After a time, however, a fresh out break of these small grayish nodules occurs; so that the disease may extend over months and at times years, until the age of puberty is attained, when the eye seems to become protected against fur ther attacks.
In consequence of the corneal involve ment, which is -usually associated with phlyctenular conjunctivitis, there is al ways a greater or less deg,ree of cloudi ness of that membrane; so that vision is interfered with and the patient rendered incapable of fine work. Again, the scars left upon the cornea are often most un sightly.
Treatment.—This must be directed, in the first place, toward the improvement of the general condition. Notwithstand ing the photophobia, open-air exercise should be positively enjoined, as it is absolutely essential for the well-being of the child. All bandages should be re moved, the eyes being protected by tinted glasses or a generous shade. The skin should be rendered more active by cold or salt baths, followed by brisk rubbing. The nourishment should be strengthening and administered at regu lar intervals. No feeding should be per mitted between meals; all sweets and pastry should be prohibited, while milk, fresh eggs, red meat (once daily), and proper fruits should represent the bulk of the diet recommended.
Internally, calomel is of value to im prove the state of the mucous membrane of the alimentary tract; codlivcr-oil, syrup of the iodide of iron, syrup of the phosphate of lime, and arsenic may also be administered with advantage.
If seen in the early stages, it is ad visable to avoid all external irritants by the use of smoked glasses. Gorecki (Le Praticien, May 20, '90).
Locally, any existing blepharitis or eczematous eruption about the eye should be combated with white-precipi tate ointment (1 to 2 per cent.) and with silver nitrate, after the removal of all crusts with a simple soda solution.
In the simple form, where there is but little irritation, calomel should be dusted into the eye once daily. This drug combines with the tears, and forms a weak solution of bichloride of mercury, which exerts a most beneficial action upon the conjunctiva. Care, however, must be observed that iodine is not being administered internally at the same time with the calomel, for the latter in this event forms with the iodine an iodide of mercury, which is very irritating to the eye.
A. salve of the yellow oxide of mer cury may be substituted for the calomel in many cases with great advantage.
In the miliary variety, or when there is recent corneal involvement with signs of active irritation, these drugs, which are irritating, should not be applied. In these cases the eyes should be kept clean with frequent washings with boric acid, and atropine should be instilled at regular intervals.
The photophobia and blepharospasm usually subside with the improvement in the conjunctival condition. Should it be very distressing, however, much relief may be had by cold baths or from im mersions of the child's head in a basin of cold water.
Croupous Conjunctivitis.
Definition. — Croupous conjunctivitis is a catarrhal inflammation of the con junctiva in which, owing to the intensity of the inflammation, there is formation of a plastic exudate upon the conjunc tival surfaces.
Symptoms.—It usually begins with the symptoms of an acute catarrh, but soon attains a severity not witnessed in ordi nary catarrh. The lids become cederna tous„ the conjunctiva much reddened and swelled, especially in the fornix, and a discharge, at first sero-purulent but later muco-purulent, appears. The tarsal mu cous membrane and retrotarsal folds be come covered with a grayish-white mem brane, the bulbar conjunctiva being but rarely involved. The pseudomembrane can be stripped off, disclosing a raw and perhaps bleeding mucous surface be neath, which serves to distinguish it from the diphtheritic variety.
The pseudomembrane usually disap pears after two weeks; the conjunctiva and lids reassume their normal appear ance and the signs of an ordinary ca tarrhal conjunctivitis reappear. There are no resultant cicatrices and vision is but seldom affected, the cornea being only involved when the false membrane spreads to the bulbar conjunctiva, which is of rare occurrence.
Case of recurrent membranous con junctivitis in which the membrane had been removed several times, but always recurred; it had the appearance of a superficial burn. Batten (Ophthahnic Rev., Dee., '97).
Diagnosis.—The main aiTections from which croupous conjunctivitis are to be differentiated are diphtheritic conjunc tivitis and ophthalmia neonatorum.