Complete Text (Part 2)

the eye. 4. Circum-corneal redness. 5. Corneal opacity gray with possibly a yellow centre. 6 Edge of opacity not sharply DEFINED. 7. Corneal surface smooth, with loss of lustre over abscess. (No loss of substance.) 8. Blood-vessels may extend to abscess. Pus may penetrate to the anterior chamber and gravitate to its bottom (hypopyon)^ or abscess may rupture externally and leave an ulcer, and in a few cases it separates the layers of the cornea and gravitates between them (onyx). Treatment. Attention to the general health, Hot fomentation for a few moments several times a day. Atropine. If abscess is large and increasing in size, an incision may be indicated. Ulcer of the Cornea. 1. Vision may or may not be im- paired. 2. Pain usually severe ; may be absent. 3. Bright light usually irritates the eye. 4. Circum-corneal redness. 5. Corneal opacity, a yellow-gray de- pression in cornea. 6. Edge of ulcer clean-cut or undermined. 7. Corneal surface excavated (loss of substance) with sharp- cut or undermined edges and loss of lustre. 8. Blood-vessels, one or two, usually penetrate to ulcer after a few days. ^^^^^^^^H H ^^^M^^^SfOTndcd with Abscess F Cornea, Interstitial Keratitis. Hypopyon. Abscess of Cornea. 1. Vision impaired if hypopyim is :. Vision depends on site of abscess. large. 2. Pain of hypopyon, /i/- if, slighl or 2. Pain usually ihghl. 3- Light may be faiily well borne. 3. Light may be well borne. 4- CirCQ ID -corneal injection due lo A- Circum-corneal injection may be other causes. slight. 5- Opacity due to pus in anterjur 5- Corneal opacity due to pus be- CHAMBER, ONE YELLOW MAW tween THE LAVERS or in THE 6. Opacity always below and assumes the korm of the '■ "T^^iiFE'EvT" CHAMBER. H the hypopyon is noTchInge''its'positio'n.'"'^^ sufficiently fluid its upper margin is Bat or horiiontal and it may CHANGE ITS POSITION BY AS- TURE, OR CHANGING THE POSI- 7. Opacity yellow, cirenmscribed. 7. Opacity yellow centre, gray edges. and not always well defined. 8. Always a result of some othei dis- 3, Complication following a poor ease, as abscess of the cornea, iritis, etc. general condition, injuries, etc. Trealrneat. If pus is not absorbed in a reason- able length of time, open the lowest portion of ant. chamber and evacuate ^m __^J 14 ULCER OF CORNEA. May be confounded with Abscess of Cornea, Opacity of Cornea, Inter- stitial Keratitis. Sloughing Ulcer of Coraea. 1 . Vision may not be impaired unless ulcer involves centre of cornea. 2. Pain severe, often referred to brow and temple ; may be absent. 3. A dread or intolerance of light (photophobia) in most cases. 4. I'ircum-corncal redness, oedema of conjunctiva (chemosis), and Mwelling of lids in severe cases. 5. Corneal lustre lost in and around the excavated ulcer. U. I'mneal opacity is a yellow-gray. 7. Ul.CKK IS DEPRESSED OR EX- CAVATED, OFTEN COVERS CON- SI DKHAHI.E SURFACE, AND IS SHALLOW. Tendency to SPRKAD or CREEP ALONG THE SIIUIA<K OR AROUND THE EDGE OK t OKNKA, often called '* ser~ pii^inous** or " creeping ulcer,"* 8. Edges are usually undermined. (Continued Perforating Ulcer of Cornea. 1. Vision usually impaired, as ulcer is usually central. 2. Pain often severe ; may be absent. 3. A dread or intolerance of light in most cases. 4. Little if any circum-comeal red- ness. 5. Corneal lustre lost at edge of ulcer. 6. Corneal opacity is gray. 7. Ulcer is deep and of small AREA. Tendency to ulcerate deeper, and not infrequently in spite of all treatment it perforates to the anterior CHAMBER CAUSING ^^ fistula of the cornea y At other times it is arrested when it has reached Descemets mem- brane, and intra-ocular pressure may push the membrane for- ward through the opening ( hernia anmta) or (keratocele). 