Hydrophthalinia is dropsy of the eye, consequent on violent acute ophthalmia, and in this disease the eye is swollen, with profusion of the cornea, which is tolerably clear, although the aqueous humour is turbid. The sclerotic coat around the cornea is of .t blue colour, the iris dull and dark, the pupil neither contracted nor dilated, and the vitreous humour much increased in quantity. In the begin ning of the disease, the patient secs objects at a greater distance than formerly, or is far-sighted, but this soon changes to weakness of vision, the eye becomes horribly disfigured, its textures are disorganized, the bones of the orbit rendered cari ous, and the patient is soon cut off. By some, it is stated that the tunics burst, while by others this is denied. In the commencement, the cornea should he punctured, or an issue or a seton established, as recommended for staphyloma; and if these fail, the cornea ought to be removed, as described under that disease. Ilypopium is an effusion of coagula ble lymph and purulent matter in the posterior, and afterwards into the anterior chamber of the aqueous humour, consequent On acute ophthalmia, and is to be treated by active antiphlogistic means, and puncturing the cornea, also using astringent and stimulating ointments, with an alterative course of mercury. If not cured, adhesion of the iris to the capsule of the lens, and an opacity of the lens, together with ulcer of the cornea, are liable to fol low.
Opacity of the cornea, named also albugo, leu coma, nebula, and speck, is one of the consequences of ophthalmia, whether acute or chronic. Nebula is said to be the result of chronic ophthalmy, and to consist of an effusion of milky serum in the tunica conjunctiva corner, with thickening of this coat and varicose veins; albugo, to be an effusion of coagulable lymph between the lamina of the cornea, consequent on acute ophthalmy, and to have first a milky and then a pearly appearance; and leucoma to be also an effusion of lymph, but to occupy the extent of the cornea, and to arise either from violent acute ophthalmy, or ulceration of the cornea, or a wound of this tunic; but these opacities indiscriminately arise from chronic as well as acute ophthalmia, and being evidently the same disease, require therefore the same line of treatment, which consists in applying daily, or every second day, the dry nitrate of silver for an instant to the opacity, and bathing the eye for a few minutes afterwards with warm water or oil. In children it may be removed by blowing into the eye a finely levigated powder of equal parts of calo mel and white sugar. In acute inflammation of the eye, a pustule occasionally appears on the cornea which requires to be freely opened; otherwise the depression or pouch is filled with lymph, and forms an opacity or leucoma. This pustule sometimes appears larger and more formidable, and is then termed an abscess, which should he treated in the same way. When the abscess bursts, it becomes an ulcer which is characterized by high ragged edges, by the base being of an ash-colour, and the discharge acrid serum. An ulcer is also con sequent on wounds from sharp-pointed instruments, glass and lime. The symptoms are the same, as in acute or chronic ophthalmy according to its duration; and the best diagnostic of an ulcer is the pain produced on looking at the light, for on gene ral examination it very much resembles an opacity of the cornea. A chronic interstitial ulcer is de
scribed by some oculists. If an ulcer of the cor nea be neglected, it either spreads superficially and destroys the transparency of this tunic, or pene trates deeply to the anterior chamber of the aqueous humour, producing a fistulous aperture, where prolapsus of the iris may take place, and even pro trusioc of the crystaline and vitreous humours. A fungous excrescence sometimes protrudes, resem bling a pterygium. As lung as the pain is severe, and there is acute inflammation, it should be treat ed as the irritable ulcer of other parts; and when ever these are subdued, by the application of the nitrate of silver every two or three days; and when granulations arc visible, by astringent collyria. Puncturing the cornea to evacuate the aqueous humour and thus relieve the tension and pain will he found beneficial, and prevent prolapsus iridis taking place. If a fungus shoots forth, it ought to be excised with the knife or scissors, and the ni trate of copper or silver afterwards applied.
When the cornea ulcerates, and the aqueous hu mour escapes, the support of the iris is removed, and the latter protrudes, forming prolapsus named also staphyloma and procidcntia This also ensues occasionally after the operation of extraction of the lens, likewise when the cornea is ruptured by a contusion, especially from glass, and in evacuating the matter in hypopium, and even sometimes Front violent vomiting. The iris appears like a small dark brown or grey tumour, surrounded by an opaque circle of the cornea, with an oval-shaped pupil, and more or less inflamma tion of the conjunctiva. On some occasions, there is more than one protrusion, simply because there is more than one aperture. The symptoms arc pain like a pin pricking the eye, an oppressive sensation of tightness over the eye-ball consequent on the strangulation of the iris, a burning effusion of tears and intolerance of light. IC the prolapsus be recent, an attempt should be made to reduce it with a probe, but if that fails, as it is very difficult, it may be removed with the knife, scissors, or ni trate of copper or silver, taking care not to con tinue the application of the eschat otic too long. Whenever the wound heals, the pupil tends to re occupy its former situation, although the adhesion remains. The wound is recommended by some oculists to be enlarged, which is improper; by others, the iris to be stimulated to retire into the eye by exposing the eye to a vivid light, a practice still more improper. Besides the iris being pro truded, the investing layer of the cornea is occa sionally forced out filled with the aqueous humour in the form of a transparent vesicle, and termed by Janin prolapsus of this tunic, in which formation of this disease he is joined by Peltier, Guerin, Des cemet, Demours and Veitch; this is considered by Scarpa to be the hyloid membrane of the vitre ous humour; while Beer and Travers conceive it to be the innermost lamella of the cornea, the for mer naming it ceratocele. We are disposed to consider Janin in the right. The symptoms and treatment of this protrusion are the same as in pro lapsus iridis. The choroid coat has also been pro truded through the sclerotic near its junction with the cornea, in consequence of violent ophthalmia producing an abscess at that point. This is to be treated in the same manner as the last.