Part 45

BLEPHARITIS MARGINALIS.--This means a chronic inflammation of the margin or edge of the eyelids accompanied by congestion, thickening and ulceration of the parts and the formation of scales and crusts.

Causes.--The underlying cause is often an inflammation of the conjunctiva where the proper care is not taken in cleansing the roots of the lashes when the discharge collects.

Other causes are keeping late hours, smoke and dust.

Symptoms.--The red swelling along the roots of the lashes is often the only symptom. This comes and goes at the least excuse, such as eye strain, late hours, dust and wind. Scales and dust form in the severe forms, of the disease. It is most common in children, extends over many years and may finally result in the loss of the lashes, with the edge of the lid, thickened, reddened and turned out.

Treatment.--This is tedious. Fit glasses if there is eye strain, reform the mode of life and attend to any constitutional disease that may tend to make it worse.

Local treatment.--Keep the parts thoroughly clean. The edges of the lids should be washed carefully with soap and warm water or mild solution of borax or soda until the crusts are all cleaned off and then use at night an ointment composed of the following ingredients:

Yellow oxide of Mercury 2-1/2 grains Petrolatum 2-1/2 drams

Mix and make an ointment and rub on the edge of the lids every night, first cleaning them. The conjunctivitis must be cured.

STYE (HORDEOLUM).--This is a swelling beginning in a gland or glands at the edge of the lid and pus forms finally.

Causes.--Inflammation of the edge of the lid, stomach trouble, run down condition, poorly fitted glasses, when glasses should be worn to relieve the eye strain.

Symptoms.--Itching and burning feeling followed by a red swollen area (lump) at the edge of the lid. Later it comes to a point and discharges.

Cause.--Styes usually run their course in a few days or a week; another frequently follows. When it does not reach the pus stage, it often leaves a hard swelling (blind stye).

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MOTHER'S REMEDY. 1. Stye.--Home Method to Kill.--"To hasten the pointing of a stye apply hot compresses for fifteen minutes every two hours. As ill health may be the cause, a tonic may be needed; glasses properly fitted should be worn and a boric acid eyewash used until long after the stye has disappeared." Applying hot compresses will relieve the congestion and gives much relief. Ill health produces a poor circulation of the blood and a good tonic will be found beneficial. Styes are frequently produced by need of glasses.

Treatment.--Treat the stomach and system if necessary. Ice or cold cloths against the stye may abort it. If it goes on, hot fomentations will hasten it. It should then be opened up and scraped out. It will soon heal then and will not leave a lump.

ACUTE CATARRHAL CONJUNCTIVITIS (Pink Eye).--Definition.--This is an acute inflammation of the mucous membranes under the eyelids, and there is congestion (too much blood), swelling and a discharge of mucus and pus.

Causes.--Exposure to wind, dust, smoke, or irritating foreign substance, cinder, sand, etc. It may occur in epidemic form and then is contagious and is called "pink eye."

Symptoms.--The lids appear stiff to the patient, the light causes discomfort and the patient fears it. Burning feeling as if there was some dirt, etc., under the lid, not much pain, but discomfort especially in the evening. The lids look swollen and red. The conjunctiva on the cornea is reddened and that on the lid is thickened, reddened and rough. The discharge collects at the roots of the lashes or lies on the conjunctiva. The lids are stuck together in the morning. The sight is slightly affected by the discharge on the cornea, which is otherwise clear. Sometimes little (minute) ulcerations are seen.

Course.--It may run into a chronic conjunctivitis. One eye is usually attacked a few days before the other. The first stage lasts a few hours or a day and then the discharge follows which may last a few days or a week or more.

Treatment.--First: Use gauze or cotton and dip in ice or cold water and apply to the eyelids. A wash of hot water can be used to cleanse the eye or ten to sixty grains (one teaspoonful) of boric acid to an ounce of water can be used as a wash also.