8. Edges sharp, dean-cut. as if punched out, on p. 15.) 1 ULCEK OF CORNEA. '^ 1 ' 9. The whole comea may ulcerate <). Comea may be perforated, ant. ^| and hypopyon, iritis, irido- chamber empties, iris comes in ^H cyclitis, panophthalmitis, and contact with cornea and becomes ^H phthisis bulbi follow. attached to it at the site of ulcei ^| (anttrior syiteehiaj. ^H Treatment. ^H Attention to the geoeral health. ^^1 Ac. boric sol. (gr. xii.-Si,), or ^^^^H Hg-bi-chlor. spray (1-5000} q. 3 h. ^^^^^1 Curetting and then rubbing with ^^^^^^H ung, hg. ox. fla. (er. xvi.-gi.). ^^^^^1 Actual tautery. Atropine in some cases. Opacitj of the Cornea. Cornea. I. Vision not impftired if ulcer is 1, Vision not impaired if opacity is near tnai^n af cornea. not central. 2. Pain slight or none. 2. Pain none. 3. Light may be well borne. 3. Light does not irritate the eye. 4. ClHCUM-CORNEAL REDNESS. 4, Sclerotic clear, white. 5. A VKLIOW-GEAV DEPRESSION JN 5, Cobne smooth, shining CORNEA (loss of substance). WHITE, OR GRAY. 6. Corneal lustre lost in and around 6. Corneal lustre not usually broken. the depressed ulcer. 7. Blood-vessels may extend to ^. No BLOOD-VESSELS SBKN ON OR a. May have had previous eye 8. History of previous eye disease. trouble. 9. Duration may have been days or 9. Duration months or years. weeks. 10. If ulcercovered considerable area, 10. Opacity crowns cornea] staphy- intra-ocular pressure may cause loma. the weakened cornea to bulge forward (anteal staphyloma J. I .fl 14 May Y>e c*» 2. Pai" 3. A ^^ 4. Cir C« 6. <^ "■• ■ 2 3 •: '■- M III.. '. ^-i Xcff J.»"""-" INTERSTITIAL KERATITIS (Continued). 17 _ ^ Corneal haziness due to dif- fuse POINTS OR SPECKS IN corneal substance. 2.7 Corneal opacity due to points ^. OR specks of infiltration in THE corneal substance, these coalesce and form THE * * ground-glass appearance ^ 8. Corneal surface smooth but lustreless. 9. Corneal surface above (and some- times below) is often a mottled red color (salmon patch) ^ due TO numerous fine BLOOD- VESSELS EXTENDING INTO THE SUBSTANCE OF THE CORNEA. 10. Iritis occasionally complicates. • II. Fundus seen imperfectly or not at all. 12. Corneal opacity often obstructs all red reflex as seen with the ophthalmoscope. 13. Usually affects both preceding the other. 14. Hereditary syphilis. 15. Peg or notched teeth. Treatment. Atropine and blue glasses. Mixed treatment, or hg. oleat. rub- bed under arms. Tonics. 6. Cornea clear except at phlyc- tenules. 7. Corneal opacity limited to the one or more small spots. 8. Phylctenules elevated, lus- tre OF the surrounding cornea retained. 9. Blood-vessels may extend to THE phlyctenules ; they are ALWAYS more SUPERFICIAL AND LARGER. 10. Iritis none. 11. Fundus seen perfectly if phlyc- tenule is not central. 12. Corneal opacity never completely obstructs red reflex. eyes, one 13. May affect both eyes. 14. No syphilitic history. 15. Teeth regular. i8 INTERSTITIAL KERATITIS (Continued). Interstitial Keratitis. 1. Vision impaired. 2. Pain increases as the cornea is involved. 3. Photophobia, lachrymation, and blepharospasm. 4. Circum-corneal injection. 5. Conjunctivitis none. 6. Corneal haziness due to points or specks in corneal substance. 7. Corneal opacity has the ' ground-glass " appearance and in it are seen points or specks where the opacity is more dense. 8. Corneal opacity diffuse. 9. Corneal surface smooth but lustre- less. 10. Corneal opacity white or GRAY. 11. Numerous fine blood-vessels MAY penetrate CORNEAL SUB- STANCE. 12. Iritis occasionally complicates. 