The treatment of this form of ophthalmia must be active in propor tion to the rapidity of its destructive effects when unchecked. Bleeding, both general and local, may be employed, and purgatives and the various other antiphlogistie means should be administered, as in the treatment of any other acute inflammation. When the inflamma tion is somewhat checked, the greatest benefit is derived from the application of powerful astringents to the eye, a mode of treatment which may be adopted with equal advantage in these and in the severer cases of catarrhal ophthalmia. The best material is'a solution of from two to four grains of lunar caustic:to the ounce of water ; of which one or two drops should be let fall into the eyes once or twice a day, according to the severity of the inflammation. This remedy produces considerable pain for a short time after its application, but is generally productive of the most beneficial results.
Oue of the most common effects of the purulent ophthalmia, when prevented by active treatment from producing its worst results, is a thickening and roughness of the inflamed lining of the eyelids, to which the name of granular conjunctiva is given. The affected sur face looks like that of a florid ulcer, and the friction of its irregularities upon the front of the eye-ball keeps up a constant slight inflammation, of which the common consequence is a complete opacity of the cornea. The granular conjunctiva may be treated by the application of power ful astringents or caustics ; the moat efficient, though a severe remedy, is to touch the rough surface with a piece of sulphate of copper, taking care after its application that no considerable portion of it comes in contact with the front of the eye.
Infants of three or four days old are often the subjects of a very severe form of inflammation of the conjunctiva, to which the name of the ophthalmia of new-born children has been given. Its course and effects are similar to those just described, and it sometimes produces entire destruction of the eye before it attracts proper attention, for the eyelids are commonly agglutinated together by the discharge, and are so swollen that they obscure the front of the eye. Its severest form may be suspected when the upper eyelid is much swollen and is exter nally of a bright red colour. The treatment must he similar in its principles to that for the corresponding disease in the adult ; in severe cases a leech should be applied to the temples, and purgatives should be administered in all ; and when the inflammation is somewhat relieved, or from the first, if it be not very severe, astringent lotions should be dropped into the eyes. The best form is composed of from two to ten grains of alum in an ounce of water, beginning with the smaller quantity and gradually increasing the strength.
Another form of inflammation of the conjunctiva is that called strumous ophthalmia. It occurs in children of scrofulous habit, and is chiefly remarkable for the extreme intolerance of light by which it is accompanied. The patient cannot be induced to open the eyes, or even to raise them to the light, but keeps his head down, with the eyelids pressed together upon the ball of the eye, and carefully covered with his hands or his clothes. The degree of inflammation is by no means proportionate to the severity of this symptom ; the con junctiva is usually only a little reddened, but in many cases little pustular elevations form upon the edges of the cornea. The treat ment of these cases should be chiefly that adapted for the constitutional disorder on which their peculiarities depend. [Scnoruts.] Pure air and exercise, mild aperients and tonics, and especially bark, iodine, and iron should be administered, and the general health should be carefully attended to-. In the earlier stages a few leeches may be applied, but afterwards eounter-irritation by blisters placed behind the ears, or by tartar-emetic ointment rubbed on the same parts, is most useful. Slightly astringent lotions may also be applied to the eyes, and the ulcers or little pustules on the cornea touched with the solid nitrate of silver (lunar caustic).
The characters of inflammation of the sclerotic.% .are very different from those of inflammation of the conjunctiva, but very often the two affections are coincident, so that the appearances belonging to each are confounded. In selerotitis, as this form of ophthalmia is sometimes called, the redness of the eye has a rose-pink or violet tinge, rather than the scarlet hue which is seen in the preceding form ; for the dis tended vessels are fewer and smaller, and are to a certain extent obscured by the conjunctiva, beneath which they lie. This redness is most intense in a zone around the cornea, at which the enlarged vessels are concentrated like rays, and from whose outer border the redness diminishes in brightness till it is nearly lost at the angles of the eye ; and by this circumstance selerotitia is further distinguished from in flammation of the conjunctiva, in which the redness increases with the distance from the cornea. In selerotitis there is always considerable pain of a dull heavy kind, which often extends all round the orbit, or over the forehead and head, and is accompanied by intolerance of light and a profuse secretion, not of mucus or pus, as iu the preceding cases, but of hot tears. The pain is very often aggravated in the evening, or throughout the night.