Symptoms.—The inflamed follicles ap pear as oval, pinkish prominences the size of a pin-head, in the retrotarsal folds, especially the lower. They may be very numerous and may be arranged in paral lel rows. In a proportion of the cases they are but few in number, and are scattered over the conjunctiva. There is some photophobia and inability to do near work for any length of time.
Etiology.—Follicular conjunctivitis is frequently seen in epidemic form in schools and asylums, especially where znany scholars are massed together, scrof ulous subjects being particularly prone to be affected. As there are frequently no subjective symptoms, the physician is often the first to discover the presence .of the follicles.
Follicular catarrh is frequently noted among sehool-children who do not com plain of their eyes; confusion may arise from confounding this innocuous inflam mation with the dangerous trachoma. H. Colin (Berliner Min. Woch., June 20, .9S).
Pathology.—The follicles consist of a mass of round cells, identical with the lymphoid stroma of the conjunctiva. There is no capsule, and the epithelium is unaffected. In the acute form, when the secretion is abundant, the affection is contagious; but, when there is but little discharge, the follicles lie hidden in the without giving rise to any acute symptoms, and contagiousness is not to be feared.
The disease is one of childhood and .adolescence, and may be associated with acute or chronic catarrh, but usually with the latter. The follicles disappear to tally after a time; so that the prognosis is favorable, notwithstanding the chro cicity of the process and its tendency to relapse, which serves to differentiate the disease from trachoma, with which it bears a close resemblance.
Treatment.—Treatment is the same as for catarrhal conjunctivitis, with the ad ditional indication of bringing about the disappearance of the follicles. This is best accomplished by insuffiations of iocloform, aristol, or calomel. In stub born cas.es excision or expression of the follicles has been recommended. The hygienic surroundings should be bet tered, if need be, the health of the pa tient attended to, and all near work pro hibited. All errors of refraction should be carefully corrected under atropine.
The confusion of diagnosis between follicular conjunctivitis and trachoma lias led to an equal confusion in the treatment. in trachoma, the essential element is lymphatic hyperplasia, and the treatment which Ile has found most suc cessful has been based on the treatment of lymphatic enlargements in other por tions of the body. First, so far as pos sible the cause of irritation, whether ellemicaloneehanical, or bacterial, should he removed. This often involves not only frequent irrigations of the con junctiva with boric acid solution, but we should consider the physical condition and surroundings of the child. Cod liver-oil and iodide of iron are valuable internally. Locally, on alternate days, he has found a combination of ichthyol, 15 minims (1 cubic centimetre) ; tinct ure of iodine, 1 drachm (4 grammes) ; giyeerin, 1 ounce (31 grammes), to be of value. On the other days an instil lation of 1 drop of the following com bination may be made at home: Zinc sulphate, 1 grain (0.06 gramme) ; wine of opium, S minims (0.5 cubic centime tre) ; water, '/2 ounce (15.5 cubic cen timetres). Alger (Med. Record, Jan. 24, 1903).
Vernal Conjunctivitis.
Definition.--Vernal conjunctivitis is a chronic catarrhal inflammation of the conjunctiva, usually occurring in chil dren and adolescents, which is attended with the formation of characteristic le sions in the pericorneal and palpebral tis sues.
Symptoms.—The changes at the margin of the cornea consist in an ac cumulation of the conjunctival epithe lium with hypertrophy of the under lying connective tissue. This gives rise to large, reddish-gray prominences, which may readily be seen. Although located in the palpebral fissure, these may ex tend for some little distance into the corneal tissue; or surround the entire cornea. The tarsal conjunctiva is thick ened in the neighborhood of the diseased area; its papillm are enlarged and present a characteristic mammillated appear ance. When the lids are first everted, the conjunctiva is covered with a fine, bluish-white haze, which resembles a layer of milk. At the height of the process there is profuse lacrymation, but rarely any discharge. Considerable pho tophobia is complained of.