13. Fundus seen imperfectly or not at all. 14. Corneal opacity obstructs the red reflex. 15. Usually attacks both eyes, one eye affected first. 16. Hereditary syphilis. 17. Peg or notched teeth. 18. No history of traumatism. Abscess of the Cornea. 1. Vision depends on site of abscess. 2. Pain usually slight. 3. Photophobia little or none. 4. Circum-corneal injection. 5. Conjunctivitis rare. 6. Corneal haziness due to infil- tration between layers of cornea. 7., Corneal opacity due to pus between the layers of, or in the corneal tissues. 8. Corneal opacity more circum- scribed. 9. Corneal surface smooth ; lustre lost over the site of abscess. 10. Corneal opacity yellow-gray. 11. Isolated blood-vessels may PENETRATE TO THE ABSCESS. 12. Iritis frequently complicates. 13. Fundus seen through clear cornea by the side of abscess. 14. Red reflex rarely all obstructed. 15. One eye. 16. No hereditary syphilis. 17. Teeth regular. 18. May have history of traumatism or some disease preceding. INTERSTITIAL KERATITIS (Comtinued). ig Interstitial Keratitis. Ulcer of the Comes. 1. Vision impaired. 1. Vision depends on site of ulcer. 2. Pain may or may not be severe ; 2. Pain may or may not be severe. volved. 3- Fholophobia, lachrymal ion, and 3, Photophobia, and usually lacbry- blepharospasm. 4. Circum-corneal injection. 4. Circum-comeal injection if ulcer is active (acute). S. Conjunctivitis none. 5. Conjtmctivitis. unless ulcer k in- dolent (chronic). 6. Corneal orAciTV has the 6. Corneal opacity is a DtsTtNCT ■' greund-glass " APPEARANCE, PATCH OK patches, SUR- SPECKS WHERE THE OPACITY IS COR^A^ "^ HEALTHY CLEAR MORE DENSE. 7. Corneal surface smooth but 7. Corneal surface excavated LUSTRELESS. (loss of substance); edges of 8 Cornell opacetv wkite.cray S. CoRNEAl^OPAaTrraLw'v-TRAV (infiltration). ■ (pus). 9. Numerous fine blood-vesski.s MAY PENETRATE CORNEA. MAY PENETRATE TO THE ULCER. 10. Iritis occasionally complicates. 10, Iritis rare. II. Fundus seen imperfectly, if seen It. Fundus seen through the healthy at all. cornea by the side of ulcer. 12. Corneal opacity often obstructs 12. Red reflex seen through the all red reflex. healthy cornea by the side of ulcer. 13. UsuaUy attacks both eyes; one 13. One eye affected. eye affected first. 14. Hereditary syphilis. 14. No hereditary syphilis. 15. Peg or notched teeth. 15. Teeth regular. I ^ ..; -1 "J .1- .■: -K!i ttrreciiv. • I I .11 ii .- ; .r- : ,i,,t 1 .iiaiiy 'ibstnici ...I . ri..« • I I.. . ■ •' ■..■•: \ ■! r:iuiiia.L:>!i •■■ '■•f!:'..^.a:::T;^. W PUNCTATE KERATITIS (Desremitis). 21 | U May be confounded with I -iTERSTITIAL KERATITIS. 1 Punctate Keratitis. Interstitial Keratitis. 1 I. Vision impaired but lilUe, I, Vision impaired. 1 =. Paionpne. 3. Pain may or may not be severe. 1 3. BHght light may not irritate the 3. A dread or intolerance of light. 1 eye. 4. Circum-coraeal injection may be 4. Circum-comeal injection marked. slight. g. Corneal opacity due to DEPOSITS 5. Corneal opacity due to diffuse OF THE CORNEA (" Desctmets TIOS IN THE CORNEAL SUB- membran.-). STANCE, and as seen by oblique These deposits when seen with LIGHT HAVE A LIGHT GRAY the ophthalmoscope look like COLOR. ON THE CORNEA, Aul if seeK BY OBLIQUE LIGHT THEV APPEAR GRAYISH WHITE. 6, Corneal surface smooth and with 6. Corneal surface smooth but LUS- 7. Corneal opacity never dense, seen 7. Corneal opacity increases as disease most on lower part of comea. advances. 8. Red reflex always seen when ex- 8. Red reflex obstructed, or lost by dense opacity. sfope. 