Diseases of Conjunctivitis (Ophthalmia)

Shri Swami Sivananda

This is an inflammation of the conjunctive, the living mucous membrane of the eye and the eyelids due to local irritation, eye-strain, infection, foreign bodies, cold wind, exposure to irritant smoke or gases, exposure to heat, excessive glare, dust or contact with dirty fingers, kerchieves and the like specially of patients suffering from this disease.

There are a smart feeling of pain and grittiness in the eyes as if sand or grit were in the eye and intolerance to light. The eyes become severely congested, red and watery. The patient feels better on keeping the eyes shut.

Although conjunctivitis is not serious in itself, it may lead to serious developments if not timely attended to. Much of the blindness in India is due to neglect of this simple and common disease.

Not in itself a serious condition, if may yet give rise to grave complications, as for instance, ulceration of the cornea.

Bacteriological investigations have shown conclusively that micro-organisms are the cause of neatly all cases of acute and tub acute conjunctivitis. This explains why epinemice or conjunctivitis often occur in schools, orphanages and similar institutions, the infection being readily conveyed by towels sponges etc, from one person to another.

Both eyes are usually affected, but very often the disease begins in one eye some days before it attacks the other. The second eye becomes infected by accidental contamination with discharges from inflamed eye.

There is pain in the forehead or head generally, and often some feverishness. There is a discharge from the eye at first clear and thin, but afterwards thick and of a yellowish-white colour. During sleep this discharge collects as the edge of the lids and dries there, gluing together the eye-lashes.

If this simple form is treated at once it will give little trouble. If it is allowed to become purulent, it spreads attacks whole family. The duration of the disease may be a few days or several weeks.

Treatment

In simple cases all that is needed is to keep the eyes clean by frequently bathing the eyes with a mild antiseptic boric lotion. The bathing is best done by pledgets of cotton wool which can be burnt after use.

A special small flask known as an 'undine' with a long nozzle may be used to direct a stream of lotion over the eyeball.

Great care should be taken that towels, soap, water, etc. are not used in common.

Rest the eyes. Use glare protectors.

Keep the patient in a dark room with a green shade over the eyes. Bathe the eyes frequently with hot water or warm boric lotion or alum lotion.

The edges of the lids should be anointed every night with boric ointment to prevent sticking. If they adhere they should not be forced open, but be bathed until they separate.

If there is persistent pain a leach or two may be applied to each temple at the margin of the hair.

In the early stages two drops of castor oil under the lids will relieve the pain.

Give a purgative.

If there is pain and much redness give hot boric fomentation. In acute cases attended with watering a weak solution of silver nitrate grs. 2 in an ounce of distilled water is the best. In chronic cases a solution of zinc sulphate or alum grs. 2 in an once of distilled water is beneficial.

Patients generally rub the eyes always with cloth. This should be avoided.

Turmeric cloth or sterilised cloth of cotton wool may be held in the hand for swabbing the discharge from the eyes.

The diet shout be light and nourishing.

Chronic Catarrhal Conjunctivitis

This is a chronic inflammation of the conjunctiva. The most common causes are: the preceding acute catarrh, constant irritation due to trichiasis, irritation due to smoke, or heat and impure air, local irritation by a retained foreign body.

The conjunctiva of the lid is reddened. There is heaviness of the lids and the patient feel sleepy. The eye-lids are together. There is smarting and burning pain of the eye. The patient feels as if a foreign body is in the eye on account of the presence of mucus under the conjunctive. There is constant blinking. There is rapid tiring of the eye.

Treatment

Remove the cause.

Avoid smoke, dust, glare and heat.

Remove foreign bodies in the conjunctiva. Correct errors of refraction.

Apply silver nitrate solution 2% on alternate days if there is hypertrophy. Evert the lid and apply the drug.

Wash it with saline lotion. Zinc, boric, or alum drops are beneficial. Apply boric ointment to the margin of the lids to avoid sucking of the lids.

Remove constipation by a purgative. Give tonics to improve the general health. Have outdoor exercises.

Pray and meditate.

Gonorrhoeal Ophthalmia

It an acute inflammation of the conjunctiva which arises from infection with gonorrhoeal virus known as Gonococcus. It generally affects adults. It is always acquired. Urethritis often accompanies the eye trouble.

It starts acutely with great swelling and redness of the lids. Sometimes it is difficult to open the lids. The eye is tender on touching. There is pain in and around the eye. There is slight fever. The discharge is serious in the beginning. It becomes purulent after some time.

If the infection is moderate the eye may return to the normal condition within 2 or 3 weeks. A severe form of infection causes corneal ulcers.

Treatment

Whenever the attendants touch the eye of the patient, it should at once clean his hands perfectly.

