CONJUNCTIVITIS.
Except the mild form of conjunctival inflammation caused by the irri tation of foreign bodies or of eye-strain, all other types of conjunctivitis must be regarded as microbic and infectious. Hence prez'entive treatment is of primary importance, the chief element in which is scrupulous clean liness and in the case of school-children isolation. All towels, sponges, basins, handkerchiefs, brushes, eye-droppers and douches, &c., should be repeatedly cleansed, and each child must have its own supply.
Catarrhal conjunctivitis yields as a rule readily to any mild antiseptic or astringent lotion, as Zinc Sulphate r to 2 grs., Boric Acid 4 to S grs., Alum 3 grs., Acetate of Lead t gr., Tannic Acid rgr., Zinc Chloride gr., Perchloride of Mercury gr., to each oz. of distilled water.
In using eye lotions the best results are obtainable by adding some inert substance to make them of isotonic strength—i.e., of the same osmotic pressure as the blood, which should be, as in the case of normal saline solution, o.9 per cent. or slightly less; by this means smarting may be obviated. Aladdox explains the soothing action of boric acid on this hypothesis; 4 grs. to the oz. of this antiseptic makes a practically isotonic solution, and when a strong substance like perchloride of mercury is em ployed for washing out the conjunctival sac 3 or 4 grs. of sodium chloride per oz. of lotion should be added to it. Bandaging of the eyes is never necessary, and the patient should spend as much time as possible in the open air, wearing darkened glasses if necessary.
The local analgesic action of opium is doubtful, but Swanzy recom mends c dr. of the tincture to be added to each oz. of the boric or zinc collyrium. The following is a good routine application: B. Zinc/ Su/pi/a/is gr. x.
Acid. Borici gr. xxxij.
rind. o pii .
Aqwe Rosce ad :73viij. Misce.
Any of the above lotions may be used every 2 to 4 hours by partially filling a small douche-glass with it and applying it closely to the opener eye, when by a nodding movement of the head the entire conjunctiva, sac can be thoroughly sluiced.
If the catarrh does not readily yield to the above treatment, a silver salt should be applied to the lids. i in 4 Argyrol is a favourite application a so gr. to i oz. of the Nitrate solution may be freely applied to the conjunctiva with a brush or on wool, and after a few seconds a strong solution of chloride of sodium should be instilled to precipitate the nitrate and t he eye irrigated freely with water or normal saline solution, the opera. tion being repeated daily. If a r or 2 per cent. solution is used, salt neec not be applied after it. The lids should be smeared with Lanoline or Ointment every night to prevent the secretion being glued in.
Phlydenular conjunctivitis, also known as strumous ophthalmia, yield: usually to Boric Acid or Zinc Sulphate lotions; there is often much photo. phobia present, as corneal ulcers are liable to form, in which case Atropim must be instilled and the remedies indicated in corneal ulceration employed.
As the disease usually appears in ill-fed and badly cared for children strict attention should be paid to regular feeding with nutritious food am a free open-air life. When out of doors the child may be permitted tc wear a broad shade over both eyes; this should not be closely fitting, should project like the peak of a cap, so that the eyes may he exposed t( the air whilst shaded from sunlight, or dark glasses may be worn. These cases often do well under Pagenstecher's Ointment made of the strengtl of 5 grs. to L oz., smeared over the lid margin, or dry Calomel may bi applied on a fine camel's-hair brush. The blepharospasm often presen constitutes a difficulty in the application of remedies; it can be overeom, by holding the child's face under water in a wash-hand basin for a few moments, after which an examination of the eye and the application of astringent remedies can be readily carried out.