PECIAL TREATMENT. — Interstitial kcratitis especially requires the employ n.t.nt mydriaties on account of the tou.knev to involvement of the iris. Atropine May be used in solution of: a:ropine sulphate, 1; distilled water, CO. The frequency and freedom of its ap p:ieations may be limited by the tend ency to cause mydriatic intoxication. When sufficient to keep the pupil well d:lated, the strength of the solution and the frequency of its application may be diminished. Locally, hot fomentations, and sometimes local bleeding from the temple. may also be employed. But the curative treatment is probably chiefly ccnstitutional: first, the preservation of the general health: and, after that, the prolonged administration of mercury and the iodides in moderate doses. Codliver oil. iron, and arsenic are sometimes most beneficial.
For neuropathic, malarial, and her petie keratitis, the E.,,eneral and tonic treatment is of most importance, with careful protection of the eyes from irri tants.
Phenate of mercury recommended in diseases of the cornea, especially in her petie plilyctenular keratitis. Galezowski (Ann. d*Ocul., Jan., '95).
The treatment recommended to pre vent keratitis after destruction or re moval of the Gasserian ganglion is: Stitching the lids together for the first few days, and, after the removal of the dressings keeping the eye covered with a Buller shield for a month. For punc tate keratitis atropine should be applied. llullous keratitis may be met with atro pine and hot applications during the at tack; and regular massage with some mild ointment during the intervals. It may also become an indication for the enueleation of a degenerated eye.
Dendritic ulcer should be scraped and touched with a solution of silver nitrate or formaldehyde of a strength of 1 to GO. Phlyctenular keratitis was long known as the common form of scrofulous ophthalmia, and must be treated with especial reference to the general condi tions that accompany it. Out-door life; plain, readily digested food; and the avoidance of sweets, tea, and coffee must be insisted on. Codliver-oil and syrup
of iodide of iron are standard remedies. The child must not be allowed to keep the eye buried in the pillow or handker chief; but should be encouraged to over come photophobia by exposure to the light and air. Local treatment is also very important. Photophobia will be di minished by the instillation of atropine. The ointment of: yellow oxide of mer cury, 1 part; petrolatum, 60; should be used in the conjunctival sac every night. The lower lid being drawn down, a piece of the ointment the size of a grain of rice is placed on its inner surface, and the lids are closed and then rubbed gently over the eyeball for a minute or two. If there is much redness of the ocular conjunctiva or enlargement of the veins on the inner surface of the lids, tannin, 1; glycerin, GO; should be ap plied to the everted lids every day or two. Treatment should be continued many weeks after an attack to prevent recurrences. A most important measure for the same purpose is the thorough eradication of all morbid conditions dis coverable in the nose.
lron, the remedy most commonly pre scribed in the phlyctenular keratitis of children. is frequently injurious. The extreme irritability of the eyes is ag gravated by its use in the early stages, while it is useful enough at a later period. In the early stages it is far better to employ mercury internally. This may be advantageously exhibited in the following combination from the Aloorfields "Pharmacorapia"; Cray pow der, 1 grain (0.06 gramme); powdered belladonna leaves, 11,,, grain (0.03 gramme); sugar of milk, 1 g,Tain (0.06 gramme). One powder twice daily.
Atropine locally is essential with fre quent bathing in boric lotion. Later, but tint in the acute stage, an ointment of the yellow oxide of mercury, 2 to S grains to the ounce, is useful. At this stage iron is indicated.