§ 278. Erysipelatous ophthalmia.

Sometimes only one eye is affected, but the inflammation frequently passes to the other eye after a short time. The whole conjunctiva exhibits a pale-red tinge, with yellowish-red, moveable, vesicular formations, arising from a serous infiltration of the conjunctiva, and sometimes increasing to such a size that they protrude between the eyelids and impart a very strange appearance to the patient. The eye is very sensitive to the light, the pain is tensive and burning, but not very intense. There is much lachryma-tion, and an increased secretion of mucus. Sometimes there is fever. In the second stage of the disease the inflammation is more intense, and the vesicular formations increase in size. The conjunctiva is very much injected and even ecchymosed here and there. Pain, photophobia, and secretion of mucus, exist to a much greater degree in this stage.

Erysipelatous ophthalmia is most frequently occasioned by cold, sojourn in damp and cold air, by washing, scrubbing, etc.

The symptoms of the first stage are principally relieved by Aconite. If the fever and the inflammatory symptoms should have subsided, and an aching or burning pain should still remain behind, Hepar sulph. is then the most suitable remedy. Belladonna is indicated if the inflammation arise from a true erysipelas of the face; but if the inflammation should be very violent, Hepar s. will be preferable to Belladon-na. In the second stage, however, if the inflammation should be so intense, the ulceration of the conjunctiva so extensive, and the secretion of purulent mucus so profuse, that the eye can only be opened with difficulty, then Sulphur is required after Aconite. It is particularly indicated when the inflammatory vesicles, redness and swelling of the conjunctiva are characterized by an itching, burning, and a feeling of painful dryness. Sulphur acts best in this case, after the previous exhibition of Belladonna. Causticum, Lycopodium, and Arsenic, are likewise useful in this disease; the latter particularly, When the inflammation of the eyelids is so violent that it is impossible to open them.

Traumatic ophthalmia, as may arise from the pressure of a hard object on the eye, is very similar to the second stage of erysipelatous ophthalmia. In such a case, Arnica should be used internally and externally, and if the inflammation should nevertheless continue, Aconite should be given, after which Sulphur or Calc. are indicated. However, it is not always possible, in such a case, to prevent the atrophy of the organ, which sometimes follows the hypertrophy.