IRITIS.
The most important element in treatment of acute primary iritis consists in the instillation of Atropine solution (i in too). The patient may be ordered to bed in'a darkened room and a smart saline purgative should be administered, but when the symptoms are not very acute he may avoid bed by wearing dark goggles. Pain, which is generally a prominent symptom, may be allayed by hot, dry compresses, by hot stuping, or by adding Cocaine to the atropine drops. If all other means fail, hypodermic injections of Morphia may be required. When there is much congestion three or four leeches applied to the margin of the orbit or temple give great relief. Blistering is still employed by some surgeons, but little benefit may be expected from it. As a rule, if wide and uniform dilatation follows the use of atropine, the case will soon yield. If there be much plastic exudation, and the atropine fails to enlarge the pupil widely, it must be pushed, a drop being distilled every five or ten minutes for six times with the view of dragging upon the adhesions. If this fails, the eye may be covered for the night with a piece of lint, smeared with atropine ointment.
Mercury should be freely given where the adhesions do not yield to atropine dilatation in order to prevent complete posterior synechia or adhesion between the iris and the anterior capsule of the lens, which may so increase the tension in the eye as to produce secondary glaucoma. In syphilitic cases a few full doses of Novarsenohllon should be administered or the action of mercury must be kept up till there is evidence that the constitutional effects of the drug have been produced, after which the dose may be diminished. Salivation is seldom necessary, and should he avoided. Mercury is essential in most cases of iritis with much exudation of lymph, but in non-specific cases its action may be suspended as soon as this disappears. The influence of atropine should be maintained till it is clear that the danger of adhesions has passed away. In all ordinary cases the instillation of a drop may be repeated twice daily after the full effects have been produced.
In serous iritis, if a deposit form on the posterior surface of the cornea, it is sometimes recommended to tap the anterior chamber by inserting a fine cataract knife into it in front of the iris, and this may be repeated if the fluid accumulates again.
With a distinct rheumatic history, Salicylate of Soda may be given in full doses, also where mercury is indicated but cannot be tolerated.
Better results may be obtained by Aspirin, which is also useful in gonor rhoeal iritis.
Tuberculous iritis is best treated by rest and atropine without mercury; Tuberculin by the vaccine method has given excellent results. Turpentine in full doses internally (ro mins. every 4 hours) has been proved to possess remarkable power in causing absorption of exudations. Pilocarpine, Colchicine, I-lomatropine, and Physostigmine have been recommended, hut the general management of a case of ordinary iritis may he summed up in the words—Rest, Atropine, and Mercury.
Good results have been obtained by injecting about .; gr. Calomel, suspended in glycerin or weak mucilage, into the tissues in the neighbour hood of the margin of the orbit.
Cyclitis or inflammation of the ciliary body is always present, and the atropine favours its resolution also, but should the ciliary body become much congested by the blood driven out of the iris in wide dilatation the instillation must be suspended.
In chronic iritis and cyclitis the same measures are indicated, and these may be aided by subconjunctival injections of saline solution.
Suppurative iritis and suppurative irido-choroiditis are generally the result of septic wounds, and little can be done to save sight, save by the evacuation of pus and irrigation with weak Perchloride of Mercury Solution. Pain should be relieved by Morphia hypodermically and Cocaine locally.
Sympathetic iritis is part of a sympathetic ophthalmitis. If the vision of the primarily affected eye be very poor, prompt excision of this eye may be successful in checking the sympathetic process. But if its vision be good, excision should not be rashly undertaken, as the originally injured eye may eventually prove the better of the two.
Treatment by scivarsan has given encouraging results.
In ordinary iritis where, in spite of atropine and mercury, or where the case has been neglected from the first and adhesions have formed which refuse to yield to atropine, they may require to he treated by operative measures. After the subsidence of the iritis an iridectomy should be performed when the posterior synechia is complete in order to restore the circulation between the anterior and posterior chambers, but it is most undesirable to operate whilst the inflammation is active owing to the exudation of lymph which is sure to follow.