The following remedies are good in combination as follows:

Alum 3 grains Sulphate of Zinc 2 grains Distilled Water 1 ounce

Mix and drop one drop into the eye two or three times daily. A weak solution of tea can be used also as a wash. Anoint the lids at night with white (tube) vaselin.

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INFLAMMATION OF THE EYE OF NEWLY BORN (OPHTHALMIA NEONATORUM).--This is a severe inflammation of the conjunctiva in the new born infant, usually due to a discharge from the mother and it is characterized by a discharge of pus.

Causes.--Mild cases may come from a less violent form of infection from the mother's discharge from the vagina, or from outside causes. The majority of the severe cases is due to a poison (the gonococcus infection).

Symptoms.--The first symptoms are swelling and redness, usually of both eyes, usually occurring a few days after birth. Soon the discharge appears and shortly becomes creamy pus, which runs from the eyes when the swollen lids are partly opened. As the disease continues to advance, the membrane of the lid is thickened, red and velvety looking and the conjunctiva (membrane) in the eye is swollen, puffy and watery.

The disease may last from two to six weeks or longer.

If the pus is not cleaned from the eye, the cornea may look dim and ulcers may appear. If the ulcer eats through the cornea the iris is apt to be caught in the opening and in the scar resulting from the ulcer. The cornea may later bulge and protrude or the disease may involve the whole eye in an inflammation which may destroy it.

The result generally depends upon how soon treatment is begun. If attended to early the great majority of cases recover. It is serious to neglect early treatment for this disease. It causes a great many cases of blindness and generally the cases are neglected too long. Treatment must begin before the disease begins. Immediately at the birth of the child, when if there is any poison in the eye due to a discharge in the mother's vagina, it can be immediately cleansed.

TREATMENT PREVENTIVE. What to do first.--As soon as the child is born and before its eyes are opened the discharges should be carefully wiped away from the lids with small squares of cotton or gauze, pieces wrung out of a weak solution, three per cent (three parts to one hundred of warm, boiled, water) of boric acid. The eyes should not be exposed to the light. At the first both the eyes should be bathed and the same piece of linen should not be used for both eyes.

As soon as any redness appears the eye should be frequently bathed with this warm, weak solution of boric acid and sometimes cold compresses should be used by taking squares of folded gauze or masses of absorbent cotton. Take them cold from a block of ice and lay them over the eyes, and keep constantly changing to keep them cold. This relieves the congestion and prevents a great amount of blood from flowing and settling (congestion) there. When pus appears in the eye it should be cleansed every half hour at least. You can do this by letting the solution run over it from a medicine dropper. After being allowed to trickle from the outer to the inner angle (corner) of the eye, it will then run down beside the nose and can be caught in a piece of absorbent cotton or sponge. If there is a great amount of pus in the eye, the eye may have to be washed out in this manner, every fifteen minutes, day and night, so that the cornea will be kept clean. If this must be done a small fountain syringe with a glass tube (eye-dropper) attached will cause a steady flow of the solution. The boric acid can be increased to five or ten grains to the ounce of water. If only one eye is diseased the other eye may be covered.

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All cloths, etc., should be burned at once and the basin which has held them, filled with carbolic acid solution of the strength of one part acid to twenty parts water. The nurse's hands should be thoroughly scrubbed in hot water and soap and disinfected in the same strength of carbolic acid solution, as the disease is very contagious and dangerous to adults. An attendant should not touch her face or hair with her hands unless they have been washed quite clean. The conjunctiva should be brushed with a solution of nitrate of silver of two per cent strength (two parts to one hundred of distilled water) and then neutralized with a salt solution, not strong enough to burn.

When the cornea is diseased one per cent solution of atropine may be necessary once or twice a day.

Caution.--In the cities this disease is disastrous in its results to the sight of babies. This is due to the want of necessary care. Persons who must be with the patient should be very careful not to get any of the discharge upon their clothes or person, as it is very contagious.

