§ 282. Scrofulous Ophthalmia.

Scrofulous ophthalmia occurs more frequently than any other variety of inflammations of the eye. It generally attacks children, scarcely ever persons who have past the age of pubescence. The inflammation is principally seated in the conjunctiva, but sometimes in the cornea. The conjunctiva of the eyeball is very red, bundles of varicose vessels run towards the cornea, and the sclerotica exhibits a rosy tinge. Photophobia, which sometimes increases to spasm of the eyelids, profuse discharge of corrosive tears, increased secretion of mucus, are almost always present. These symptoms are worst towards morning, and decrease towards night. The eyelids are likewise reddened, and continue so, even after the real inflammation has been relieved. If the cornea be affected, it becomes dim, in consequence of extravasation of lymph, or phlyctaenae form, which sometimes pass into ulcers. Patients affected with this disease are liable to relapses. Scrofulous ophthalmia has been divided into erethic and torpid, according as the disease runs a more or less rapid course; the former is found in children of a sanguine disposition, the latter in children of a phlegmatic disposition and bloated appearance.

Pulsatilla is particularly indicated at the commencement of the disease, when the following symptoms are present: redness of the lids and conjunctiva, aching-stinging pain in the eye, photophobia and discharge of corroding tears, profuse secretion of mucus, nocturnal agglutination of the eyelids. Euphrasia, Nux, Ignatia, or Ferrum are sometimes indicated by the symptoms. In some cases, where the disease was distinctly worse in the morning, Nux v. has proved very useful. Hepar s. is one of the best remedies in this disease; I have given it with the best result at the commencement or acme of the disease, and even when the cornea had become completely dim. I gave two or three grains of the 2d or 3d trituration at a dose, two or three times a day.

Belladonna is a suitable remedy when the disease has somewhat progressed, and the above-mentioned bundles of varicose vessels have made their appearance, extending into the cornea; when the sclerotica looks red and phylyctaenae have formed at the termination of the vascular bundles, changing to ulcers; when the patient complains of painful pressure in the eyes, which increases by turning them up when photophobia is occasioned by the inflammation; and when the symptoms which have been enumerated under catarrhal ophthalmia are present, and the disease is aggravated by the least cold, or by a sudden spell of cold and damp weather during the fine season. Sometimes, however, this remedy is not sufficient, and we have to give Sulphur, Calcarea, Sepia or Causticum.

The alternate use of Sulphur and Calcarea in this disease is frequently attended with the most brilliant results; I give Sulphur one day and Calcarea the next, using the 2d or 3d trituration. By this means I have frequently cured scrofulous ophthalmia of years' standing in a week or a fortnight. Conium mucul. is likewise indicated by the above symptoms, except that the photophobia results from the morbid action of the optic nerve, and not from the inflammation of itself.

For the pustules and ulcers which sometimes form on the sclerotica or cornea, and leave herpes and scars, the following remedies are used with benefit: Nux v., Dig., Euphrasia, Hepar s., Cannab., Sulphur, Calc, Silic, Sepia, Rhus tax. is an excellent remedy-in scrofulous ophthalmia, when accompanied with scrofulous or herpetic eruptions in the face. Staphy-sagria has likewise been used with benefit.

If the inflammation should resist any of the above remedies, in that case a few doses of Arsenic, either alone or in alternation with Euphrasia, will cure the disease in a short time.

We refer the reader to the second part of this work, where he will find a detailed description of the treatment to be pursued for scrophulosis; for, in most cases, a scrofulous inflammation of the eyes will not yield till the source from which the disease springs has been eradicated.