Opacities

It was for opacities of different kinds in the cornea that massage was first used in modern ophthalmic surgery, and it is in this condition that we at present best know its value. Here too we meet with the usual great differences in regard to the estimate of its value. But on the whole all who have used massage for this condition, without letting themselves be discouraged by one or two negative results in difficult cases, recognised its power of strongly assisting in reabsorption of spots on the cornea after keratitis of different kinds. The prognosis, even if considerably improved by massage, naturally follows the old rule that the more external, the thinner and the fresher the obscuring spots are, and the younger the individual, the easier and more possible is it to obtain complete clearness. As a general rule I may state decidedly that even quite small spots, nebulae, nebeculae, maculae, or whatever they may be called, usually require several weeks, often months, of work before they vanish; deep, old, well-nourished leucoma remains unaffected by massage as by other treatment. The foremost ophthalmologists of the present day, however, strongly believe in massage in these cases, and Michel, for example, states that, combined with calomel and yellow ointment, it is our best means of treatment.

The mechanical irritation due to too strong massage may cause the recurrence of parenchymatous keratitis which has been arrested. Hirschberg utters a warning on the subject.

In parenchymatous infiltrations of syphilitic origin massage undoubtedly has some effect, but general anti-syphilitic treatment is of far greater use. They can be quite suitably combined, and for massage it is best to use lanoline-mercurial ointment (which Darier, Malgat, and others recommend also in other cases of eye massage).

Massage should be performed by means of not too gentle knead-ings, the direction of which is of minimum importance. But it is of the greatest importance that while the front of the eyeball is kneaded through the eyelid the patient should keep the gaze directed so that the kneading is performed upon the cornea.

Besides massage other means than those generally indicated in cases of opacities of the cornea need seldom be used. Dantziger in four cases first used abrasion either of the epithelium only or including also a layer of the corneal tissue, and about a week later began massage.

Pannus

By this name is generally understood a membrane rich in cells and vessels and finally becoming an organised membrane of connective tissue between the corneal epithelium and the anterior elastic membrane. It is due either to trachoma or to phlyctenular conjunctivitis. It is treated by many with massage whether it is of trachomatous or scrofulous origin, and the results are naturally good in proportion as the pannus is fresh and less organised and has penetrated less into the normal tissue elements of the cornea. Massage now has become a strong rival of the old methods of inoculating blennorrhoea and of the newer methods of producing jequirity-ophthalmia, and has the advantage over these (both of which may get beyond control and cause perforation, panophthalmia, etc.) of not being dangerous. At the same time it has the disadvantage of being considerably slower, often producing satisfactory results only after treatment for months.

We attempt in this to bring about retrogressive changes in the numerous cells and small blood vessel walls as well as of all the newly-formed and more or less organised tissues. In order to bring about absorption we must maintain a strong hyperaemia,* and must therefore give as vigorous massage as possible, and may advantageously use a strong precipitate ointment (I have used 1 : 12). Schmidt-Rimpler recommends for trachomatous pannus Guthrie's ointment (silver nitrate 0.4, lead acetate lotion 8, white American vaseline 8).

* It is well to impress upon the patient beforehand that a condition of irritation is necessary and beneficial, especially during the early stages of treatment.

Combined with massage we can advantageously use cauterisation with bluestone, Paquelin's cautery applied to, or excision of, the blood vessels of the pannus, etc. On comparative research by E. Nordenson and myself we found that massage only, with yellow precipitate ointment, gave better results than blistering.

Finally, even some acute diseases of the cornea have recently been treated by massage with certain partial success. In all these cases massage must undoubtedly be used with gentle pressure and with a weak precipitate ointment.