9. If not due to hereditaiy syphilis, it 9, HerediUry syphilis. is always associated with deeper Triaimcnl, ^^^^^ Mixed Ireatmenl ; or, Treat the cause. i 22 OPACITIES OF THE CORNEA. May be confounded with Cataract, Ulcer of Cornea, Abscess of Cornea, Interstitial Keratitis. Phlyctenular Keratitis, Arcus Senilis. Opacity of the Cornea. 1. Vision impaired according to size and location of opacity. 2. Pain none. 3. Light does not affect the eye. 4. No circum-corneal redness. 5. Corneal opacities one or more ; if dense, usually circumscribed, white, and glistening; and if of considerable size is called ^ leucoma^' ; if iris is adherent to corneal opacity, it is called ^^ leucoma adherens y If the opacity is thin, it appears of a grayish color, is usually diffuse or at least not circumscribed, and is called a ** nebula J'^ 6. No blood-vessels on or in cornea. 7. No inflammatory symptoms. 8. Previous history of eye trouble, g. One or both eyes. 10. No syphilitic history. 11. Teeth normal. TreaimenU If case is recent, dust calomel on the opacity, or use the ung. hg. ox. fla. (gr. xii.- J i.). Interstitial Keratitis. 1. Vision always impaired. 2. Pain slight; increases as cor- nea IS involved. 3. A dread or intolerance of light. 4. Circum-corneal injection. 5 . Corneal opacity of * * groand^lass " appearance and not circum- scribed. 6. Fine blood-vessels may pene- trate SUBSTANCE OF CORNEA. 7. Inflammatory symptoms soon DEVELOP. 8. May or may not have had previous eye trouble. 9. Usually both eyes affected after a time. 10. Hereditary syphilis. 11. Teeth peg or notched. OPACITIES OF THK CORNE.V (Contimjed). 23 Opacity of the Cornea. Abscess or the Cornea. I. Vision impaired according; to Che I. Vision impau-ed according to the siie and location of (he opacily. size and location of nbscess. 3. No pain or photophobia. 3. No ci.cum-CQraeal redness. 3. Circum-comeal injection may be absent. 4. Corneal opacity smooth, shin- 4. Corneal opacity dull yellow- 5. Corneal lustre may not be broken. 5. Cornell lustre lost over abscess. 6. Duration several weeks. 6. Duration a fbw days. 7. Previous history of eye disease. 7. No previous history of eye trouble. Arcus Senilis. Opacity of the Cornea. I, Rare before fifty years of age. I. Any age. 2. Opacity symmetrical in each 2. Usually one EYE AND NOT regu- sup'ahdinf borders of cor- lar. 3. Noprevioushistoryoteyelronble. 3. Previous history of eye disease. Triatmcnl. None. Conical Cornea. Corneal Staphyloma. 1. Pain and photophobia none. I. Pain and photophobia none. a. CORN-EA CLEAR. 2. Cornea opaque, OPACITY USUAL- STAPrLO«AI.r„'aTTHEWHo!I 3. Cornea is conical. 3. A portion of cornea is bulging. 4. Ant. chamber deep. 4. Am. chamber deep. 5. Vision very poor. 5. Vision very poor or lost. 6. Near-sighted, improved a lillle by 6. Vision not usually improved by concave glasses. glasses. 7. No previous history of painful eye 7. Previous history of painful eye disease, disease. Trealment. None. Trealment. None, or operation. IRITIS. as Conjunctivitis. Phlyctenular Conjunctivitis, Keratitis, Episcleritis, Serous Iritis. Iritis. Phljctenular Conjunctivitis. I. Vision impaired, a. Pain may be absent, but is usually severe, eitending to nose, brow, z. Pain, if a»y, is conlined lo ihe eyeball. 3. Bright liehl Hsaally irrilales Ihe eye (ph^t^hcbia). cold in the nose " on Ihe affecfed 3. Bright light rarely irritates the eyes sufficient lo cause spasm of the orbicularis (blepharospasm). 4. L-aehrymation in some cases. Bide. S. Secretion not sticky. 5. Secretion sticky. 6. No RLEVATfON ON CONJUNCTIVA. 6. Yellow-orav elevation on a reudeheii patch of conjunc- 7. (Edema of lids, and conjunctiva 7. CEdema rare. (chemosis), not infrequent in becomcsaf[ected<'(rH/e-mVjV. 9. Phlyctenular keratitis may com- plicate. 