BLEPHARITIS, OR TINEA TARSI.
This is due to an eczema of the margins of the eyelid, and may be caused in mild cases by errors of refraction, which tend to produce a chronic hyperemia of their conjunctival covering. In severe cases the disease may be part of a strumous or phlyetenular ophthalmia, both of which conditions will require treatment before the blepharitis can be removed.
The form known as squamous blepharitis yields after a time to an ointment of Boric Acid (r in 2o), or Yellow Oxide of Mercury (r in ioo), applied after the branny scales have been washed away every morning and evening by the thorough use of a warm solution of Bicarbonate of Soda (I5 grs. tor oz.). The margin of the lid should be carefully dried before applying the ointment, or the scales may be removed by swabbing the margins with lint or wool soaked in Olive Oil before the ointment is applied.
In ulcerous blepharitis the treatment is more radical; the crusts having been removed as in the squamous variety, though without the use of friction, the minute ulcers coming into view are each to be cauterised by a pointed stick of Mitigated Nitrate of Silver, and any pustules pricked with a cataract knife and all loose eyelashes epilated. Where the ulcerated
surface is extensive it may be brushed over with a solution of the Nitrate of Silver (10-15 grs. tor oz.). After thorough washing and drying by pressure, Swanzy used the following ointment rubbed in with the finger: I lyd. Precip. Alb., gr. xij.; Zinci Ox., gr. xvj.; Liq. Plumbi subacet., min. xij.; and Adeps. Benz., ad 5j.; and in mild cases Boracic Acid oint ment (t in to). Diluted Citrine Ointment meets most requirements, but these applications are useless unless the crusts and loose eyelashes are scrupulously removed by the previous use of alkaline lotions, or soaking of the lids with oil. Lachrymal obstruction, resulting from the inflam matory action, is often present in severe chronic cases, and ectropion may follow these with such complications as trichiasis, and tylosis must be remedied by appropriate surgical treatment. The general health must be attended to, and as the disease is often associated with anemia, chlorosis, and struma, constitutional treatment with Cod-Liver Oil, and removal to a bracing seaside resort are often essential.