When the disease develops it will be manifested, as a rule, from three
to five days after birth by redness of the eye and a slight discharge.
It is the duty of the nurse, as well as of the accoucheur, to examine
the eyes of the new-born babe each day during the lying-in period, and
at the first sign of trouble, if discovered by the nurse, the attention
of the physician should be directed to the matter. During the first two
or three days after the disease begins there is usually little or no
pus present, and comparatively little swelling of the lids, except in
the most violent cases. During this so-called first stage the treatment
should be that of an ordinary acute catarrhal conjunctivitis—viz.: iced
compresses applied for an hour twice a day if the baby is well and
strong; gentle flushing of the conjunctival sac with a warm saturated
solution of boric acid. As soon as pus begins to form, the eyes must be
cleansed more frequently—every hour during the day and every two hours
during the night—and the edges of the lids should be kept constantly
anointed with sterile vaselin to prevent their agglutination and the
retention of the discharge. Drainage is indicated whenever there is
suppuration, and if we can prevent the sticking together of the lids
in this way, we allow free drainage and reduce the irritation which
invariably results from retention of the discharges in these cases.
In all cases it will be noticed that after the discharge has been
washed away from the everted lids there are strings or shreds of
mucus in the folds of the conjunctiva. The nurse should endeavor at
each cleansing to wash them out by continuous flushing and gentle
manipulation of the lids. If she does not succeed in keeping the eyes
free from these shreds the physician will remove them at least once a
day.
If the conjunctiva of the globe becomes swollen and edematous and rolls
up over the edge of the cornea, the nutrition of this precious membrane
becomes threatened, and inflammation of the cornea, with ulceration or
sloughing, is the cause of the blindness which follows this disease. At
the slightest indication of haziness of its surface the iced compresses
should be discontinued and hot fomentations resorted to. They may be
applied every three hours for fifteen minutes each time. Great care
and judgment are necessary in order that the heat be sufficient to be
effective without burning the delicate skin of the lids and that it
be continuous. The compresses should be changed at least every sixty
seconds during their application. When the cornea becomes ulcerated
great care must be used in the manipulation of the lids not to make
pressure upon the eye-ball for fear of causing perforation. If the
lids are slippery from the presence of vaselin or discharge, a single
thickness of gauze or a little cotton held between the finger and the
lid will be found a great help in opening the eye.
As the discharge of pus begins to diminish, which may not be for
several weeks in bad cases, we may somewhat modify our treatment; the
strong applications need not be quite so strong, and the cleansing need
not be quite so frequent; but the most important item in the treatment
of all these cases is the frequent thorough cleansing of the eyes, and
if the cleansing is thoroughly done as above described each hour and
the lids kept constantly anointed, in order to prevent accumulation
of the irritating discharge, more frequent cleansing will not be
necessary. Great care must also be exercised to prevent much crying by
these little patients. They must be kept warm, regularly nursed or fed,
and the slightest derangement of the alimentary canal must be attended
to. If the cause of the crying cannot be ascertained and removed, it
is wiser to soothe the baby with a simple anodyne than to permit the
crying to go on.
It should not be necessary to point out the danger which lies in all
things which come in contact with the discharge from these eyes.
Blennorrhea neonatorum is responsible for at least 25 per cent. of all
the blindness in the world, and yet not one case in a hundred should
result disastrously if skilfully and patiently managed.