In consequence of the division of Medicine and Surgery into Physicians, Surgeons, Accoucheurs, Oculists, Aurists, Dentists, Sze., the diseases of the eye have multiplied to no less a number than one hundred and eighteen; a catalogue at once frivolous and arbitrary.
Ophthalmia, or inflammation of the eye, is most absurdly subdivided according to the part affected, thus there are ophthalmia conjunctiva palpebrarum, ophthalmia conjunctiva oculi, ophthalmia conjunc tiva corneae, and ophthalmia sclerotica. There is also idiopathic, symptomatic, erysipelatous, mucous, purulent, catarrhal,orbital,and chronic ophthalmia.
In acute inflammation of the eye, there are pain, heat, redness, and swelling, with the feeling of sandy particles between the upper eye-lid and the ball of the eye. and an increased secretion of tears and mucus; which symptoms vary according to the severity of the injury, and the extent of the inflam mation. As the disease advances, it extends to the brain, and the whole constitution, producing more or less phrenitis and inflammatory fever. The sen sation of sand is caused by the blood-vessels of the eye-ball becoming turgid with blood, and being felt as a neutral body between the globe of the eye and the eye-lid. The eye, when thus affected, has its blood-vessels enlarged and increased, those which formerly carried serum, now conducting coloured blood, while the ciliary glands appear turgid and secrete yellow mucus resembling pus. The treat ment depends on the violence of the inflammation: if the brain or constitution be not affected, leeches, warm anodyne applications, cathartics, low diet, rest and confinement in a darkened chamber will suffice: but if the brain or constitution be involved, general blood-letting from the temporal artery, ex ternal jugular vein, or one of the veins of the arm, will be required. The turgid vessels of the eye ball and eye-lids ought only to be scarified when the affection is tardy, or these blood-vessels threaten to shoot over the cornea. The rubbing in gently of the extract of belladonna on the outer surface of the eye-lids and contiguity is of benefit. Whenever the sensation of' sand leaves the eye, the warm applica tions are to be laid aside, and pure cold water used in their stead, bathing the eye whenever it feels weak and tender; at the end of twenty-four hours, rose-water is to be substituted, and after a few hours perseverance, as much sulphate of zinc is to be added as to produce the feeling of heat in the eye. This solution is to be progressively and cau tiously strengthened, and to be dropped into the eye whenever it feels feeble. Laudanum may be early added to it, and afterwards sulphuric ether. As soon as the sulphate of' zinc can be employed, the margins of the eyelids should be gently anoint ed at bed time with an ointment of the red oxide of' mercury, in the proportion of three grains to the two drachms of lard. After blood-letting has been performed, blisters to the temples and nape of the neck will be found advantageous. There are other local astringents besides those mentioned. If the eye-ball feels very tense, it will be advan tageous to evacuate the aqueous humour with a couching needle. See Fig. 22 of Plate DXV. The causes of ophthalmia are exceedingly various; when it arises from sand, lime, pepper, snuff, insects, Sze., they should be washed away with
warm water and a syringe; when front a piece of a quill, iron, steel, gunpowder, small leaden shot, the couching needle, or cataract knife, de picted in Fig. 20 of Plate DXV., the forceps and camel's hair brush arc the best to remove them. When ophthalmia becomes chronic, which is best distinguished by its duration, it ought to be treated with the same astringent applications rendered gradually stronger, together with mer curial ointment and opium to the eye-brow, and blisters, moxas, and setons. For further informa tion on ophthalmia, the reader is referred to the article MEDICINE.
or acute inflammation chiefly of the iris, although it affects at once the whole choroid coat, and rapidly extends to the other structures of the eye, is consequent either on an injury, or occurs in syphilis, gout or chronic rheumatism, and fre quently after operations on the eye. The surface of the eye, or tunica conjunctiva, is slightly in flamed, the iris appears swollen, changes its colour, when naturally black or brown to red, and when grey or blue to green, and the pupillary Is darker than the ciliary margin, with some degree of de !'ormity, not being so distinct and sharp, and grad ually becoming more and more contracted. The inflammatory action extends most rapidly to the capsule of the lens, to which the iris is liable to ad here, and a deposition of lymph takes place early in the texture of the iris. There is a dull heavy pain of the eye, with intolerance of light, violent headach, and symptomatic fever. This affection equires very active antiphlogistic treatment; and after the first bleeding, mercury ought to be ad ministered so as to prevent the deposition of lymph, or to excite its absorption; and in order to prevent the adhesion between the iris and capsule of the lens, the extract of belladonna ought to be em ployed, also mercurial ointment, with opium. Co agulable lymph is not unfrequently effused into the posterior chamber of the aqueous humour, espe cially in the iritis consequent on syphilis, and forms a delicate semitransparent web, which shuts up the pupil. Closure of the pupil also occurs from ad hesion of the iris to the cornea, and is that in which an artificial pupil succeeds best. This ope ration, however, should never be attempted if the patient can see with the other eye, or when there is any complication of disease, and not until all in flammatory tendency has ceased for some time. In the majority of cases, there is more or less opacity of the cornea, so that the best point of the iris for making a pupil depends on the part where the cornea is transparent; it is therefore better to remove the opacity in the first instance. Various modes have been recommended for making an arti ficial pupil, from Chesselden downwards, and the most simple is that supported by Janin, Maunoir, Guerin, Scarpa, Richter and Beer, which consists either in making a puncture of the cornea with Daviel's scissors, as represented in Fig. 11 of Plate DXVI. at the upper part, and then cutting the iris perpendicularly near the inner or nasal canthus, or in making an incision of the cornea, first with the cataract knife, and next using the scissors.