Our Eyes, and How to Take Care of Them: Iv

DISEASES OF THE EYELIDS.

THE edges of the lids are often thickened and crusted, and the eyelashes fall out, in consequence of neglected disease of the roots of the lashes and the lubricating glands which open near them.

If left to themselves the lids grow more and more unsightly, the bulbs which form the eyelashes are at last destroyed, and no new growth is produced, the margin of the lid being left bare and rounded. Yet the healthy condition may be easily restored and preserved by a little care and the seasonable use of proper applications. The crusts should not be allowed to remain upon the edge of the lids and give rise to ulceration, but should be softened with warm water and removed, without violence.

After the thickening has continued a long time, the parts are not at once restored to a normal state, and the mild remedies prescribed by the physician must be patiently continued, and should even be used occasionally after the disease has been subdued, to give a healthy tone to the parts and prevent any reappearance of the symptoms.

Rounded tumors are sometimes slowly formed in the lid, at a distance from its margin, which are seldom dispersed by local applications, but require a slight surgical operation for their removal. They should not be allowed to become very large.

Erysipelatous inflammation of the lids causes much swelling and redness, and an abscess sometimes results. Should this occur it should be opened as soon as possible, otherwise the skin of the lid is extensively undermined by the matter which spreads beneath it. But this should be done with great care, lest the eyeball itself should be injured.

The swelling of the lids which accompanies inflammation of the tear-sac resembles that caused by erysipelas, and is often mistaken for the latter when it is so great as to close the eyes. But it may be distinguished from erysipelatous disease by the greater hardness and tenderness near the nose, over the region of the sac.

OBSTRUCTIONS OF THE TEAR - PASSAGES.

Great suffering results from want of attention to the early symptoms of obstruction to the proper flow of the discharges from the eye. The lining of the tear-passages is often at first merely thickened, and its healthy state may be easily restored ; but if neglected, the lachrymal sac, the reservoir placed in the side of the nose to receive the secretions from the eye, acquires a condition of chronic inflammation, and the passage leading downward from it becomes more or less completely closed, perhaps requiring tedious and painful treatment for its restoration. When in this condition, a slight exposure may cause inflammation of the sac, with great pain and swelling of the surrounding parts, often mistaken for erysipelas. Matter rapidly forms, and if the sac is not promptly relieved, it bursts, and the pus spreads beneath the skin and at last finds its way to the surface, forming a fistula lachrymalis which is annoying and difficult to heal.

Formerly, leaden or other styles, or gold or silver tubes, were inserted into the sac and the duct leading thence to the nose, and were worn for a long time. But this unsightly and often ineffectual means has given place to milder and more successful methods of dilatation. Prevention, however, easily accomplished at first by the use of the mildest remedies, is better than the cure of these obstructions.

STRABISMUS.

Strabismus, or squinting as it is often termed, is a deviation of the eyes from their proper direction in looking at objects. Its most common form, where one or both eyes turn towards the nose, is, as I have already shown, associated with hyperopia in a large proportion of cases. As it usually shows itself about the time when a child begins to look carefully at objects, and is especially likely to occur if the child is enfeebled by illness, its origin is often attributed to an attack of whooping-cough, measles, or other disease.

It is a great mistake to allow this abnormal turning of the eyes to continue unrelieved for years, as is too often the case. Especially is this true where the squint seems to affect one eye only ; for the eye which habitually deviates does not receive images of objects which harmonize with those in the other eye, and after a time disregards the impressions made upon it and gradually loses its perceptive power. It is common for parents to wait, first “to see if the eyes will not come right,” and afterwards, “to let the child decide when old enough,” whether he wishes to have the deformity relieved. This would be a very proper course if it were merely a question of appearances, and the sight did not also become involved by delay.

If the other eye be covered, it will often be found that the child sees less well with the squinting eye ; and this loss of acuteness of vision increases and becomes confirmed with time, so that, though an operation done at a later period may remove the deformity, it cannot restore the diminished visual power.

At first, the disposition to turn in is perhaps noticed only when the child is fatigued, excited, or ill; but if this becomes after a few months more and more constant, it is best not to defer treatment. This does not, however, necessarily involve an operation, for the disposition to squint may often be controlled by suitable glasses, which take away the necessity for the excessive calling into action of the internal recti muscles. But if an operation is required, there is no excuse for postponing it, in these days of etherization, from a reluctance to subject the child to pain.

