Ophthalmia (Gr. bmiuia, from b^al/wg, an eye), inflammation of the eyes. Under the head of ophthalmia maybe included inflammation of all the various structures that enter into the formation of the eye; we shall here however confine ourselves to the inflammation of the external and visible tissues. Inflammation of the white of the eye assumes a variety of forms, dependent partly on the special character of the inflammation and partly on the constitutional peculiarities of the patient. 1. Catarrhal Ophthalmia. Here the eyes are bloodshot, the redness being produced by injection of the network of vessels which covers the white of the eye, and early in the disease is most marked where the conjunctiva is reflected from the lids, while it gradually lessens as we approach the cornea. The lids are swollen, and sometimes the upper lid overlaps a little the lower one. The patient complains of a feeling as if there were sand in the eye, while there is a good deal of smarting and itching at the angles of the eyelids and along their free margins. There is at first lachrymation, which is soon followed by the secretion of a thin muco-purulent discharge which accumulates at the corners of the eye, and which with an increased secretion of the Meibomian glands glues the eyelids together during sleep.
The disease may be brought on by irritation or injury of the conjunctiva, though atmospheric influences are its commonest cause. It is ordinarily mild and manageable, but when severe or badly treated it may produce ulceration of the cornea or leave the lids thickened and granular. In all cases of disease of the eye, absolute rest of the organ should be enjoined, and it should be protected from strong light and heat. In mild cases of catarrhal ophthalmia, rest, a brisk purgative, and the occasional application of tepid water to the eye, are often all that is necessary. If the inflammation does not subside in the course of one or two davs, a weak solution of nitrate of silver (gr. ii.-vi. aq. i.) may be dropped into the eye once a day, and the eye may be bathed several times a day with a dilute solution of alum or of bichloride of mercury; while at night the edges of the lids may be smeared with dilute citrine or red precipitate ointment. In the severe form, bloodletting, either general, or more commonly by means of cupping glasses to the temples or of leeches, may be required.
When the palpebral conjunctiva is congested and thickened, it may be scarified, and after the active inflammation has subsided it may be brushed over with strong nitrate of silver ointment or with undiluted vinum opii. 2. Egyptian Ophthalmia - Purulent Ophthalmia. This disease has probably existed at various places and various times, but the attention of the public was first strongly directed to it during the wars of Napoleon, when the British army returning from the expedition to Egypt brought the disease with them, and communicated it to other troops with whom they came in contact. The milder cases of purulent ophthalmia differ but little from the severer cases of the catarrhal form of the complaint; there is however even in these cases a very marked tendency to a granular condition of the lids. When the lids are everted they appear velvety, "the enlarged papillae being separated into groups by furrows and fissures, or tuberculated and sarcomatous looking, like a mulberry." (Jones, " Ophthalmic Medicine and Surgery.") In the severer forms of the disease the eyelids are tense, livid, and often enormously swollen, the upper overhanging the lower one; on separating them they often become everted, from the congested and swollen state of the palpebral conjunctiva.
The conjunctiva lining the globe, red and swollen, soon becomes raised like a wall around the cornea (chemosis); a copious secretion of muco-purulent matter is poured out, runs down on the cheek, and bursts forth when the swollen lids are pressed asunder. The patient is unable to bear the light; there is burning pain in the eye, with pain around the orbit and in the temple, increasing at night. During the violence of the disease fever is present, though commonly moderate. The inflammation is not confined to the conjunctiva, but extends to the sclerotic and the cornea; the latter becomes vascular, opaque, and often ulcerated; sometimes it bursts, discharging the aqueous humor. The disease was first attributed solely to contagion imported by the British troops from Egypt, but it is now certain that it arises sporadically, and that under favoring circumstances, such as overcrowding, innutritious diet, or want of cleanliness, it becomes highly contagious. Purulent ophthalmia even in its milder forms requires prompt and decided treatment, both because the disease may at any time suddenly assume a violent and intractable form, and because of its tendency to produce thickening and granulation of the conjunctiva of the lids.
When the disease is severe, or when it occurs in a strumous constitution, there is always great risk of permanent injury to the eye; in the worst cases the eye is sometimes destroyed in from 24 to 36 hours. In the severer forms of the disease recourse must be had to bloodletting, either general or by means of leeches or cupping glasses in the commencement; afterward the lids may be pencilled once a day with a solution of nitrate of silver, or brushed over with the lunar caustic in substance, and the eyes should be cleansed frequently with warm water or with a weak warm solution of alum or bichloride of mercury (alum gr. xvi., water viii., solve; or bichloride of mercury gr. i., hydrochlorate of ammonia gr. vi., water viii.). To relieve the congestion and swelling of the conjunctiva of the lid, it should be freely scarified, and when great chemosis is present recourse must be had to incision of the ocular conjunctiva. When the inflammation extends to the iris, as evinced by the irregularity and contraction of the pupil and by the change of color in the iris, mercury combined with opium may be cautiously administered, while the pupil should be dilated by the application of extract of belladonna around the eye.