9. ClRCUM-CORNEAL INJECTION, 9. No CIRCUM-CORNEAL INJECTION. 10. EyebaJJ i^ painful lo touch. 11. Aqueous usually tuhhid or 10. Eyeball not painful lo touch. 11. AQUROUS CLEAR. DOES not RESPUND TO BRIGHT AflLV CONTRACTED fmyasisj. """■ (Continue d on p. a6.) 26 IRITIS (Continued). 13. Iris discolored, and usually adherent to the crystal- LINE LENS (post, synechia). The attachment may be com- plete all around the free edge of iris (exclusion of pupil )^ or exudation may bloek the whole pupil (occlusion of pupil), 14. Tension may be increased (T. +). Atropine instilled CAUSES DILATATION OF THE PUPIL (mydriasis). The DILA- TATION IS USUALLY irregular, showing the adhesions between the iris and lens (post, syne- chiae) ; IF ANY OF these ad- hesions ARE broken, a deposit OF PIGMENT REMAINS ON THE LENS AND MARKS THE PLACE OF FORMER ATTACHMENT. 15. Fundus seen imperfectly. 16. Disease of adults. If ciliary body is involved it is called irido-cyclitis (see irido- cyclitis, page 31). If choroid is involved it is called irido-choroiditis (see choroiditis, page 56-57). Treatment, 13. Iris not discolored. 14. Tension never increased. Atropine dilates the pupil regularly. no post. syne- CHIiB. 15. Fundus seen perfectly. 16. Disease of children, rarely seen in adults. 1. Atropine (gr. ii.- J i.). 2. Absolute rest of eye. 3. Colored glasses. 4. Leech to temple to relieve pain. 5. Hot-water fomentation for 5 m. q. 2 h. 6. Operation of iridectomy is indicated in a few rare cases. Anti syphilitic (* one half of the 7. Constitutional treatment. cases"). Anti rheumatic. Anti malarial. IRITIS (Continued). 27 Iritis. 1. Vision impaired' by exudation in pupil. 2. Pain often severe, extending to nose, brow, and temple. 3. Pain most at night. 4. Bright light irritates the eye. 5. Lachrymation usually profuse with *' cold in the nose" on the affected side. 6. Secretion not sticky. 7. Odema of conjunctiva (chemosis) not infrequent. 8. CiRCUM- CORNEAL INJECTION, DEEP. 9. Usually one eye affected. 10. Tension often increased. 11. Globe painful to touch, in severe cases. 12. Pupil sluggish or stationary, and contracted. 13. Iris discolored. 14. Aqueous ' MUDDY." 15. Exudation may or may not BLOCK the pupil. 16. Post, synechi^e seen in most OF THE old cases. 17. Pigment deposits may be seen on lens. 18. Fundus seen imperfectly or not at all, on account of exudation in pupil. 19. Disease of adults. Conjunctivitis. 1. Vision may be impaired by mucus on the cornea. 2. Pain, itching, burning, or smart- ing, and confined to eyeball. 3. Pain less at night. 4. Bright light usually irritates eyes. 5 . Lachrymation may be pronounced. 6. Secretion sticky with scales dried on edges of lids ; or, muco-purulent and copious. 7. Chemosis not infrequent, and in purulent cases may be marked. 8. Whole conjunctiva red ; in- jection SUPERFICIAL. 9. Usually both eyes affected. 10. Tension normal. 11. Globe not painful to touch. 12. Pupil normal. 13. Iris normal. 14. Aqueous normal. 15. Pupil clear. 16. Post. sYNECHii« none. 17., Crystalline lens clear. 18. Fundus may be seen imperfectly on account of mucus on the cornea. 19. Disease of all ages. 28 IRITIS (Continued). Iritis. 1. Vision impaired. 2. Pain may extend to nose, brow, and temple. 3. Bright light irritates the EYE. 4. Lachrymation profuse, mod- erate, OR POSSIBLY none. 5. CiRCUM-CORNEAL INJECTION. 6. No ELEVATION ON CONJUNCTIVA. 7. Globe may be painful to touch. 8. Tension often increased. 9. Pupil sluggish or stationary and usually contracted. 10. Iris discolored. 11. Aqueous often ** muddy.' 12. Exudation may or