This stage—that of infiltration—lasts about three days, when the disease attains its height. The lids then become less tense, the conjunctiva softer, and a copi ous purulent secretion follows. After a week the discharge gradually declines, the tissues undergo restoration, and, at the end of four to six weeks, beyond a condition of chronic inflammation of the conjunctiva, which persists many weeks, the parts resume their normal appear ance. Cicatrices rarely follow.
At times the disease assumes more of a subacute type. All the signs of in flammation are then less severe, the pal pebral conjunctiva being alone affected, and it is often only possible to diagnose these cases from catarrh of the conjunc tiva by a microscopical examination. When the disease is particularly virulent, it may simulate the croupous type, a false membrane being formed, which gives the conjunctiva a yellowish-gray appearance.
ia the prophylaxis of purulent eon jnnetivitis, which is generally go»or rhceal in. character, great care must be taken not to contaminate the eye with pus from the urethra or vagina. In purulent ophthalmic neonatorum the eyes of every infant are first washed outside with thereury cyanide or bieldo ride, 1 to :20, and a drop of a 2-per-cent.
silver nitrate solution is dropped into eaeh eye. This, Crede's method, has greatly decreased the number of eases gonorrlmeal ophthalmia in infants.
A. Trousseau (La Presse March DI. 1902).
Complications.—The chief danger in purulent conjunctivitis is the implica tion of the cornea. It results from the pressure of the swelled tissues; the cor rosive action of the secretion, including the invasion of the gonococci; and direct continuity of inflammation to the sub stance of the cornea.
At first the cornea may look dull and slightly clouded; but soon circumscribed areas of grayish infiltration appear, which soon become more dense and yellow, and then form ulcers. The ulceration usu ally occurs at the Embus, and may lead to rapid perforation. In many instances this is a relatively-favorable result, as further infiltration of tbe cornea is fre quently prevented thereby. In other cases, however, the infiltration may form at the margin of the cornea and extend a considerable distance around its circum ference, giving rise to a marginal ring ulcer. Sloughing of a great portion or
even the whole of the cornea usually fol lows, and the eye is usually lost.
The ulceration may also occur at the centre of the cornea, when the whole cornea becomes opaque. As a rule, the greater the severity of the conjunctivitis, the greater the liability to corneal in volvement, especially if the bulbar con junctiva be much chemosed. As a rule, also, the earlier the corneal ulcers form, the more likely are they to result seri ously.
Corneal ulceration usually appears on about the third day, but this depends upon the severity of the inflammation; in a certain number of cases it does not appear until late in the disease.
Iritis may supervene when the ulcera tion has extended to the deeper layers of the cornea or when perforation has oc curred. It generally gives rise to great ciliary neuralgia, photophobia, and lac rymation.
The inflammation may extend from the iris to the other ocular tissues, and a panophthalmitis be set up.
Prognosis depends entirely upon the degree of implication of the bulbar con junctiva, for, if this be much chemosed, corneal ulceration will probably occur and vision be seriously compromised.
Etiology. — Gonorrhwal ophthalmia arises through infection with gonorrhceal pus alone, the virus being conveyed di rectly from the genitalia to the eyes, or from a diseased eye of another person, or from the patient's fellow-eye by the hand, handkerchief, etc.
The serious ophthalmias are those pro duced by streptococci or by an associa tion of streptococci and gonococci, or by the combination of these two with others. The gonococci, when alone, are compara tively harmless (?) and yield to treat ment, which should be prompt and vig orous, consisting of copious irrigations with potassium permanganate, boric acid, and cauterization with silver ni trate. This combination acts on all the various species of microbes which may be producing the ophthalmia. Chartres (Arch. Clin. de Bordeaux, Dec., '96).
Case of g,onorrhceal conjunctivitis sec ondary to a gonorrhcea induced by inter course during menstruation. Formalin proved effective. Hansel] (Editorial, Phila. Polyclinic, '97).