ULCER OF THE CORNEA.--Causes.--Poor general health is an underlying cause or the cornea itself may be poorly nourished. Ulcers are common among the poor classes. They often begin through a rubbing of the cornea by a foreign body. They also come from diseases of the conjunctiva. Weakly babies are easily affected.

Symptoms.--The light hurts the patient; there is a feeling of something in the eye. When the ulcer is over the pupil the sight is impaired. The eyeball shows a ring of pink congestion about the cornea, with congestion of the conjunctiva. The form of the ulcer may be irregular, circular, etc.

Course.--The simple ulcers heal in a week or two. Infected ulcers may spread, or they may sink deeply into the substance of the cornea and eat through. The danger to the sight depends upon the kind and severity of the ulcer. There is apt to be more or less film over the eye for some time and if the ulcer eats through it may destroy the sight.

Treatment. Preventive.--When the cornea has been injured and there has been some rubbing off of its tissue (abrasion) mild antiseptic solution in the form of eye drops should be used. Boric acid, as much as will dissolve in warm, distilled water and some dropped in the eye three or four times a day. If there is a foreign body in the cornea, clean instruments should be used to remove it. The cocaine used to render the eye painless must be pure.

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General Treatment.--If the patient is "run down" the general system should be built up.

Local Treatment.--One to two per cent solution of Atropine should be put into the eye three to six times a day to keep the pupil dilated and prevent it from adhering to the cornea. Hot fomentations repeated according to the severity of the case and the amount of "easing" they give. A three per cent solution of boric acid should be used for cleansing purposes. The bowels should be regular. The patient should remain in one room.

FILM ON THE EYE PTERYGIUM.--This is a growth beginning near the inner or outer corner and extending with its point towards the center of the cornea.

Symptoms.--The patient only complains when it has advanced toward the center of the cornea and the vision is lessened or cut off. It occurs more often from the inner corner. It keeps growing for many years and may cease advancing at any time.

Treatment.--Surgical treatment is often necessary. Dr. Alling says: "Dissect off the growth from the cornea and sclera coats, leaving the base attached (toward the corner of the eye) and bury its point under the undermined conjunctiva below. If the growth is dissected off the cornea, which may readily be done, and then cut off (towards its base) it would recur."

IRITIS. (Inflammation of the Iris.)--This is an inflammation of the iris, characterized by congestion, small pupil and posterior synechia.

Causes.--It occurs in the second stage of syphilis, second to eighteenth month, from rheumatism, diabetes, gout, injury, and without any known cause (idiopathic).

Symptoms.--More or less severe pain in the eye, forehead and temple, worse in the night and early morning especially. There is fear of the light and the eyes water very much. The sight is affected and there may be some fever. On examination the lids are found swollen and red, the eyeball shows congestion in the cornea and ciliary body, with some congestion of the conjunctiva. The cornea looks hazy. The anterior surface of the iris looks muddy and does not look so fine and delicate. The pupil is small and the light does not make it contract readily. If atropine is put in the eye (one per cent solution) the pupil will not dilate regularly, because at different points the pupillary edge of the iris is held to the lens by an exudate that lightly holds it.

Course and Recovery.--The disease may occur at any age, but it is most common in children. It may last from one to six weeks.

Chances of recovery are good if treatment is begun early. There is a tendency to recurrence.

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MOTHER'S REMEDY.--1. Iritis.--Sensible Remedy for.--"Doctor the blood with sulphur and lard, a teaspoonful three times a day. Refrain from using the eyes. This disease is said to be brought on by rheumatic fever, and rheumatism is a disease of the blood." This is a very serious disease and a physician should be called.

Treatment. What to do first.--Confine the patient in a darkened room and if the attack is severe in bed.

Local Treatment.--Dry or moist heat should be applied, according to the ease they give. Leeches are good in severe cases placed near the outer corner of the eye. Atropine usually made of about the strength of two to four grains Atropine to an ounce of water; or one per cent (1 to 100) may be used, and it should be dropped into the eye from three to six times a day. The pupil must be dilated and kept so from the beginning to keep the adhesions from forming between the iris and lens. If too much is used the throat and tongue will feel dry, face will flush, and there will be dizziness and a rapid pulse. Stop it until that effect is gone and then cautiously use it again. The bowels should be kept open.

