The disease usually becomes worse upon the approach of spring, the eyes being comparatively free from irritation in the winter. It is quite rare and gen erally affects males, being essentially a disease of childhood and adolescence. The prognosis is good, although the dis ease runs a very chronic course and may persist from ten to twenty years. It finally disappears, however, leaving no trace, except in rare cases, in which a faint haze may remain on the cornea.
Etiology.—The disease frequently oc curs in malarial subjects of both sexes, and is at times seen in women with ir regular catamenia. The primary cause is unknown.
Treatment.—The disease is incurable, and palliation of the acute symptoms represents all that can be done. Van ligen, who has had excellent oppor tunities to study the disease in Constanti nople, where it occurs more frequently than elsewhere, has employed a solution of acetic acid, 1 to 20 grains to the ounce, with marked benefit. I have ob tained excellent results from the same remedy.
Spring catarrh is an attenuated form of trachoma, the affection of the con junctiva of the lid being primary and the immediate cause of the hypertrophy of the Embus. Good results obtained from vigorous friction of the lid with mitigated nitrate-of-silver stick. Cliihret (Revue Gen. d'Ophtal., Afar., =93).
In vernal conjunctivitis, applications of nitrate of silver or sulphate of copper are not always indicated, and do good only when. the stringy, muco-purulent se cretion is very abundant. In the peri corneal form the best treatment is mass age of the cornea -with mercurial oint ment, made up with lanolin. Darier (Annals of Oplitli., July, '97).
As there is no discharge, the disease is not really a catarrh, and does not de mand the same treatment as this class of cases. The eyes should be kept clean with a 10-grain-to-the-ounce solution of boric acid; dark glasses should be pre scribed to protect the eyes from the light and other irritants, such as dust, smoke, etc. If there is much pericorneal in jection, a Is-eak mydriatic should be pre scribed: either atropine in small doses or homatropine. Iced compresses dimin ish the vascularity and afford marked relief. Arsenic, quinine, and iron should be administered internally.
Extirpation of the hypertrophied pa pillm by electrolysis, and obliteration of the superficial vessels supplying the growth in the Embus, have been resorted to with (food results.
Purulent Conjunctivitis.
Definition.—Purulent conjunctivitis is an acute, contagious inflammation of the conjunctiva caused by infection with gonorrhceal virus, and attended by a copious, purulent discharge. It is one of the most dangerous and virulent dis eases of the eye. The contagion is car ried by micro-organisms, the gonococci of Neisser, which appear not only in the pus, but also in the superficial layers of the conjunctiva itself. The gonococci may be found in isolated groups, either in the pus-cells or epithelial cells, and their virulence depends upon the severity of the urethral disease at the time of infection; the more violent the latter, the greater the ocular inflammation.
Purulent conjunctivitis may be pro duced during any stage of the urethral disease, but about the third week of the existence of the latter is the most danger ous period, the discharge being then very copious, thick, and noxious. The dis charge from a gleet may, however, give rise to severe and even destructive gonor rhceal ophthalmia.
According as the affection occurs in adults or infants, it is called gonorrhceal ophthalmia or ophthalmia neonalorum.
Gonorrhceal Ophthalmia.
Definition.—Purulent or gonorrhceal ophthalmia is a specific purulent in tlamination of the conjunctiva charac terized by great swelling, of the lids and conjunctiva, and by copious secretion of contagious pus, presenting a marked tendency to destruction of the cornea.
period of incubation varies, according to the intensity of the contagion, from a few hours to three days.
At first the signs of a simple catarrhal conjunctivitis may alone be present, but soon the lids become red and so tumefied and tense that the patient is no longer able to open them. The palpebral con junctiva and retrotarsal folds also be come intensely red and swelled, and the former is often speckled with hmor rhages. The membrane becomes hard and granular, owing to an infiltration of seroplastic lymph into its substance. The bulbar conjunctiva soon becomes simi larly swelled, forming a hard rim about the cornea. The discharge is at first watery and sanious, but soon changes to a yellow or greenish-yellow pus. The eye is painful to the touch, and there is intense pain in the eye and temple. The constitutional symptoms are often severe, the patients being generally in a weak and feeble condition. Slight fever is also present in some cases.