When the squint is considerable, it is often necessary to divide the muscle which is affected in both eyes, in order to insure a perfect result ; the deformity and the defective optical conditions being only partially relieved by an operation on one eye only. After operation it is often essential that convex glasses should be worn, at least for study and fine work.

The opposite deviation, where the eye turns outward, is most frequently a consequence of near-sightedness, resulting in many instances from alteration of the shape of the posterior part of the eyeball, rendering its motions less free in the socket. This diseased condition makes it more difficult to remove the deformity by operative means than in convergent strabismus, and the condition of the interior of the eye should be carefully examined to ascertain if progressive and dangerous myopic changes are in progress.

Temporary or permanent strabismus may also occur where the nerves which supply the motor muscles of the eyeball are paralyzed from the action of external causes or from disease of the brain. The cure in these cases must depend on the removal, if possible, of the original paralyzing influence.

DISEASES OF THE CONJUNCTIVA.

Some of the affections of the conjunctiva, the mucous membrane covering the front of the eyeball and lining the lids, are among the most fatal to vision ; and their frequency and often-times their severity, their tendency to linger, and the danger of their being communicated from one individual to another, give them an important place among the diseases of the eye.

INFLAMMATION IN NEW-BORN CHILDREN.

Within a few days after birth the lids of one or both eyes sometimes become red and swollen and a creamy matter begins to form. Except where the affection is slight the symptoms rapidly increase, the lids swell so much as to project beyond the eyebrows and completely close the eyes, the discharge of matter becomes so copious that it pours out in great quantity if the lids are separated, and the eyeball itself becomes involved.

If the disease is not checked, the transparent front of the eye, the cornea, is liable to more or less complete destruction from ulceration. This may take place suddenly, from the extreme severity of the inflammation ; or it may occur only after the symptoms have already diminished, — the cornea holding out for a time, but at last yielding to the effects of the inflammation of the surrounding parts and the constant flowing over it of the abundant and irritating discharges.

The liability to ulceration of the cornea renders this disease a source of great anxiety to even those of most experience ; yet it is common to see the management of these cases undertaken by nurses or friends, whose little knowledge is worse than ignorance, and who waste precious time in trying worthless means, until it is discovered, too late, that fatal injury has been done to vision.

Cleanliness is of the first importance in these cases, not only for the safe recovery of the eyes affected, but to lessen the danger of contagion. Many an eye has been lost in consequence of being touched with a finger or a towel or handkerchief which had been in contact with matter from the eye of the babe. The discharge must not be allowed to remain in the eye, but should be thoroughly washed out every hour or half-hour if necessary, by means of a small syringe introduced under the swollen upper lid, so as to completely cleanse the eye from the accumulated secretions. Applications to the outside of the lids, such as poultices, etc., should be absolutely abstained from, as they are highly dangerous. It is important that the medical adviser should see the disease in its earliest stages ; as its fearful progress may often then be cut short or its severity mitigated.

INFLAMMATION FROM EXPOSURE TO COLD OR DUST.

The most common affection of the external membranes of the eye results from the action of cold or dust or some similar source of irritation. It may also extend through a family or neighborhood where the same towels or wash-basins which have been used by an individual having sore eyes are made to serve for other persons.

The pain complained of is a smarting or itching, as if sand or sticks were in the eye, and matter is discharged in greater or less amount, frequently causing adhesion of the lids together during the night.

The disease is often easily relieved at the outset by suitable remedies, but if these are neglected, or if inert or too harsh measures are resorted to, the symptoms are aggravated or indefinitely prolonged, the disease having little tendency to spontaneous cure. Examples are constantly seen of the melancholy results of inattention and mismanagement. Workingmen are unwilling to lose time in attending to their eyes during the early period, and when at last they seek advice because they are unable to work any longer, the slight changes of structure at the beginning have become so great that months instead of days are required for the restoration of the healthy condition. When not absolutely neglected, the eyes are often tampered with, and with ruinous results. The catalogue of substances in popular repute as sure means of relief would be almost endless. Of these a few would be useful if employed in cases to which they were suited, but most of them are worthless and many injurious.