On the subsidence of active inflammation the diet should be improved, and iron, bitter tonics, and quinine may be necessary. Gonorrhceal ophthalmia closely resembles the severest and most intractable forms of Egyptian ophthalmia, and is to be treated in a manner precisely similar. Its only cause is the direct application to the eye of gonorrheal virus. 3. Ophthalmia Neonatorum. New-born infants are subject within a week or two of birth to a disease closely resembling catarrhal ophthalmia. The infant is first observed to have the lids glued together after sleep, their edges are red and slightly swollen, and the eyes themselves are weak and watery. The inflammation is at first mainly confined to the lids; as the disease advances they become swollen, tense, red, and shining; on being separated, a thick, yellow muco-puriform discharge bursts forth, the lids often become everted, and their conjunctival surface is seen to be velvety and dark red; the sclerotic conjunctiva is at the same time seen to be injected, and more or less chemosis is present. In the worst cases the cornea may become ulcerated and the eye destroyed; but if treated early enough the disease is easily subdued.
In mild cases bathing and cleansing the eye several times a day with warm water, or with a weak colly-rium of alum water, may be all that is necessary. In severe cases the nitrate of silver solution may be applied to the eye daily, while the eye is cleansed three or four times a day with the alum or bichloride of mercury solution. Sometimes it may be necessary to scarify the conjunctiva of the lids. 4. Scrofulous or Strumous Ophthalmia - Phlyctenular Ophthalmia. Strumous ophthalmia is eminently a disease of childhood, and, excluding ophthalmia neonatorum, before 12 years of age inflammation of the eye assumes this form in nine cases out of ten. While it is most common in children presenting other evidences of the strumous diathesis, it sometimes occurs in those whose constitutions are apparently without taint. It is early marked by great intolerance of light; the child seeks the shade, shelters the eye with the hand, bends down the head, and keeps the eyelids nearly closed. Any attempt to open the eye is resisted by a spasmodic closure of the eyelids, which the child even if inclined is unable to resist. On forcing them open there is often little appearance of inflammation, merely a faint blush of redness, with perhaps a few vessels running from the angles of the eye toward the cornea.
As the disease advances, one or more phlyctaenulae form upon the cornea, and these bursting leave small ulcers. There is commonly little suffering except from the intolerance of light, and from the excoriation caused by the tears running down the cheek. The child is fretful, the appetite irregular, and the digestive organs disordered. The disease is apt to be obstinate, with a great tendency to relapse. When ulceration of the cornea occurs, a permanent cicatrix (leucomd) is apt to be left. In bad cases the ulceration may penetrate deeply, the cornea be pierced, the aqueous humor discharged, and prolapse of the iris take place. The treatment may be commenced by an emetic of antimony or ipecacuanha (vini antimonii ii., or ipecacuanhas 3 -. - 3 ii-, every ten minutes until vomiting is produced; afterward a purgative dose of calomel and rhubarb, or of calomel followed by a rhubarb and soda mixture, may be given. The bowels should be kept open and their secretions regulated by minute doses of hydrargyrum cum creta or calomel with rhubarb, soda, and ipecacuanha; and finally sulphate of quinia may be given in doses of from one to two grains three times a day. This last in many cases seems to act like a specific.
Iron, in the form of lactate, pyrophosphate, or ammonio-citrate, is often useful in conjunction with the quinine. An infusion of belladonna applied as a wash is frequently of service in relieving the photophobia. Finally, in some cases, counter-irritation by small blisters, applied behind the ears, may be necessary. 5. Sclerotitis - Rheumatic Ophthalmia. Here the inflammation in pure cases is confined to the sclerotic coat, though it is apt to extend to the cornea or iris, or to be complicated with conjunctivitis (catarrho-rheumatic ophthalmia). The redness of the eye is of a pink tint, forming a zone around the cornea when it is most marked, and gradually shading off toward the circumference of the eye, the vessels being minute and disposed in radiating straight lines. The cornea becomes dim, and vessels may be seen encroaching upon its margin to the extent of 1/20 or 1/10 of an inch, and then suddenly stopping. The iris becomes discolored and the pupil contracted and sluggish, and sometimes hazy; there is intolerance of light, lachrymation, and dimness of vision. The patient suffers from pain, compared to that of rheumatism, in the temple or around the orbit, which is increased at night and remits toward morning; and there is also deep-seated pulsatile pain in the eyeball.
There is constitutional fever, the appetite is destroyed, and the rest broken. One eye alone is commonly affected, or if both are attacked one is much worse than the other. In mild cases a full dose of calomel and opium may be given at bedtime, followed by a purgative on the following morning; afterward nitrate of potash, in doses of from gr. x. to gr. xx., may be given three times a day dissolved in barley water. In severe instances recourse must be had to the abstraction of blood, and small doses of calomel and opium are to be given every night until the gums are slightly affected. Counter-irritation by means of blisters is often decidedly useful; occasionally colchicum has seemed to be of service; the iodide of potassium has likewise been given with success.