CORNEA, Inflammation of.
Where corneal ulceration follows phlyctenular keratitis and injuries the first indication is to afford as complete rest as possible to the eye. Atropine should be instilled, but if the corneal ulcer is marginal Eserine is preferable. Both eyes should be carefully bandaged over a padding of lint. When much pain is present hot Boric Acid compresses should be kept over the eyelid after the temporary removal of the bandage, and Belladonna with Glycerin may be smeared over the brow.
Where corneal ulceration is the sequel or concomitant of severe con junctivitis, bandages must not be employed; the eye should be freely irrigated by a warm 4 per cent. Boric solution or by a i in io,000 Per chloride of Mercury solution after the lids have been treated by Nitrate of Silver solution (2 per cent.).
NV here the photophobia is intense a free division of the outer canthus may be made, and counter-irritation or leeches to the brow often afford considerable relief.
Calomel, dusted inside the lids once daily, often acts with great and causes superficial ulcers to take up new action and induces rapid granulation. Seldom will Nitrate of Silver be required. In large pustules or sluggish ulcers, a mixture of Cocaine (8 per cent.) with Atropine solution relieves pain and tension, and Mitigated Caustic may be lightly applied to the ulcerated spot with very marked benefit. Better still, after the instillation of Cocaine or the use of a Cocaine disc and staining by fiuorcscin, a little pure Carbolic Acid may be applied with a fine camel's-hair brush, confining the application strictly to the dried ulcerated spot. This method may even be employed for deep ulcerations of the cornea if perforation do not threaten, and if there be no iritis. Routine use of cocaine for the relief of pain in corneal trouble is dangerous owing to its desiccating action. Absolute alcohol is sometimes used in a similar way to disinfect the floor of the ulcer. When the ulcer shows any signs of spreading it should he cauterised with the platinum loop of the electro• cautery.
When the acute stage is over, much benefit will be obtained by stimulat ing treatment. This may be carried out before pain subsides if Atropin(
be constantly used. The best application is the yellow Oxide of Mercury Ointment, but it is too often used of a strength that aggravates the affec tion. S grs. tor oz. Vaseline is generally strong enough for all purposes, and sometimes half this strength will be found to answer better. A minute portion of the ointment may be inserted inside the lids twice a day, but the effect must be watched carefully, and it should be stopped at once if signs of irritation reappear.
A seton above the temple or behind the ear, or blisters in the same locality, prove useful in very chronic cases. When the ulceration is caused by the presence of granular lids, this condition must be met by proper treatment. (See Conjunctivitis.) In ulcerative, strumous, or suppurative keratitis„ Ford resorts to peri tomy, on the principle that as the cornea receives its blood-supply from the conjunctiva, the local consequent upon a division of its vessels and of the loops which surround its circumference, tends to promote a healthy reaction and an absorption of stagnant cellular elements. Walker performs perikerotomy, or cutting round the cornea in these cases; he makes a series of short incisions at the base of the cornea.
Where the ulcer is threatening, Shaw points out the necessity of anticipating perforation as the best means of preventing the aqueous humour escaping with a gush and carrying the iris with it. He perforates the floor of the ulcer with a fine knife.
Internal treatment is of the greatest and constitutional measures must be employed from the beginning. Thus, in the phlyctenular form, as in strumous ophthalmia, the treatment directed under Conjunctivitis must be carried out, and an early change of air and scene is often followed by marked benefit. Special attention should be paid to the feeding of the patient, meals at regular hours being insisted on even for the youngest, and all forms of refreshment between them absolutely prohibited.