INFLAMMATION FROM CONTAGION.

Rapidly fatal ulceration of the cornea may ensue upon inflammation of the conjunctiva following the introduction of a minute particle of contagious matter, eyes being sometimes thus totally lost in from twenty-four to forty-eight hours. Immediate and skilful treatment is imperative if the eye is to be saved. Great care should be taken to preserve the other eye, as well as those of any persons who may be exposed, from inoculation with the virulent discharge by a careless touch with the fingers or with anything which may have been infected by it.

GRANULATIONS OF THE EYELIDS.

After long-continued inflammation, and frequently without this, the inner surface of the upper lid may become rough from the formation of what are termed granulations. Sometimes these are almost cartilaginous in their hardness, and their constant friction upon the cornea, a thousand times a day, every time the eye rolls or the lids wink, leads to dangerous alterations of its condition. The cornea loses its smoothness and transparency,blood-vessels are developed where none ought to be visible, and at last ulceration and perforation take place, causing more or less implication of internal parts and injury to vision.

When the front of the eye has become so entirely clouded that the person cannot find his way or do more than perceive light, great patience and confidence are required on the part both of the sufferer and his physician. Speedy removal of the morbid changes is wholly impossible : until the roughness of the eyelids has been greatly lessened the cloudiness of the cornea can be but little diminished, for the cause continuing to act the effect remains. It is hard for a person and his friends to believe that he is improving, and is even nearly well, when he cannot perceive that he sees much if at all better : yet this may be the case ; it being only when the granulations have been almost removed that the cornea recovers from the effects of their friction and its clearness is gradually restored. Therefore the sufferer should take courage if his eyelids are made more comfortable and the discharge from them grows less, and treatment should be hopefully continued till the amelioration of some of the conditions prepares the way for an evident improvement of his sight. No advantage is obtained from frequent changes of remedies in the hope of a more rapid gain.

It is important that the granulations should be entirely removed. Those who have been blind for months or years are too often so rejoiced at the recovery of sight, and of a comfortable state of the eyes, that they disregard the lingering of some remains of disease beneath their lids, which may be roused by slight causes to renewed activity. They are anxious to return to their occupations, and hope their eyes will go on in their course of improvement. It is unsafe, however, to indulge this hope prematurely, and treatment should not be abandoned till all parts of the lining of the lid have been brought to so healthy a state that the inconveniences and dangers of a relapse are no longer to be feared.

ULCERATIONS OF THE CORNEA IN CHILDREN.

Ulcers of the cornea, most frequently near its centre, are very common in young children. They are attended with intolerance of light, sometimes so extreme that the child gives up all his usual pleasures and even his food, to keep the lids day after day spasmodically closed and the head buried in cushions or pillows. In other cases the eyes can be opened in the afternoon or evening, though they shrink from the morning light. Children often become restless and peevish, the whole disposition being changed during the continuance of the disease. These cases differ greatly in their duration, and if neglected may be prolonged for months, till the health suffers from want of air and exercise.

It is usually possible, by engaging the child’s attention, to obtain a look at the eye in a moderate light, so as to ascertain the extent of the ulceration, without resorting to forcible opening of the lids.

Even when superficial, these ulcers usually leave behind them a temporary cloudiness of the cornea ; and if they penetrate deeply they cause a permanent opacity, which, though it may lessen in extent and density, does not wholly disappear, but affects vision in a greater or less degree. It is therefore very desirable that the ulcerative process should be arrested as soon as possible, to shorten the term of suffering and avert the injury to sight.

Solutions of sugar of lead, a favorite popular remedy, should be avoided with especial care in all diseases of the eyes in children, since, where ulceration exists, the lead solution is decomposed and forms an indelible white deposit upon the ulcerated surface. Laxative medicines, or blisters, so often used as domestic prescriptions in the hope of clearing the system of “ humors,” are also objectionable ; the child more often needing tonics and good diet than any debilitating treatment.

Small pimples, of which there may be one or several at or near the edge of the cornea upon the white of the eye, must not be mistaken for the ulcerations above referred to. They are of comparatively trivial importance, and can be disposed of in a few days by the use of mild lotions, which are better than more severe treatment.

Henry W. Williams, M. D.