In ophthalmia, attended with profuse _purulent_ discharge, the
structure of the eye is in great danger of being destroyed, from the
intensity of the action, and its liability to extend to the deep parts
of the organ; the most active practice is required from the first.
Copious general depletion, ad deliquium, must be quickly had recourse
to; and the patient must be freely purged, and kept in a state of
partial nausea for some time, by exhibition of antimonials. After
general bloodletting, the repeated application of leeches to the inner
canthus is necessary, in order to empty sufficiently the vessels of the
part. Where the chemosis is so extensive as to bury the cornea, as it
were, beneath the folds of the swollen conjunctiva, sloughing of the
transparent tunic is frequently threatened. In order to arrest this
fatal result, much good is often obtained by division of the chemosis.
A sharp-pointed bistoury is passed through the swollen membrane, and
radiating incisions practised, commencing at the corneal margins, and
directing them towards the circumference of the globe. Sometimes four
or even five of such divisions are called for, while care is taken not
to wound the sclerotic coat beneath. A considerable quantity of blood
is sometimes lost by this procedure, and, the chemosis subsiding,
the cornea is saved. Infusion of tobacco, solutions of acetate of
lead, and nitrate of silver, æther and laudanum, have been used as
applications to the eye from the very commencement of the affection;
but the propriety of the practice appears very questionable. Blistering
the nape of the neck proves highly beneficial, after the employment
of the antiphlogistic measures; and in many cases it is necessary
to keep up discharge from the blistered surface for some time. On
subsidence of the violent symptoms, the swelled conjunctiva is to
be attacked with escharotics and stimulants, as the nitras argenti,
sulphas cupri, or various collyria: then only can such applications be
advantageous; at an earlier period they must do harm. They repress the
exuberant granulations which may have formed, or may be forming, on the
conjunctiva of the eyelids, promote contraction of the dilated vessels,
diminish the relaxation of all the tissues, and stimulate the now
dormant action of the part into a healthy state of excitement. Gently
stimulating collyria may be injected betwixt the lids, by means of a
small syringe. In granulated conjunctiva, it is sometimes necessary to
remove a greater or less part of the diseased membrane by escharotics,
the knife, or scissors; and after this has been accomplished it is
well to encourage bleeding to a slight extent. In removing part of
the palpebral conjunctiva, care must be taken to avoid injuring the
cartilage of the tarsus; and, in the lower lid, not to take away too
large a portion, lest entropion should occur during cicatrisation. In
hospital practice, the infected should be separated from the healthy;
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