Inflammation of the Conjunctiva.— When an increased and perverted secre tion is added to the symptoms of hyper mmia, the conjunctiva may- be said to be in flamed.
All varieties of conjunctivitis are con tagious, and, while they occasion certain fixed changes in the tissues, which per mit of their being grouped into certain types, they have this peculiarity, that the secretion from one type when inoculated into a healthy eye may set up quite a different variety of conjunctival inflam mation from that of the eye from which it was obtained; this, therefore, shows that the secretion of the different forms cannot be regarded as being specific, but that the type of inflammation set up by it depends upon other causes as well.
Corneal involvement is a common complication of all forms of conjuncti vitis and must always be regarded in the prognosis, as its occurrence usually indi cates that there will be a permanent dis turbance in vision after the subsidence of the inflammation.
According to the nature of the secre tion and the character of the patholog ical changes observed in the tissues of the conjunctiva, inflammations of that membrane have been divided into the catarrhal, diphtheritic, purulent, granu lar, and phlyctenular varieties.
Catarrhal Conjunctivitis.
Symptoms.—In the simple form the conjunctiva is red, vascular, and swelled, the vessels usually forming a large, coarse net-work. At first these changes are lim ited to the palpebral conjunctiva; but they soon extend to the retrotarsal fold, the caruncle, and semilunar folds, and finally to the bulbar conjunctiva. The siirface of the membrane is smooth, serv ing to differentiate it from other forms of conjunctival inflammation. The eye lids are slightly swelled, and their edges reddened and covered with yellowish crusts, and bathed with an abundant se cretion.
Severe cases are characterized by the involvement of the bulbar conjunctiva, and by an increase in the redness and swelling of the palpebral portion of the membrane and of thc retrotarsal folds. The net-like formation of blood-vessels can no longer be differentiated; small litemorrhages appear, scattered through the membrane, and there is a serous in filtration from both the superficial and deep vessels. This fluid collects in the
submucous tissue and occasions chemosis.
The lymph-follicles may develop, and the papithe of the conjunctiva become swelled and turgid and give to the mem brane a rough and granular appearance.
In chronic forms the objective syrap toms are not prominent. There is mod erate swelling and congestion of the con junctiva and but slight secretion, the symptoms being those of hypermraia.
There is a constant sense of heaviness and a sensation of sand in the eyes; there is burning and watering, and vision is momentarily blurred by some of the se cretion covering the pupillary area of the cornea.
Complications.—Secondary corneal in volvement occurs in the aged, especially when the catarrh has persisted for years. The ulcers are usually at the Embus, and their formation is attended with pain and photophobia. They appear as small, round, gray points, which may become confluent and form a crescentic ulcer. These usually heal, leaving small, bow shaped nebulce. Iritis may also present itself, and is usually the result of kera titis; but it may also be seen in severe cases of conjunctivitis without involve ment of the cornea.
In gouty persons there is a form of conjunctivitis to which the name of "catarrho-rheumatic ophthalmia" has been given, which is attended with great pain in the eyes and temples and great photophobia. There is usually mark-ed lacrymation, but no discharge.
Singular and rare conjunctival affec tion occurring in arthritic persons, and in those affected with arteriosclerosis, consisting of the onset of an active hy perxmia of the conjunctiva coming on suddenly, without appreciable cause, and disappearing spontaneously, the attacks almost always coming on during the night, lasting three or four hours, and recurring regularly two or three times at intervals of twenty-four hours. Trousseau (Recueil d'Oplital., No. 6, '96).