CONJUNCTIVITIS. 297 CONJUNCTIVITIS. and eye-strain. The conjunctiva is red and smooth, the secretion is but slightly increased. FoLLicuLAK Conjunctivitis. This is an obsti- nate form of chi-onio catarrhal conjunctivitis, and may be recognized by the small follicles or gran- ular swellings which form under its inlluonce upon the lower lids. It closely resembles tra- choma (see (Sranuhir Conjuiictivilis, below), commonly caled "granular lids.' and some even maintain that they are identical. Those who differ from this op'inion assert that the follicles in follicular conjunctivitis disappear after a few weeks' treatment, while in trachoma there are persistent changes in the conjunctiva. Acute Purulent Conjunctivitis of Adults, or Gonurrhaal OphtJitihiiia. This differs from tatarrhal conjunctivitis in the severity of its snnptoms and in its exciting causes. It is a violent form of inllammation of the conjunctiva; is accompanied with a thick, purulent discharge on the second or third day, and is very apt to occasion loss of vision. It begins Avith the same sjTuptoms as catarrhal ophthalmia, but in a very exaggerated form. The conjunctiva rapidly becomes intensely red, and soon appears raised from the sclerotic by the elTusion of serum be- tween them, projectiiig around the cornea, which remains buried, as it were, in a pit. Similar effusion takes place beneath the mucous mem- brane lining the eyelids, causing them to project forward in large,' livid, convex masses, which often entirely conceal the globe of the eye. These symptoms arc accompanied by severe burning pain, tenderness of the eye, some constitutional symptoms, and slight fever. When the disease is unchecked, it is liable to produce ulceration or sloughing of the cornea, with the escape of the aqueous humor and protrusion of the iris; and, even when these results do not follow, vision is often destroyed by permanent opacity of the cornea. The disease is unquestionably contagious, ajid arises from the application of gonorrhoeal dis- charge or matter to the surface of the eye ; and hence is most connnon in persons suffering from the disease from which this variety obtains its specific name. It may be conveyed directly to the eye, or by means of towels or other articles used by such a person. It is, moreover, often occasioned by the disgusting practice, adopted by the poorer classes, of bathing the eyes in human urine, under the idea that by this procedure they strengthen the sight. Purulent Conjunctivitls of Infants, or Ojihthidniin Xeoiiatoriim. This usually appears about the third day after birth. Its importance is apt to be overlooked until it has made con- siderable progress. The edges of the lids appear red and glued together, and the eye, when the lids are separated, shows redness and swelling of the conjunctiva. The disease, if not checked, progresses in much the same way as in adults. It is, however, much more amenable to treat- ment, and with proper care the sense of sight is seldom impaired, provided the disease has not extended to the cornea before medical aid is sout'ht. Ophthalmia neonatorum is the result of gonorrheal infection of the eyes from the mother during birth. It is practically preventable by the use of Credo's method of cleansing the ey.es immediately after birth, and putting one drop of a 2 per cent, solution of silver nitrate into each eye. This is a routine practice in many of the maternity hospitals, and has done nnicli in these institutions, and among t.lie better classes, to diminish the frc(iucncy of the affection. The treatment of purulent conjunctivitis must be left entirely to a competent physician, whose advice should be sought as soon as there is the slightest suspicion of the nattire of the case. Dii'imiEiiiTic Conjunctivitis and Croupous Conjunctivitis. These are forms caused by the bacillus of diphtheria. Phlyctenular Conjunctivitis, called also Pustular Conjunctivitis, or Scrofulous Ophthal- mia. This occurs in children, especially of the lower classes, who suffer from the tuberculous or so-called scrofulous diathesis or constitution. The most prominent symptom is extreme intol- erance of light, the lids being kept spasmodically closed. When they are forcibly separated, a slight vascularity, usually stopping at the edge of the cornea, is observed, and at or about the line of separation between the cornea and scle- rotic small opaque pimples or jmstules ai)i>ear. The treatment consists (I) in improving the general health, and (2) in local apjilications. This form of disease, being dependent on con- stitutional causes, is often very obstinate, and is always liable to recur. Granular Conjunctivitis, or Trachoma, pop- vdarly known as 'granular lids.' This is a con- tagious affection of the eye, conve.yed by means of the secretion. The contagion is most fre- quently carried by towels, etc., used in common by many persons, and so the disease is found chiefly in crowded and dirty houses, in schools, barracks, etc. It occurs very frequently in Arabia, Egv'.pt, and the lowlands of Europe. In this country the negro race is comparatively seldom affected by it. The disease has been called Eg;^'ptian ophthalmia on account of its importa- tion into Europe from Egypt during the wars of Napoleon. The Irish and Jews are especially liable to the affection. It is accompanied by a varying degree of dread of light, itching and burning "of the lids, pain, flow of tears, and trouble with sight. The lids are swollen, the upper droo])ing; there is a variable amount of muco-purulcnt discharge. The conjunctiva of the lids and fornix, or fold between lids and eye- balls, is red, thickened, and covered with many small papilhe, or velvety elevations, or by gran- ules which are round, translucent, and yellow or grayish. After a time, scar tissue forms and the papilla? and granules disappear. The disease may be acute, but usually begins gradually and lasts for years. It is liclieved by some that the cases in which the granulations give few or no symptoms, and there are no signs of inilamma- tion, are not contagious. The dangerous com- plications are ulceration of the cornea alone or accompanying a condition known as pannus. In the latter, new tissue containing blood-vessels gradually fomis until the upper half of the cornea is covered, occasionally the whole. If this disappears later, sight will be restored; otherwise, the new tissue causes permanent opa- city, an accident which may also result from corneal ulceration. Entropion (q.v.), trichiasis (q.v. ), or ectropion (q.v.), or symblepharon. a cicatricial adhesion of the conjunctiva of the lid to that of the eyeball, may follow trachoma. The treatment of trachoma may require either local applications or surgical interference. Pre- vention is most important. Persons having the
