Detachment of the treatment of this serious malady, which often ends in blindness, is still in a most unsatisfactory condition.
Rest in bed is essential in all cases, and the recumbent position should he maintained as long as the patient can be got to submit to it. Bandag ing of the eyes is desirable, but few individuals will tolerate this for any length of time; hence a darkened room or one with a subdued light with a couch to which the patient may be gently removed must suffice. Cough, if present, should be relieved, and straining at stool prevented by avoiding constipation.
Iodides may be administered in combination with mild diaphoretics; Pilocarpine injections administered with the intention of producing copious sweating were formerly much relied upon, but the absence of any real evidence of their value has led to the abandonment of this form of treatment as a routine.
Puncture of the sclerotic for the evacuation of the subretinal fluid, when skilfully performed, always permits the retina to come again into contact with the choroid, and in some cases thc fluid does not reaccumulate, hut in the great majority of cases this desirable result does not follow, so that the effects are as a rule only temporary, even when pressure bandage is resorted to after the operation. Scleral puncture may, however, be em
ployed in conjunction with the following procedure : Subconjunctival injections of 4 to 8 per cent. Saline Solution—these alone or with the addition of a small amount of Cyanide of Mercury or per cent. Quinine—may be made beneath the conjunctiva, to mins. every 5 or 7 days. Gelatin has been employed likewise in combination with weak saline solution.
Dor advises cauterisation with the view of cementing the retina and choroid; after puncturing to withdraw the fluid the galvano-cautery is introduced into the scleral wound.
Deutschmann's method of treating the detachment is bolder than any of the preceding plans, and he claims to have cured over 25 per cent. of 267 cases. His operation consists in introducing a narrow two-edged knife through the sclerotic, detached retina and vitreous to a counter opening in the sclera on the opposite side; this bisection of the vitreous and retina he repeated in some cases as many as ten to twenty times at fortnightly intervals, only 38 per cent. of the cases proving failures, the remainder being improved or cured.