SPECIES I. OPHTHALMIA TARAXIS. Lachrymose Ophthalmp. INFLAMMATION CHIEFLY SEATED, OR COMMENCING, IN THE SCLEROTIC TUNIC OF THE EYE-BALL: INCREASED Explana THIS is the common inflammation of the eyes produced GEN. VIII. by cold, dust, or any other external irritation, as exces- SPEC. I. sive light, vivid colours, blows, or wounds: and has tion. been often called, and with great propriety, LACHRYMOSE OPHTHALMY, as the morbid secretion chiefly excited is that of tears. By Paul of Ægina it was named TARAXIS, from Tapáσow "to disturb, confuse, tumultuate", in allusion either to the violent action that takes place, or the confusion of the objects presented. And as the Greek name has been very generally continued by medical writers, and especially those of the Continent, to our own day, I have employed it in the present system, to distinguish the species before us. It occurs under two varieties as follow: a Mitis. Mild Lachrymose B Acuta. Acute Lachrymose The inflammation limited to the surface: the pain passable: the The inflammation extending to a O. Taraxis Mild la The FIRST VARIETY is a very frequent disease in most mitis. countries, but particularly in those exposed to sudden chrymose changes in the temperature of the atmosphere. It is the ophthalmy. Causes. GEN. VIII. SCLEROTITIS of Professor Beer. SPEC. I. a O. Taraxis mitis. Mild la chrymose Clouds of dust, in dry seasons, are another common cause; as is also an exposure to smoke, or other acrid fumes or exhalations. A strong incessant glare of light, or of vivid colours has ophthalmy. also not unfrequently proved a source of affection; but perhaps less frequently so than an undue use of wine and ardent spirits. Description. Progress. The disease commences with the appearance of a net-work of red blood-vessels in the sclerotic tunic, and particularly at the angles of the eye: and it is by its commencement in this tunic, the nature of the ́discharge, which is serous, the character of the inflamed vessels which are very small and distinct, and the colour of the inflamed surface which is rosy or carmine, rather than scarlet-red, that this species is chiefly distinguished from purulent ophthalmy which has its seat in the conjunctiva. The eye-lids are often swollen and tender, the fine membrane that lines their interior is turgid with blood, and there is a feeling as if gritty particles had insinuated themselves under the lid, accompanied with great heat and a pricking pain. If the inflammation commence in one eye it will generally extend to, and sometimes alternate with the other; and during sleep a glutinous fluid is secreted which collects towards the angles, and sometimes so closely cements the eye-lids, that it is with difficulty they are opened in the morning. In ordinary cases, this milder modification of ophthalmy runs its course in four or five days, and ceases Treatment. spontaneously, or is easily removed by local applications, and particularly astringent lotions, as cold water or solutions of alum, zinc, or lead; though, in irritable habits of a particular kind, relaxants and anodyne fomentations prove most successful. And even when the first are employed, it is always best to wash off the adhesive fluid that glues the eyelids together during the night, with a little warm water in the morning, before a free use of them. * Janin, Beobachtungen über das auge, &c. Berl. 1776. SPEC. I. Acute la In the SECOND VARIETY, constituting the chemosis of GEN. VIII. Plenck, and produced from the same causes as the pre- 60. Taraxis ceding, the symptoms from the first assume great vio- acuta. lence; the inflammation passes rapidly from one part of chrymose the ball to another; a keen darting pain penetrates fre- ophthalmy. quently to the bottom of the socket, accompanied with a Description. burning heat, and intolerable head-ache; the temples often throb, and the pulse is quick. If an ulcer ensue it forms what was called HELCOMA by the Greeks, or Helcoma. ONYX if in the cornea. Under either of these varieties Onyx, what. the disease will sometimes become chronic from neglect, and be distinguished by a permanent and distressing flow of tears which has been called an EPIPHORA; and, Epiphora, if such flux become acrid, it lays a foundation for an ectropium, or blear-eye *. If the chronic inflammation be without tears, it was called by the Greeks XEROPH- Xerophthal THALMIA. what. mia, what. The most active measures are here necessary from the Treatment. earliest commencement; for, from the violence of the inflammation, ulceration may take place internally or externally, and the pupil be irretrievably lost. Copious bleedings by leeches or cupping-glasses, are usually recommended from the temples; but the former may be employed with inconceivably more advantage if applied directly to the inflamed tunic, by placing the patient with his back to the light, and gently everting the lower lid. We learn from Dr. Crampton that this method has been pursued with almost universal success in the most severe cases in the Royal Military Infirmary at Dublin†; and it has the great advantage of not being followed by that erysipelatous affection which so often succeeds when leeches are applied on the external surface of the eye-lids, or even to the temples. Large and repeated general bleedings carried on to syncope will also frequently be found successful; and if the blood be taken from the temporal artery, the success will be still more Frank, De Cur. Hom. Morb. 11. 