The diet should consist of milk to a great extent. Water of course can be taken freely. Soups, broths, gruels, etc., can be used if desired; but meats should be withheld for a time unless the patient runs down.

Caution.--If a person has any of the special symptoms above mentioned it would be prudent to begin treatment at once. The great danger is permanent adhesion of the iris to other parts, especially the lens, and the dilating and contracting power may be lost.

INJURIES OF THE IRIS.--Concussion of the eyeball may produce an irregular dilation of the pupil. This is due to paralysis of the sphincter muscle of the pupil, but it generally disappears. The edge of the pupil may be torn in the form of one or more rents, or the iris may be separated from its root at its circumference, leaving a clear space, or it may be entirely torn from its attachment.

Perforating wounds are accompanied by injury to the lens and other structures; when the cornea is wounded it is often complicated by falling of the lens. When a small foreign body passes through the cornea and iris a small opening may be seen. The greatest danger from wounds is due to infection and if it reaches the iris, it may produce violent iritis. If the lens is displaced or absent the iris being without support, will tremble with every movement of the eye. In some cataract operations, if there is a loss of the "Vitreous" body a part of the iris may be folded upon itself, thus enlarging the pupil in that point.

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CATARACT.--This is an opacity of the crystalline lens or its capsule. The lens is not clear and bright and keeps the light from going through it. Then it is called opaque.

SENILE CATARACT.--The vast majority of these cataracts are found after the age of fifty. They simply come without any known cause. Of course, injury can cause a cataract and it is then called traumatic cataract.

Symptoms of Senile (Old Age) Cataract.--Blurred vision, flashes and streaks of light, dark spots, double vision. There is no pain. Eye strain due to imperfect sight. Sometimes the first symptom is ability to read without glasses (second sight). This is due to the increased refractive power of the lens from swelling. The lens looks a little whitish through the pupil opening and looks more so as time goes on.

Course.--The progress is slow. It usually takes a number of years before it is "ripe" for operation. They may remain in the same condition sometimes. In this kind of cataract both eyes are affected sooner or later, although one eye may be fully matured before the other is much changed.

The result of an operation depends upon the condition of the eye. The eye should be free from evidence of disease. "The anterior chamber should be of normal depth. The pupil should react to light. There should be a homogeneous (all alike) white or gray opacity immediately back of the pupil, with no shadow from the edge of the pupil (except in cases of sclerosis, already mentioned). A candle carried on all sides of the patient while the eye is fixed, should be properly located by him. The tension of the eyeball should be normal."

The operation is very frequently done and it is very successful. The patient should be ready and willing to place himself in the charge of the operator and do as he says.

SYMPATHETIC INFLAMMATION OF THE EYE.--(Sympathetic Ophthalmia.)--A condition in which the healthy eye becomes the seat of a destructive inflammation transferred from the other eye which has been the subject of a similar inflammation usually following a perforating injury of the eyeball. The injured eye is called the exciting eye; the other, the sympathetic eye.

This is a rare disease, but it may occur when one eye is injured or diseased and on the first indication of trouble in the injured eye the other eye should be closely watched for symptoms of sympathetic trouble so that if can be removed.

Symptoms in the Exciting Eye.--This is more or less congested and painful; when pressure is made upon the upper lid, it shows tenderness. The tension is not as strong; the pupil may be blocked with an exudate.

In the Sympathizing Eye.--There is an inflammation involving the choroid, ciliary body and iris. There is pain, tenderness, small blocked pupil and sight is poor.

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Course.--It usually appears between the third week and the sixth month after the original injury. "The extreme limits are two weeks and twenty years." The sound eye is likely to be attacked when the exciting eye is in a state of active inflammation.

