* As this work is partially intended for medical students who have not yet completed their ophthalmic studies, I give in every form of the disease mentioned in this chapter a short summary of the most important symptoms. Under ordinary catarrh are included here both the so-called chronic hyperaemia, distinguished from it by many authors, which is related to the more developed catarrhs by innumerable transitional forms, and the more severe form in which swelling of the follicles is the most apparent symptom.
The conjunctiva is rather red, in milder cases or in children often smooth or a little swollen; in more severe or older cases hypertrophic, thickened, and velvety. Occasionally one sees in the transition part small round red or yellowish pale lumps (= C. follicularis). The secretion is variable, often inconsiderable, the eyelids being merely glued together on waking. There is a feeling of weight in the eyelid, of itching, burning or pricking pain, or as if there were a foreign body in the eye, and rainbow colours around any light (owing to mucus on the cornea). Milder forms usually go for ten years or more without greater changes; more severe forms may cause blepharitis, eczema, eversion of the lower punctum lacrymale, ectropion, blepharophimosis, etc. It usually attacks adults.
Kiaer is, so far as I know, the first who has treated these diseases with good results by massage, which is of great value combined with the usual astringent collyria, cauterising, bathing, hygienic measures, etc. Kiaer for this uses only vaseline. Hirschberg, who massages directly on the conjunctiva, uses iodide of potassium ointment; Motschulsky, who specially recommends massage for thickening of the conjunctiva, uses boracic acid. Follicular conjunctivitis, which form many consider to be more like trachoma than like catarrhal conjunctivitis, is treated by Heizberg massage with iodide of potassium ointment, immediately upon the mucous membrane of the everted eyelid.
Acute Blennorrhoea of the Conjunctiva = the dangerous purulent gonorrhoeal conjunctivitis has for many years been treated by Schmidt-Rimpler by massage, for severe chemosis and oedema in the eyelid, along with other treatment, usually after incising the external commissure, during the early days of the disease and in its most acute stage.
Burchardt advises as quite the best for this disease a treatment of which massage forms a most important item. He condemns ice and cold compresses, leeches, and scarification. Instead he tells an assistant to inject a solution of 0.8 silver nitrate in 500 distilled water into the inner corner of the eye, while he himself performs gentle quick kneadings, with the thumb of one hand on the under eyelid and with the first and second fingers of the other hand placed upon the upper eyelid, for one minute four times a day. Between times a compress is used made of 5 per cent. chlorine water.