§ 283. Blepharophthalmitis glandulosa. blepharoblen-norrcea, inflammation of the Meibom an glands.

This disease is in many cases a sequel of other inflammations, such as catarrhal ophthalmia. The lightest degree of this disease is a mere blennorrhea of the canthi (lippitudo.) The higher forms of the disease are accompanied with burning and itching of the eyelids and a feeling of dryness in the eye which is particularly violent towards evening. The secretion of mucus is likewise worse towards evening, causing an agglutination of the eyelids over night. On looking at candle-light, the patient experiences a sensation of heaviness in the eyelids, obliging him to close them. The inner surface of the lids is red, and has a velvety, puffed-up appearance. Sometimes, in the highest forms of the disease, the eyelids become excoriated. This kind of inflammation is frequently very obstinate, or is excited again by the least exertion.

The disease may be caused by the action of deleterious substances, or by catarrhal causes; it may likewise spring from dyscrasia, gout, scrofula, syphilis, (see the paragraphs where this disease is treated,) or from old age (ophthalmia senilis.)

For the milder form of the disease, Euphrasia is an excellent remedy, particularly when it arises from cold, and photophobia is present. If the inflammation should be very acute, with profuse secretion of mucus, Clematis erecta or Spigelia is to be exhibited. Digitalis purp. has been found very efficient in many cases, particularly in chronic blear-eyedness; the patients complain particularly at candle-light of a sensation of burning dryness about, the margins of the eyelids, with swelling of the lower lid. If the inflammation should terminate in suppuration or ectropium, whether it be painless or attended with stinging, burning and itching, a few doses of Mercurias followed by Hepar sulp. should be given. Belladonna will prove useful after Mercurius, when the eversion of the eyelid is accompanied with twitching, trembling, and blinking of the lids, or when the lids are paralyzed and droop (blepharoptosis.) Next to Belad., Sepia deserves to be recommended for the latter affection. In most cases, however, Digitalis diminishes the inflammatory symptoms, and changes the disease to a form which requires Sulphur for its complete removal.

Heaviness of the eyelids, which frequently increases to a spasmodic closing of those parts, (blepharo-spasmus,) yields most readily to Hyoscyamus, Chamom., or Crocus. If these remedies should not prove sufficient, Veratrum, Stramonium, Hepar sulph., or Tinctura aeris or Causticum are indicated.

§ 284. If the inflammation should be confined to a single Meibomian gland, or a circumscribed portion of cellular tissue, the disease is termed hordeolum or stye. It sets in with a sensation of pressure or itching, a narrow spot on the eyelid becoming gradually raised and red. This small tumour either disperses or suppurates. In the former case the trouble does not last long. The swelling may likewise become hard, (chalazion.) The disease is seldom accompanied with conjunctivitis, photophobia, or acute pain. It is apt to recur when patients are constitutionally disposed to it.

The disease either arises from dyscrasia, or in consequence of blepharoblennorrhoea. To remove it, the patient should be kept under a strict diet, and should take Pulsatilla, which prevents the suppuration. If it should set in frequently, particularly in scrofulous subjects, with obstinate stoppage and ulcerated crusts in the nose, redness and swelling of the eyelids, Au-rum is said to be a specific remedy. Staphysagria will be found an excellent remedy when the stye becomes indurated, and the indurated stye shows a disposition to torpid inflammation, with agglutination of the lids over night. If Staphys. should prove unavailable, Silic. will be found the best remedy. In some scrofulous children I have removed a disposition to styes, together with the scrofulous disease, by a few doses of Sulphur and Calc. carb. Graphites, Lycop., Rhus t., Con., etc., deserve likewise our attention.