Treatment.--The "exciting eye" should be enucleated (taken out) before any signs of sympathetic inflammation appears in the healthy eye. If it has appeared, enucleation will be of no value; at all events if there is vision in the exciting eye, the operation should not be done then.

INFLAMMATION OF THE RETINA FROM BRIGHT'S DISEASE (Albuminuric Retinitis).--The retina is a very delicate structure and we are often able to diagnose Bright's disease from the peculiar effect it produces upon the retina.

Causes.--The cause is usually Bright's disease, (nephritis) and usually the chronic Interstitial variety. Pregnancy causes it sometimes. Interference of the vision, sight, is what the patient complains of. This may be very slight, when you consider the great changes occurring in the retina. Such patients are subject to attacks of temporary blindness of uremic origin. The vessels of the retina are swollen and tortuous. Bleeding and shining white patches are scattered through the back part of the eye and a peculiar arrangement of glistening white dots around the yellow spot. This disease shows itself late in Bright's disease and the patient is not likely to live more than two years after the appearance of this eye lesion.

Treatment.--It sometimes occurs during pregnancy. Then the question of inducing premature labor arises. There is no local treatment that can be of any use when it is caused by Bright's disease.

FITTING GLASSES.--This is done by lenses and prisms, etc.

Lens.--A lens is made of glass and prisms graded in strength, one surface curved, and has the power of refracting or changing the direction of the rays of light. A prism is wedge-shaped and bends rays of light towards its base. A great many people are troubled with their eyes, much more than years ago. We even see little children wearing glasses. It is unfortunate, but true, that even more children and grown people should wear them. Fitting glasses is an art in itself. It takes more ability to fit glasses well than it does to operate well. Poorly-fitted glasses are not only annoying to the wearer, but dangerous. Glasses rest the eyes, not tire them. When the eyes water and feel tired or strained, even after using them but little, glasses are needed. Headaches are frequently caused by the eye strain. When glasses are needed it does not pay to put off getting them and the person needing them should go to one competent to properly fit them. A great many eyes are hard to fit, and they need not only ability to fit them well, but time and attention must be given to fitting them properly.

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SQUINT OR STRABISMUS.--Both lines of sight are not directed towards the same object of fixation.

Internal or Convergent Squint.--Where one eye is turned inward toward the nose.

External or Divergent Squint.--One eye turns outward toward the temple. Squinting upward and downward are uncommon.

Causes of Convergent (Internal) Squint.--It generally appears between two and five years; at first periodically, later constantly. The patient is generally far-sighted.

Treatment.--Internal squint in very young children may be treated by covering the well eye and forcing the child to use the other. When the child is old enough, proper glasses should be worn. Operation can be done when needed and is generally successful.

External (Divergent) Squint.--This may appear at any age and is often associated with near-sightedness. An operation is necessary and the tendons on both sides must generally be cut and properly placed. Parents should always attend to a child who has this trouble. The operation is not difficult to perform and it will not only, as a rule, give the child good sight, but better looks. Parents who are able to have an operation or glasses fitted when needed, and who neglect their children, should be punished; they are guilty not only of neglect, but cruelty.

MOTHERS' REMEDIES. Inflammation of the Eye. 1. Chickweed a Relief for.-- "The juice of chickweed is good for inflammation of the eyes, when dropped into them."

2. Inflammation of Eyes, Sassafras, Excellent Remedy for.--"Take sassafras bark and make into a tea. Apply this externally to the eyes, and it will be found very beneficial for this trouble." This is a very good remedy, on account of its oily soothing nature.

3. Inflammation of Eyes, Tried Remedy for.--

Boric Acid 10 grams Camphor Water (not spirits) 1/2 ounce Water 1/2 ounce

Apply this with a soft cloth.

This trouble usually results from or is associated with constitutional disease and requires treatment for same, but the above wash is good for local applications. This prescription was given me by an oculist."

4. Inflammation of Eyes, Common Potato Will Cure.--"Scrape raw potato and apply to the temple until relieved." This helps to draw the blood away and relieves the inflammation.