3. _Acute iritis_ not infrequently occurs after extraction. It usually
comes on about the third day and may be accompanied by hypopyon. It may
settle down under atropine, leeching, and dry heat, but may also pass on
into the more chronic form; adhesion of the iris to the capsule,
however, frequently results. More rarely the disease may not make its
appearance till two or three weeks after the operation (latent sepsis),
the patient suffering from recurring attacks of hypopyon. In these cases
in which the hypopyon persists, washing out the anterior chamber with
peroxide of hydrogen (10 vols. %) and the administration of a vaccine is
of service.
4. _Chronic irido-cyclitis_ is usually primary, but may occasionally
follow an acute attack of iritis. Of all the disastrous complications,
this is by far the worst. It may not only destroy the sight of the eye
on which the operation has been performed, but may set up sympathetic
ophthalmia in the other eye. The eye does not settle down well after the
operation, there being usually some prolapse of the iris or capsule into
the wound. It remains injected or flushes up on exposure to light. After
a time (usually about the end of the third week) keratitis punctata
makes its appearance, and the tension of the eye may become decreased or
occasionally increased. The disease may resolve or go on to shrinking of
the globe. Energetic treatment with atropine and hot fomentations
locally, with the internal administration of iron, is indicated. The
administration of staphylococcus vaccine causes only temporary
improvement in most instances. In six cases so treated by the author the
improvement was only temporary, in spite of the fact that there was a
definite local reaction to the vaccine and in two cases the
staphylococcus albus was isolated from the fluid in the anterior
chamber. If at the end of two months the eye be red and well-marked
keratitis punctata be present, and if the pupil be beginning to be drawn
up and the eye shows no tendency to improve, enucleation should be
seriously considered; this is especially advisable if the projection of
light has become defective, showing that the retina is probably
detached. If any signs of sympathetic irritation, such as mistiness of
vision, ciliary flush, or photophobia, appear in the eye which has not
been operated on, the exciting eye should be enucleated. On the other
hand, if well-marked inflammation has developed in the sympathizing eye,
which may also be cataractous, and the other eye has a fair amount of
vision, it becomes extremely questionable whether it is advisable to
enucleate the exciting eye. Every case must be judged on its own merits
according to the extent and severity of the disease. In a few cases in
which the incarceration of the capsule in the wound leads to a very
chronic cyclitis, its division with a cutting needle will sometimes lead
to subsidence of the inflammation. It is most important that every eye
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