Secondary glaucoma—i.e., that form which supervenes upon previous diseased conditions of the structures of the eye—will require treatment modified in each case by the old intra-ocular disorder. Thus when due to complete annular adhesions between the iris and the anterior capsule of the lens (posterior synechia) an iridectomy should be done. Injury, displacement or dislocation of the lens causing glaucoma will demand removal of the lens from the eye in order to restore or open up the angle of the anterior chamber. Dislocation of the lens into the vitreous will demand an iridectomy if the symptoms do not yield to eserine instillation. Deep corneal wounds and ulcers involving the iris in their cicatrices must be treated by removal of a large portion of the iris. When the exudation is extensive in an acute iritis which blocks the normal circula tion of the intra-ocular fluids, though no adhesions exist, the contents of the anterior chamber must be removed by paracentesis.
Where the sight is totally lost and the glaucomatous eye is painful and tender, though iridectomy has been already performed, the only pro cedure is enucleation.
Ikemorrhagic glaucoma is always grave: a strong Saline purge should he given immediately, and small doses of nitroglycerin to reduce the general blood-pressure, and Eserine should be instilled. Paracentesis is the best routine procedure, the aqueous being removed as slowly as possible. Iridectomy must be avoided, as the sudden withdrawal of fluid is certain to increase the haemorrhage, unless in cases of primary hemorrhagic glaucoma after Eserine, Purgation and Leeching have gradually reduced the tension. Enucleation of the eyeball will often be necessary.
t should always be remembered that atropine must never be employed in the glaucomatous condition, owing to its dangerous power of increasing the intra-ocular tension. Its instillation with the view of breaking down adhesions in synechia may determine an attack of acute glaucoma in elderly subjects.