The main essentials for patients suffering from granular conjunctivitis are cleanliness, fresh air, and clean clothes. In order to prevent the in fection of others, patients should have their own toilet-articles, particularly towels. At the earliest symptoms of infection, cooling applications and lotions are indicated, which may he followed later by cauterisation of the conjunctiva with nitrate of silver or sulphate of copper. In obstinate cases it may be found necessary to resort to an operation by which the nodules should be removed as rapidly and completely as possible. The troublesome inversion of the lids can likewise be corrected only by operative means.
Purulent Conjunctivitis is an acute conjunctivitis with the formation of serum, fibrine, and pus. It is most frequent in the new-born. A sup purative inflammation of the mucous membrane of ,the eve in the new-born infant results from an infection by secretions which are present in the genital passages of the mother, and it can usually be proved that the latter had been afflicted with a gonorrhoeal discharge. The conjunctivitis begins, two or three days after birth, with a profuse, thick, yellow, purulent discharge, and a swelling of the mucous membrane of the eyelids. For preventing the disease, the method devised by CT& is now almost universally employed. See EYE, CARE OF, 1 a purulent discharge is observed even after the use of this treatment, medical aid should at once be sought. Very often it is possible to save the eye, although it may require weeks of earnest and devoted attention. The condition must be looked upon as an extremely dangerous one, and any prediction regarding its course must he made with caution. In very severe cases the process may go on to ulceration of the cornea and complete loss of sight. About ten per cent. of all cases of blindness due to inflammation are usually found to have occurred in children who were not given the benefit of medical treatment or who received such treatment at a late stage of the disease.
In adults the disease may be caused by accidental inoculation or by lack of cleanliness, where a gonorrheal discharge from the urethra is present. As a general rule, the course of the disease in adults is even more virulent than in new-born infants. The disease manifests itself, within twelve hours after infection, by the excretion of a profuse purulent discharge, which is at first watery and later creamy, and also by an intense swelling of the lining mucous membranes. Here, as in the infantile type, the danger lies
in the formation of conical ulcers, and the prognosis depends upon the amount of swelling of the conjunctiva and upon the time at which the patient comes under treatment. If no complications occur, the disease lasts about three weeks in children, and six in adults. It is advisable for adult patients to go to a hospital or sanatorium if possible, on account of the numerous chances which they offer of infecting their surroundings. The affected eve must be irrigated every hour or even every few minutes, day and night, a task which had best be assigned to a skilled nurse. The eyelids arc separated with the second and third fingers of the left hand ; as much of the secretion as possible is removed by gentle manipulations toward the inner angle of the eye ; and irrigation is done with a wad of cotton saturated with the prescribed solution or with boiled water, and held between the fingers of the right hand. The cotton swabs should be burned immediately after use.
The healthy eve should be covered with a contrivance consisting of a \ va t ch -g I a ss held in place by adhesive plaister (see Fig. 137) in order to protect it from the purulent infectious secretion. Ice poultices, kept on continuously day and night, are very efficacious, hut they must never he placed directly on the lids, a protecting compress made of several folds of a thin handkerchief being interposed between them. The necessary medi cinal treatment can be undertaken only by the physician or by a specialist. Every patient afflicted with a gonorrhoeal discharge should he cautioned to practise extreme cleanliness, and should be informed of the dangers attendant upon infection of the eves.
Diseases of the Cornea.—Acute affections of the cornea are always accompanied with marked redness of the eyes, with pains, photophobia, and secretion of tears. A characteristic sign of an inflammation of the cornea is the appearance of a sharply defined or more extended cloudiness of this otherwise transparent membrane. The otherwise reflecting surface of the cornea becomes opaque and uneven, or smooth, according to whether the affection is situated in its more superficial layers, or in its deeper ones.