If one eye of patient is already infected the other eye should be protected by the application of the Buller's shield to the eye. Let the patient lie down on the diseased side so as to avoid infection getting into the healthy eye. Cotton and others things which have been used for cleansing the eye must burnt.

The eye should be cleansed repeatedly every two hours with antiseptic lotion. A 2% silver nitrate solution should be applied. It should be continued as long as the secretion and the hypertrophy of the lid persists.

Granular Conjunctivitis (Trachoma)

This is very common disease of the eye due frequently to neglect of a simple conjunctivitis. It is characterised by the formation of granular bodies on the inner surface of the lids, more or less resembling sago grains, which irritate the front of the eye. Neglected trachoma causes opacity of the cornea.

This is infectious and generally bilateral. This is a contagious disease liable to spread in schools. It is an Inflammation of the conjunctiva. The infection is carried one eye to the other either directly or indirectly through infected clothes towels wash waters etc. Insanitary surrounding and over-congestion in sleeping rooms predispose the attack.

This is a chronic, persistent, and severe form of conjunctivitis very common in the East and in many Europe countries.

In the later stages of the disease there is much scarring and shrinking of the conjunctiva and the lids are turned wards (trichiasis), thereby causing the lashes to rub on the cornea. Loss of transparency of cornea and consequent direness of vision are therefore very frequent result of the disease.

The constant friction of the-granules with the causes an uncomfortable grit-like sensation and itching sometimes reddens the eyes and makes them water. It causes a vascular growth of the upper half of the cornea called parnus which obscures vision.

The cornea gets ulcerated on account of the rubbing the granules. Opacity of the cornea and impairment of vision result.

The disease is contagious. Therefore a towel or a cloth with which the affected eye is wiped should not be used for healthy eye.

The patient complains of photobia phob (fear of light) achrymation tears itching and burning sensation, feeling of a foreign body in the eye, heaviness of the lids, and swelling of the lids.

Treatment

The granules may be lightly touched with copper sulphate protecting other parts from its action.

The treatment takes a very long time. The doctor and the patient should have immense patience, where there is hypertrophy copper sulphate is used. It should be used if there is corneal ulcer. The touching up must be continued for months or even years till the whole hypertrophy vanishes. The application is made gently and repeated every few days. After touching the eyes should be washed with normal saline or boric or mag. Sulph. solution. In the later stages after completing the course copper citrate ointment may be applied once a day.

Nitrate of sulphur is used in the acute stage, and copper sulphate in the chronic stage if there are ulcers in the cornea care must be taken that the silver solution does not come in contact with them.

Sulphanilamide tablets are useful. Six tablets of 7grs. Each are given daily for a week supplemented with the eye ointment of the drug. Penicillin is highly useful.

There are various operative measures resorted to for the care of granular lids viz, scarifying, scraping of dissecting of the granules, excision of the transitional fold of the conjunctiva (a radical method), excision of the tarsus if there marked thickening and degeneration of the tarsus.

Avoid exposure to dust, smoke, heat and glare. Take heating things such as chillies and other hot spices.

Good diet, tonics and bracing air are desirable.

Great care should be taken to avoid the infection of second eye when one only is affected.

Ophthalmia Neonatorum

Conjunctival inflammation in the new born with 2 or 3 days is known as the Ophthalmia Neonatorum.

During the process of delivery the child's head and pass through the genital canal and receive the infection from the mother.

This is purulent conjunctivitis of early infancy due infection of the eyes at birth. It is the most common can of life-long irremediable blindness through perforation resulting opacity of cornea. This is due to gonorrhoea the mother.

This disease was once the scourge of many maternity hospitals and dirty tenements. It can only be checked by and cleanliness.

If may be attended with very several corneal ulcerative thereby destroying or doing great permanent harm to the sight. This disease has been held responsible for about fifth of all cases, of blindness in young persons.

Treatment

The treatment is the same as that of gonorrhoeal conjunctivitis. The eye should be washed thoroughly at frequent intervals with saline or boric or concentrated mag. Sulph. or perehide of mecury 1 in 20,000.

Silver nitrate 2% can be applied to the lids daily till all the symptoms and signs subside. Boric ointment should be applied to the lids at bed-time to prevent adhesion of the lids. If there is a corneal ulcer, atropine drops 1% should be used twice or thrice daily with hot boric fermentation.

Panophthalmitis

This is characterised by purulent inflammation of the whole eye-ball. It is due to Infection from perforting wounds, pyaemia, etc.

The signs and symptoms are acute and severe. There are acute pain, photophobia, watering of the eyes, swelling of the lids, redness of the conjunctiva. Pus accumulates in the anterior and posterior chambers. The whole eye ball undergoes destruction. The sight is completely lost. There are fever, headache and vomiting. There may be proptosis.