62. + Dublin Medical Reports, Vol. III. SPEC. I. acuta. Acute lachrymose GEN. VIII. certain though less so than when taken locally as above 60. Taraxis recommended. Brisk purgatives should at the same time be employed, and blisters applied behind the ears, but not to the temples, as they often spread their own irriophthalmy. tation from this quarter to the eye itself. The room should be kept moderately dark, but cool and airy; and astringent lotions, chilled by ice or frigorific mixtures, be constantly applied to the forehead, temples, and eyelids, by folds of linen successively wetted for the pur Free vomiting often highly beneficial. Confirmed by earlier practice. by Dobson. pose. I have known, however, the vomiting plan, which I shall have to notice under the third species, employed here also with very great advantage, and in some cases where every other plan had failed; and I find the same practice had recourse to with like success in a very strongly marked case, published by Dr. Robert Dobson of Kirkham; who tells us that at that time, 1773, there was a rumour of the utility of emetics in some inveterate cases of this kind, notwithstanding the general prejudice against them, from their being supIllustrated posed to add to the congestion of the head. The patient, from a case whose history he describes, was a young woman, aged twenty-two, of a delicate habit. The attack was sudden, and produced a total inability of sight in the right eye. The tunica albuginea, and indeed the whole globe of the eye were preternaturally enlarged, and the former in a considerable measure covered with deeply-inflamed red vessels; the cornea being greatly distended, and the crystalline lens apparently protruded, by an accumulation of fluid, through the pupil so as to be in contact with the inner surface of the cornea itself, possessing an irregular and unequal form. The eye-lids were very much swollen and glued together; the admission of light and air was insupportable; and followed by a copious discharge of acrid tears; and the whole was accompanied with excruciating and incessant pain, entirely preventing sleep, and sometimes so intolerable as to induce fainting. The left eye was similarly affected, but in a less degree. Copious and repeated bleeding from β SPEC. I. acuta. Acute la the temples, blisters, purgatives, shaving the head and GEN. VIII, cold applications to it, and all other means that could be 60. Taraxis thought of, had been tried, but to no purpose. As a doubtful and desperate remedy, a tartar emetic mixture chrymose was prescribed of which the patient was to take a large ophthalmy. spoonful every hour till it vomited or purged her. The second dose both vomited and purged; after this at bedtime, she took a grain and a half of Thebaic extract with two grains of ipecacuan. She passed a quiet and composed night, and enjoyed more sleep, and slept far more comfortably than she had done during all her illness. The tartar emetic mixture was continued the next day in smaller quantities, and in a few days more she recovered her former health and strength*. some other Where the inflammation is a mere symptom or con- Where a comitant of some other disease, it can only be removed symptom of by a cure of the original malady. And this is not unfre- complaint quently the case; for it is often dependent on a stru- the latter to be particumous, or syphilitic habit, or a suppressed blenorrhoea : larly attendon a disordered state of the stomach, liver, or some other ed to. digestive organ, and especially in hard drinkers; on an abuse of mercury as a medicine; and on various affections of the teeth t. If the inflammation be produced by an influx of sand Treatment or gravel, or spicule of flint or iron driven into the when idiopathic. external tunic, every such foreign substance must be carefully removed with as much speed as possible: but it will be generally found that the pointed and pricking pain caused by the incursive substance will remain for some time after its removal, and induce in the patient's mind a strong belief that it is still fixed in the membrane. We have various examples of an extraction of spiculæ of iron forcibly driven into the eye, by the application of a magnet +. * Edin. Med. Com. 1. p. 411. † Beer, Lehre von den Augenkrankheiten, Band. 1. Wien. 1813. Morgagni, De Sed. et Caus. Morb. Ep. xi. 22. Weber, Würkung des künstlichen Magnets in einem Augenfeler, p. 18. Hanov. 1767, 8vo. Phil. Trans. p. 164. |