Follicular conjunctivitis is often associated with enlarged tonsils, ade noids and other forms of lymphatic overgrowth, and open-air life. with judicious feeding and Cod-Liver Oil combined with Syrup of Iodide of Iron, should be prescribed. An astringent lotion, Zinc Sulphate 2 grs. to r oz., or r gr. per oz. of Zinc Chloride, or an ointment of Copper Sulphate to grs. to i oz. Vaseline should he applied. When much catarrhal conjunctivitis is associated with the presence of the follicles which are often confined to the lower fornix of the conjunctiva, ro grs. Nitrate of Silver solution may be applied to the lids and Chloride of Sodium swabbed on.
illenzbranotts, croupous or diphtheritic conjunctivitis must be treated by the injection of the antitoxic serum at the earliest possible stage. even when the case is of the mildest type and no other manifestation of diphtheria is present. Some authorities instil the serum into the conjunctival sac, but it is better never to trust entirely to its local action. The mildest type of membranous conjunctivitis, known as the " croupous," is recog nised by the ease with which the superficial exudation is detachable; the treatment of this affection is that of the simple catarrhal variety, the con junctival sac being frequently flushed with warm 4 per cent. Boric solu tion; many ophthalmic surgeons use a r per cent. Quinine solution for this purpose. Though it is not probably due to the diphtheritic bacillus. it is a wise routine to inject serum. Silver Nitrate should never be used in the membranous varieties whilst exudation is present.
In the severer or truly diphtheritic type the same local treatment is to he at first employed, the Boric or Quinine irrigation being used freely and often, and iced compresses or Leiter's tubes applied to the eyelids, unless when warm or hot compresses afford most relief. After the detachment of the membrane Silver Nitrate may be applied to the velvety pus-secreting lids, but it must be used with extreme caution owing to corneal trouble. and if possible should be avoided. Underlying ulceration must be treated by Atropine or Eserine, as described under Cornea, and the greatest care taken to prevent adhesion of the lids to the globe.
Purulent conjunctivitis, purulent ophthalmia or acute blenorrhceal conjunctivitis is usually in the adult clue to inoculation of gonorrhoeal matter into the adult eye, and the less frequent cases where infection is conveyed to the eyes of an adult from those of an infant affected with ophthalmia neonatorum. The treatment during the early stages should
consist of iced compresses frequently applied and thorough irrigation of the conjunctival sac with gr. tor oz. Perchloride solution or the same strength of Permanganate of Potash till the swelling and induration of the membrane and lids are reduced. If great chemosis of the conjunctiva occurs--a dangerous symptom—it should be freely incised, and bleeding encouraged by hot applications and by application of leeches to the outer angle of the lids or to the temples; it may be necessary to incise the ex ternal canthus. The other eye, if sound, should be most carefully guarded against the possibility of inoculation by bandaging over a pad of cotton wool, or in the case of infants by sealing the lids with collodion or by using a Butler's shield.
When the swelling is reduced and the suppurative stage established Nitrate of Silver io to 20 grs. to I oz. should he applied on cotton-wool to the everted lids, which should then he swabbed with solution of Chloride of Sodium, the operation being repeated at the end of twenty-four hours. In the interval the sac should he Irequently flushed out with gr. tot oz. of Mercury solution or Boric :Acid, 4 per cent. solution, and the lids kept from sticking to each other by applications of Boric Ointment. Many surgeons prefer the Alitigated Caustic Stick to the nitrate solution. After the acute purulent stage has been subdued, a weak astringent lotion, Copper Sulphate, Zinc Sulphate or Chloride, should be employed. Corneal ulceration must be treated by Atropine or Eserine and astringents avoided.
Ophthalmia neonatorum is identical with the above condition, being nearly always caused by gonorrhoeal infection during the progress of the infant's head through the vagina or immediately afterwards. Preventive treatment is of vital importance, and has become a routine in most lying in hospitals. The vagina should he washed out during labour with a strong Permanganate or weak Perchloride solution, and the child's eyes should be carefully washed and a few drops of a 2 per cent. Nitrate of Silver solution instilled into the conjunctival sac immediately after birth (Credo's method), or the eyes may be irrigated with a i in 5,000 Perchloride of Mercury solution.