=Symptoms and Course.=—There is a gray area surrounding the ulcer
at first, also the floor is grayish in color. In this condition it
is known as a =progressive= ulcer or a =foul= or =unclean= ulcer.
This cloudiness or gray area may increase in size and the ulcer keep
spreading, or it may go deeper even to perforation of the cornea.
Some ulcers advance or spread on one side and heal on the opposite
side so that they creep along on the cornea—these are the so-called
=serpiginous ulcers=.
With corneal ulcers there is irritation, pain, photophobia and
increased lachrymation. There is usually some ciliary injection which
is an indication of involvement of the iris and ciliary body. If
iritis occurs there is contraction of the pupil with slow reaction.
=Hypopyon= may develop. With iritis and the exudate there is likely to
be adhesions between the iris and the lens known as posterior synechia.
A few corneal ulcers are asthenic and do not have irritative symptoms
and yet are dangerous.
When the ulcer begins to heal it is called =retrogressive=. Dead
tissue is cast off; other tissue becomes transparent from resorption.
We have a =clean= ulcer. Symptoms disappear and cicatrization begins.
Vessels extend to the ulcers and soon it is leveled up with the corneal
surface. Cicatrization may leave it slightly below the corneal level or
above it.
If there should be perforation of the cornea from the ulcer there may
be =complications=, e. g. keratocele, loss of aqueous, dislocation
and expulsion of the lens, intra-ocular hemorrhage, flattening of the
cornea, fistula of the cornea, glaucoma, intra-ocular suppuration,
prolapse of the iris into the opening, etc. These complications and
sequelæ that occur occasionally will not be considered here.
After healing is complete by cicatrization there is opacity of the
cornea in proportion to the depth and size of the ulcer. In months
and years of time there is some clearing of the opacity so that small
superficial opacities may become invisible.
=Treatment of Corneal Ulcers.=—Most ulcers of the cornea are quite
amenable to proper treatment and the prognosis is favorable. Neglect
or wrong treatment is very dangerous. The treatment is local and
constitutional. Often the ulcer is kept going by unwholesome
constitutional conditions.
=Local Treatment.=—This varies according to the stage of the ulcer,
whether progressive or retrogressive. In a progressive or foul ulcer if
due to trauma any foreign bodies should be removed. If the ulcer is a
result of pathology of the conjunctiva it is of primary importance to
treat the conjunctival condition.
In mild cases of ulcer a dressing over the eye with atropine ½% to keep
the pupil dilated is sufficient local treatment. The bandage protects
the eye from bright light and other environment and the atropine puts
the iris and ciliary body at rest preventing complications and giving
nature her best chance to work.
Public-domain text, read in full here on John Shaqi.
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