Case of pseudornembranous conjuncti vitis in newborn child, due to strepto coccus, treated by Roux's serum; total loss of both comm. Darier (Annales d'Oculistique, June, '95).
Diphtheritic Conjunctivitis.
Definition. — Diphtheritic conjuncti vitis is au infrequent specific inflamma tion of the conjunctiva, attended by the formation of a plastic exudate within the layers of the bulbar and tarsal mem brane.
Symptoms.—The exudation penetrates deeply into the tissue and causes its death, thereby destroying the nutrition of the cornea and causing subsequent loss of that membrane. The lids become hard, board-like, and tumefied. At first there is a scanty sero-ptrulent or sanious discharge, which is followed by a more purulent one as the disease progresses. The secretion is very contagious, and, if there be abrasions at the orifices of the mouth and nose, the membrane will quickly invade them. Patches of mem brane are often found in the pharynx and nares.
After the period of infiltration—which lasts from one to two weeks—has sub sided, the membrane is thrown off, leav ing a raw, granulated surface. At times the membrane may be absorbed. After a time vascularization sets in and the symptoms of an ordinary purulent con junctivitis supervene. The termination of the process, however, is less favorable than in the catarrhal form, for during the period of cicatrization changes occur which cause atrophy and shrinking of the conjunctiva, and not infrequently occa sions great deformation of the lids.
Complications.—The chief complica tion is corneal involvement, which oc curs in the vast majority of the cases, and occasions the intense pain by which the disease is accompanied. As a rule, the cornea is affected early in the af fection, either by ulceration or diffuse infiltration.
Etiology.—The disease is of specific origin, and the constant presence of Lofiler's bacillus has lead to the assump tion of this germ being the causal factor in the diphtheritic process.
Children between the ages of two and eight years are usually affected, both eyes being involved. The disease is rare in this country, but is not infrequent abroad, where it occurs in an epidemic form. The prognosis is decidedly grave on account of the tendency toward cor neal involvement.
Treatment.—In the first stage, when the lids are hard and board-like, and there is a necessity of limiting the a.mount of exudation, ice-compresses should be employed, but hot compresses are indicated as soon as the cornea. shows signs of involvement. Treatment must be tentative. Mild antiseptic lotions should be employed to remove all secre tions, either bichloride of mercury (1 to 8000) or potassium permanganate in 2 per-cent. solution. Silver nitrate is con tra-indicated in the early stages, but may be utilized when the membrane comes away. Atropine should be in stilled early on account of the tendency to corneal involvement. Great attentiou should be directed toward building up the general health. Mercury and quinine should be administered and stimulants ordered if the child shows signs of col lapse. The isolation of the patients is necessary to prevent further contagion.
Treatment by antitoxin of 25 cases of diphtheritic conjunctivitis occurring among S000 cases of diphtheria at the Boston City Hospital. In all these eases the bacillus CV/1 S present in the discharges from the nose. Eight eases were admitted for ocular diph theria; the others were fancial diph theria which had incidentally a mem brane on the conjunctiva. All were treated with antitoxin, the first dose being 4000 units. Usually a second dose of like amount was given at the end of six or eight hours, and some had three or four injections. Such cases in twenty-four hours usually were doing well, and after forty-eight hours no more anxiety was felt for the eyes. In those cases in which there were corneal ulceration the antitoxin favorably af fected the corneal lesion, and with the exception of 4 cases the patients left the hospital with good vision. In 1 of these 4 eases the cornea upon admission seemed to be wholly necrotic. SiK months later there was conSiderable ViS101). An opaque scar occupied ap proximately half the cornea. In the 3 other cases every cornea was lost. These 3 patients had diphtheritic infec tion during an attack of measles. This probably accounted for the severity of the corneal process. M. Standish (Bos ton Med. and Surg. Jour., Oct. 2, 1902).