When the infant comes under the physician's care when the purulent conjunctivitis has already appeared, the ease must be energetically treated as in the adult, the best routine being irrigation every hour or two with a in to.000 Perchloride or Permanganate solution, followed later by the application of Nitrate of Silver in strong solution (to to 20 grs. per oz.) or the \litigated Stick, after which Chloride of Sodium is to be swabbed on the everted lids. A 25 per cent. Argyrol solution is preferred by some surgeons both in the infantile and adult forms of gonorrhoeal ophthahnia.
Granular Con junetivitis, Granular Ophthalmia, or being a highly contagious disease, liable to cause serious visual defects, its pre ventive treatment in schools, asylums and barracks is of great importance. Isolation is therefore necessary, and towels, sponges, handkerchiefs, brushes, &c., must be carefully disinfected, and when belonging to infected subjects must never he used by the healthy. Those affected in schools should be kept by themselves and should spend most of their time in the open air, with the best food, ventilation and hygienic surroundings pos sible, overcrowding and uncleanliness being powerful factors in the spread of the disease.
The acute form of the disease is rare; its treatment is identical in its early stage with that of acute catarrhal conjunctivitis. The eyes should be irrigated every two or three hours with 4 per cent. Boric Acid solution, and after the subsidence of the conjunctival inflammation the remedies indicated in the chronic affection should be employed. The writer has successfully treated all mild chronic cases of the affection in a large charity school, when these were detected early, by frequent irrigation with a i in 5,000 douche of Perchloride of Mercury solution and by an occasional brushing of the inner surface of the lids with a i per cent. solution. Some authorities recommend the application of a 2 per cent. solution in glycerin rubbed into the lids.
If no granulations are visible the best routine is the application, after Cocaine, of solid Sulphate of Copper to the velvety conjunctiva every second day, the eyes being irrigated three or four times a day with a i in to,000 Perchloride solution. Should there be much swelling or any corneal ulcers, this copper treatment is contra-indicated, the brushing over of the lids with a 2 per cent. solution of Silver Nitrate or the Mitigated Stick, followed by Sodium Chloride, being the best procedure.
When the trachoma bodies or granulations are exuberant and project much beyond the surface they may be excised or destroyed by the electro cautery when only a few are present, but the best routine treatment of the granulations is that known as " expression." Grady's trachoma
forceps being employed after thoroughly cocainising the conjunctival sac, each portion of granulation tissue is separately seized and broken down, so that the trachomatous matter is squeezed out, after which the caustic solution 2 grs. to i oz., the solid Mitigated Caustic or Copper Sulphate is applied and the resulting inflammation treated by Boric Acid irrigation and cold compresses. When pannus occurs (a fleshy growth over the cornea), should there be no ulceration of the cornea, and the tracho matous growths be dry, the best treatment is the employment of Merck's Jequiritol, which is to be instilled with the view of setting up an acute inflammatory action. The degree of inflammation may be easily con trolled by the use of jequiritol serum and iced compresses. .After the subsidence of all inflammatory reaction the pannus is usually found to have disappeared, though Copper Sulphate treatment may be required to remove any conjunctival granulations which remain.
The X rays have been successfully employed for the treatment of pannus.
Carbonic Snow has been extensively tried by Marston at Hong Kong, and the results are most successful. There is little pain, the disease rapidly yields, and a splendid cicatrix results. When pannus exists he uses the N rays.
In all cases the most persevering treatment for a long period must be kept up, and it is most desirable that in very chronic examples of the disease a method should be placed in the hands of a skilled nurse when such can be safely done, in order to insure that between the intervals of the more active treatment by the ophthalmic surgeon the disease be not permitted to relapse. The use of the solid Copper Sulphate for tlk purpose is a valuable routine, and if a drop of Cocaine be instilled a few minutes before the application the remedy need cause little pain, but it must not be employed when corneal ulcers are present. Corneal ulcera tion will require Atropine or Eserine, and as some ointment is necessary to prevent sticking together of the lids 4 grs. of the Yellow Oxide of Mercury to i oz. Vaseline or Boric Ointment may be used throughout the treatment.
In most serious cases operative treatment has been advocated. Thus Darier advocates the following under Chloroform ananthesia: Enlarge ment of the palpebral fissure; exposure of the entire sac by everting the lids; scarification of the conjunctiva by deep incisions parallel to the margin of the lids; scraping with a Volkmann's spoon, and brushing in with a hard brush a solution of Corrosive Sublimate, r gr. to I oz. Schneller excises the fornix of the conjunctiva with the view of preventing extensive cicatricial contraction.