Tubercular Disease of the Conjunctiva.
Symptoms.—Tubercular disease of the conjunctiva may be either present itself as a primary or a secondary manifesta tion; in either event it is an extremely rare disease. In both varieties the dis ease occurs in the form of small, yellow ish-gray nodules on the palpebral con junctiva. These break down and form ulcers with uneven and indurated edges.
The floors of these ulcers have either a lardaceous appearance or are covered with grayish-red granulations. The con junctiva is swelled and turgid, the lids are thickened, and there is considerable discharge. The bulbar conjunctiva and the cornea may become affected, and in severe cases the ulcers on the palpebral conjunctiva may burrow down and in volve the entire thickness of the lid.
Although this gives a clinical picture -which is almost characteristic, the diag nosis may be verified by the discovery of the tubercle bacillus in the contents of the ulcers.
Case of tubercle of the conjunctiva in a boy 15 years of age. The condition re sembled that of trachoma; the mem brane was greatly shrunken aud the eye ball was atrophic. Microscopical study showed giant-cells, but no bacilli. Rob erts (Brit. Med. Jour., June 10, '93).
Conjunctival tuberculosis ma.y closely simulate trachoma. In one case a micro scopical examination of a piece of the conjunctiva was necessary before an ex act diagnosis could be wade. H. Eleiners dorlf (Klin. Monats. f. .A.ugenli., Mar., '98).
The disease usually affects but one eye and occurs almost without exception in the young. It manifests a great tend ency to recur, and may become the start ing-point of general tuberculosis. Etiology.—As a rule, tubercular con junctivitis is a primary disease and orig inates in a direct infection of the con junctiva. When the disease occurs as a secondary manifestation, it is usually transmitted from the nasal or pharyngeal mucous membrane by means of the lacry mal passages.
Treatment.—This should consist in the removal of all the diseased structure if the process be localized, by the curette, knife, or galvanocautery; but, if the in volvement of the ocular structure be seminated, enucleation should be in stantly performed.
Case of undoubted primary tubercu losis of the palpebral conjunctiva, veri fied by the finding of a few Koch bacilli. The eye in other respects remained un involved. The palpebral ulceration was treated and cured by frequent application of silver nitrate, bathing with saturated solution of potassium chlorate, and cu rettage. The patient died, two years later, from laryngeal and pulmonary plithisis. H. Armaignac (Ann. d'Oculist., Aug., '97).
Lupus of the Conjunctiva.
Conjunctival ulcers occurring in this disease are distinguishable from tuber cular ulcers chiefly by the fact that they have involved the conjunctiva from the skin, instead cf from the mucous mem brane, and, like cutaneous lupus, they undergo spontaneous healing in one place, while the ulcer keeps advancing in another. The disease occurs either
as a primary process or as an extension of the disease from the surrounding skin. It appears as an ulcer, the bottom of which is covered with granulations, which bleed on the slightest touch and are filled with tubercle bacilli.
Treatment consists in thorough re moval of the contents of the ulcer with a curette, followed by careful cauteriza tion.
Pemphigus.
Pemphigus of the conjunctiva is a very rare affection, and is usually seen in connection with pemphigus vulgaris of other parts of the body, although it may occur as an independent disease. Bulla-3 form upon the conjunctiva and are attended with pain, photophobia, and lacrymation. The blisters break down and form cicatrices in the conjunc tiva. Repeated recurrence is the rule, so that the membrane finally becomes much shrunken and atrophied, and appears dry, smooth, and tense. The cornea be comes cloudy and the lids are frequently distorted, aggravating the symptoms by the displacement of the cilia which this occasions.
Treatment is of no avail, though the condition may be mitigated by emoll ients, and protection from the light and air by coquilles. Arsenic may be admin istered internally.
Syphilitic Disease of the Conjunctiva.
Chancres about the eye, as a rule, de velop on the edge of the lids; they may also be observed on the palpebral con junctiva and rarely on that of the globe. The disease is usually transmitted by kissing. At times, however, ulcers may form from the breaking-down of gum mata of the conjunctiva.
Instance of a syphilitic ulcer of the bulbar conjunctiva. The initial lesion had occurred eighteen months previously. Under general antisyphilitic measures the local manifestation disappeared promptly. Fromaget (Gaz. IIebd. des Sciences Med. de Bordeaux, Aug. 6, '93).
Case of inucous patch of the conjunc tiva complicated by a pseudomembranous formation in a woman, 20 years of age, who exhibited other secondary lesions of syphilis. The conjunctiva of the lower eyelid was swelled and congested and covered by a pseudomembranous exudate. Schwartzschild (Med. Rec., Apr. 22, '93).
Tumors of the Conjunctiva.
Tumors of the conjunctiva may be both malignant and benign.
DERMOID.—The most common among the latter is the dermoid, which is always congenital and is often found associated with wart-like growths from the skin in front of the ears, and with harelip. They are ascribed to an arrest of development. They occur as pale yellow rounded or oval bodies the size of a split pea, usually at the extreme limbus of the cornea. Their surface is dry and smooth and frequently has a few hairs projecting from it.
If, as sometimes happens, the growth shows a tendency to involve the cornea or cause imitation, it should be excised, care being taken to avoid injuring the deeper layers of the cornea.