Treatment

Free purgation and salieylates will relieve pain and the constitutional disturbances to some extent. Locally atropine and warm compress will relieve pain.

When all the signs of inflammation subside, enucleation or removal the eyeball necessary.

Pterygium

This is a triangular thickening and extension of the junctiva on the cornea. The apex of the triangle is toward the centre of the cornea, the base usually towards the inner eanthus, sometimes towards the outer canthus. It is unsightly and may impair vision by encroaching on the space of the pupil or by causing astigmatism.

Both eyes may be affected. It is rare in children but common in persons above middle age. It is usually found in these persons whose occupation requires them to expose their eyes in the heat and glare of the sun.

Treatment

This disease can be prevented by wearing sun-glass glasses. It is removed by a surgical operation. Operation is the only cure.

Purulent Conjunctivitis

Acute conjunctivitis becomes chronic when there is discharge of pus, it is called purulent ophthalmia. When it is traced to a case of gonorrhoea, it is calIed gonorrhoeal thalmia.

Purulent conjunctivitis is a very severe variety or disorder. This may result from neglect of simple ophthalmic or from septic noxious matter as the discharge passed gonorrhoea being introduced into the eyes, either from dirty clothes, or otherwise children get the gonorrhoeal infection from adults from use of infected clothes, flies the carriers of the infection from eye to eye. It may also be resultant of smallpox or measles.

Inflammation is so severe, that the middle of the eye or cornea is almost hidden. Pain is also intense. It may also be difficult to open the swollen, eye to examine.

This may be contracted by infants from the mother during labour. As it is contagious it spreads rapidly in families, schools, etc., where there is overcrowding and want of sanitation.

Instead of a watery or slightly white discharge, pus is secreted in large quantities. In some cases the inflammation may spread to the deeper parts of the eye, and the organ is destroyed (Pan-ophthalmitis).

The duration of the disease may be, from 10 days to 2 or 13 weeks. It often leads to ulcer of the cornea or to a rough and irritable condition of the inside of the lids, either of which ailment may prolong the illness for months.

Treatment

Thorough and frequent bathing of the eye is of primary importance.

The use of penulin eye drops is of the greatest value.

Silver nitrate (1-2%) may be applied gently on a camel-hair brush once or twice. This is painful.

Protargol 5-10%, or argyrol 20% applied twice daily is also very beneficial. This is not painful.

Care should be taken that the disease is not communicated by clothes or otherwise, either to the other eye or to the eyes of attendants.

The camel-hair brush should be, washed in warm water after use and destroyed at the end of the illness.

The healthy eye must be prepared by a watch-glass held down with stocking plaster. This prevents pus trickle over the nose into the good eye during sleep.

The affected eye should be covered with a moist dressing with cotton wool and light bandage. The cotton should be frequently removed and burnt.

Keep the patient in a dark room. The bowels should be opened.

If the pain and inflamtion are great apply apply leeches to the temples.

The edges of the lids should be smeared at night with boric ointment to prevent them sticking together.

The strength of the patient should be maintained with good, easily digestible food, plenty of milk, etc. General health should be improved by giving tonics.

Symblepharon

This is an adherence complete or partial of the eye-lid to the eye-ball.

It is usually the result of burns of the conjunctiva by fire or caustic substances. This is as a result of apposition of two granulating surfaces.

Treatment

If the symlepharon interference seriously with the motions of the eye ball, or if it causes defect of vision by obscuring the cornea, it becomes desirable to relieve it by operation.

The operation consists in repairing the bulb from the adjacent lid by means of a scissors and preventing re-union of placing a graft or an oil cloth placed between the two granulating surfaces and allowing the granulating surfaces to beat separately.

If it consists of a simple band stretching from lid to eye-ball, it may be severed by ligature. If the band is board two ligatures may be used, one for either half.

Sympathetic Ophthalmitis

It is an inflammation of one eye due to effects of a similar inflammation of the other eye. The first eye is the exciting eye and the second is the sympathising eye. It generally arises as a result of injury of the ciliary body or the iris.

The sympathetic ophthalmitic generally arises four weeks after the affection of the excited eye. It may occur even months later. The sympathising eye shows a picture similar to that of the excited eye.

The symptoms slight disturbance of vision, pain, photo-phobia and watering of the eyes. Later on the eye is blind and the vision is totally lost.

Treatment

If there is irrecoverable loss of sight and if there is great pain and inflammation the eye should be removed in order to prevent the symphathetic ophthalmia of the other eye.

Locally atropine, hot compress and bandaging will relieve the pain to some extent.

Milk injections are beneficial.