the eruption of one or more grayish eleva tions or phlyctenuke on the bulbar con junctiva. It usually occurs in scrofulous children under ten years of age.
suffering from this disease have the characteristic stru mous appearance. They are either pale and thin or bloated and flabby. The cervical lymphatics are enlarged and the nose and upper lip tumefied. There is a moist, eczematous eruption on the face and constant watering of the eyes and nose. Otorrlicea is frequent. A dis tressing symptom—intense fear of light and blepharospasm, due to the corneal involvement, which occurs in most cases of phlyctenular conjunctivitis — com pletes a clinical picture which renders an examination of the eyes almost su perfluous.
.An inspection of the eye, however, will reveal the presence of phlyctenulm. These appear as minute red eminences, either alone or in numbers. In the lat ter case they are situated on the limbus of the conjunctiva and resemble grains of fine sand.
In the simple, or solitary, variety the injection of the blood-vessels is localized immediately around each phlyctenule; but in the multiple, or miliary, variety the conjunctival injection is general and is usually quite marked. Jn the latter variety there is also much photophobia and lacrymation and rarely some dis charge. Usually there is an eruption of these phlyctenulw on the cornea as well. This is always accompanied by an increase in the photophobia and lacry mation and adds greatly to the gravity of the disease.
conjunctivi tis occurs chiefly among the poorer classes, and is fostered by the improper and insufficient nourishment which they receive and by their damp and unhy gienic surroundings. It may be found, however, in children, otherwise healthy, whose vitality has been depressed by febrile disturbances, such as measles. whooping-cough, scarlet fever, and the like. The disease rarely occurs in adults, and only when a tendency toward this disease was manifested in youth.
Emphasis upon the relationship exist ing between phlyetenular diseases of the cornea and conjunctivitis and general malnutrition. Wallace (University Med.
Mag., Apr., -921.
Scrofula is, the causative factor in 97) per cent. of all phlyetenular diseases of the conjunctiva. Baas (Woch. f. Therap. u. Hyg. d. Anges.. Sept. 29, '98).
Strumous diathesis present in 90 per cent. of 200 cases of phlyctenular con junctivitis. It is a most important and perhaps a necessary factor. Phlyctenules are, however, not a local tuberculous process, since animals cannot be inocu lated with tuberele for them. Axenfeld ("Bericht iiber die xxvi Versammlung der Oplitiml. Gesellschs. zu Heidelberg-; Med. and Surg. Reviews of Review.s, Dec., '98).
Pathology. — A phlyctenule consists of an accumulation of lymphoid cells packed closely together around a nerve filament, just beneath the epithelium of the conjunctiva or cornea. Soon after its formation the apex of the mass be gins to undergo softening and liquefac tion. The epithelial covering is thrown off and a shallow ulcer remains. The softening process continues, the epithe lium dips down into the ulcer, and heal ing is accomplished in ten to fourteen days.