On the conjunctiva of the eyeball in the region of the limbus (sometimes on the cornea itself = phlyctenular keratitis) are to be found one or more round elevations as large as (pustular) or smaller than (vesicular) hemp seed, or small miliary efflorescences consisting of collections of white cells and (on the conjunctiva) of lymph immediately beneath the epithelium. The condition begins with vascular injection, intolerance of light, pain, cramp in the eyelid, and lacrimation. Sometimes it vanishes leaving no trace, but it may give rise to ulcers owing to the breaking down of the phlyctenulae. It arises usually in scrofulous children (see Phlyctenular Keratitis).

Many doctors have treated this common complaint by massage, and have thus to a certain extent improved upon the good results of the usual anti-scrofulous internal treatment by means of hygiene, calomel or yellow precipitate ointment. Kiaer has compared the different methods of treatment using in twenty-seven cases massage only, in twenty-seven other cases precipitate ointment with out massage, and in twenty cases massage with precipitate ointment. In the case of "pure" massage the time necessary for treatment lasted eight or nine days; when the precipitate ointment (1 : 40) without massage was used the time of recovery took six days; when massage with ointment was used the length of time decreased to five days.*

* These statistics, without being quite valueless, are not sufficient to allow us to draw any definite conclusions when it is a question of such a variable disease as phlyctenular conjunctivitis. Personally the general opinion of Riser and other thoughtful, observant, and experienced ophthalmologists, e.g., Pagenstecher, that it is possible to improve the results by introducing massage, is to me of greater value by far than any number of mere statistics.

The subjective symptoms disappear under this treatment extremely quickly, often after one treatment.

Friedmann had two cases, Kiaer one case, all three belonging to the vesicular kind with rather large phlyctenules, in which massage was not well tolerated and the injection and pains became more severe.

In all these forms one must use very gentle pressure during quick kneading, and preferably perform these as in Pagen-stecher's radiating massage. This quickly causes the loosely-formed phlyctenules to absorb.

General treatment with fresh air, salt-sea baths, cod-liver oil, iodine and iron is naturally far more important in scrofulous ophthalmia than eye massage, which only deals with the local changes temporarily. (For a more complete account of the value of massage treatment of scrofulous ophthalmia, see Phlyctenular Keratitis.)

Darier praises the use of massage in pterygium.

Subconjunctival ecchymoses are quickly absorbed by massage (Schenkl, Klein).