=Acute=.—mostly affects the conjunctiva of the lids in the light form.
If severe it invades the bulbar conjunctiva. There is redness and
swelling and increased secretion which dries at night upon the edges of
the lids and glues them together. The eyes are better in the morning
and worse toward evening. =Corneal ulcers= and =iritis= may arise as
complications. Chronic inflammation may result.
=Etiology.=—Textbooks on the eye give =bacteria= as the chief cause;
some scarcely mention anything else. After discussing how the bacteria
get there and multiply, they usually bring in some statement to
indicate that in many cases no bacteria can be found in the secretions
from the conjunctiva. These latter are unaccounted for in the etiology.
=Catarrhal conjunctivitis= is non-specific in its origin.
The great science of osteopathy will fill in the missing links to works
otherwise very exhaustive on the eye.
If the cause is due only to a passing irritant as dust, smoke, pollen
or wind the disturbance may vary from hyperemia only, to a severe
attack of conjunctivitis. Fuch says the majority of cases are produced
by bacteria, but THAT IN NOT A FEW CASES OF CONJUNCTIVAL CATARRH THE
EXAMINATION OF THE SECRETIONS FOR BACTERIA PROVES NEGATIVE. He also
says that the usual course of the disease is from eight to fourteen
days, but NOT INFREQUENTLY THERE REMAINS A CONDITION OF CHRONIC
CATARRH PROTRACTED OVER A LONG TIME; THAT NOT INFREQUENTLY THE NORMAL
CONJUNCTIVAL SAC CONTAINS PATHOGENIC GERMS.
Some authors divide the =etiology= into (1) specific, (2) non-specific.
The first they account for by irritants due to dust, heat, smoke,
metal, pollen, cold, wind, glare of light, eye strain from overwork of
the eyes, ametropia and chronic alcoholism. The second they account
for by germ life, most often the Morax-Axenfeld diplobacillus or the
Koch-Weeks bacillus, the latter germ being found in the so-called
“pink-eye.” It is contagious. This is one condition for which the zinc
sulphate (½% to 2% solution) is almost a specific.
No doubt the irritants and the bacteria mentioned, with others, do
cause much of our catarrhal conjunctivitis and that one who fails
to consider properly the local conditions in practice will be sadly
lacking in best results.
On the other hand many cases, treated for local conditions only by
very competent men who used the best antiseptics and germicides, have
very indifferent results. The acute condition would continue and
gradually become chronic. From observation, study and experience there
are causes aside from local irritants, ametropia, bacteria, syphilis,
rheumatism or measles. There is some disturbance to the integrity of
the =spinociliary sympathetic arc=. In many cases of eye disease note
lesion and tenderness at the upper dorsal, the removal of which will
cause improvement of the eyes. Many cases of eye strain can be relieved
by correction of the first, second or third dorsal, and the use of
glasses made unnecessary.
Irritation of the eye will cause more or less tension of the muscles at
the second and third dorsal, and stimulation of the tissues near the
second and third dorsal spines will cause dilatation of the pupils and
contraction of vessels of the cranial mucous membranes; which means
vasomotor, secretory and trophic disturbances.
It follows then that an =osteopathic lesion= at the second or third
dorsal will cause or tend to cause disease of the eye. There may be all
gradations in the effect produced, the lighter being mere tendency,
while again it may be enough to set up profound vasomotor, secretory
and trophic changes in and about the eye. The first effect of the
lesion may be stimulatory, and later, inhibitory. The normal resistance
of the eye would be lowered and naturally, local irritants, bacteria
and ametropia would have a more profound effect. This will explain how
one can develop conjunctivitis in the absence of a local irritant with
no bacteria present, and no eye strain.
All of these causes, or any number of them, may be acting together, and
each more virulent because of the influence of the other.
=Lesions= of the =occipito-atlantal= joint or any of the cervical
articulations may cause eye disturbance. There are no efferent
ramicommunicantes in that region and the course of the physical
disturbance must be greater in proportion to the eye trouble produced,
than at the upper dorsal. It is important however to make a close
examination of the entire cervical region in eye trouble.
What has been said on the osteopathic causes of acute catarrhal
conjunctivitis applies with equal force to chronic and =follicular
concatarrhal conjunctivitis.=
What has been said on the osteopathic causes of =acute= catarrhal
conjunctivitis applies with even greater force to the =chronic=
form. The great variety of local irritants may account for acute
conjunctivitis, and does in most instances; but in chronic
conjunctivitis local irritants are more often secondary or
incidental while the osteopathic lesion with its effect upon the
=bulbo-spino-sympathetic= ciliary arc is the =fundamental= cause. Of
course some continuous local irritant, e. g., an uncorrected refractive
error, excessive light, heat, dust or germ life in the environment may
cause a chronic conjunctivitis. Other causes may be retracted lids
(lagophthalmus) leaving the eyeballs too prominently exposed; turning
in of the cilia (entropion, trichiasis or dystrichiasis) which impinge
upon and irritate the bulbar conjunctiva. =Chronic blepharitis= may
spread to the palpebral conjunctiva and then the bulbar. Foreign
bodies in the eye, or infarction of Meibomian glands may be causes.
The diplobacillus (Morax-Axenfeld) is the most common germ in chronic
catarrhal conjunctivitis.
=Symptoms and Course.=—In mild cases the redness is only moderate.
The conjunctiva is smooth and not swollen. Old cases have hypertrophy
with thickening. There was a small girl who came into the office
recently who had the conjunctiva of the lids decidedly swollen with
some hypertrophy. Her eyes were glued shut with pus every morning. Pus
pockets were forming along the follicles of the cilia and on the direct
edge of the lid. Her troubles started a year ago and got gradually
worse. A few osteopathic treatments were given during three months
(she was irregular in coming) and argyrol, 20%, used locally. All pus
and debris were cleared off the lids and conjunctiva each time. The
swelling all left and the thickening became inconsiderable; the eyes
looked almost clear. On pressure there was tenderness at the right side
of the second dorsal. No mechanical lesion was apparent there but in
treatment that region was thoroughly loosened.
The subjective symptoms are usually worse at night; pain, heaviness of
the lids; feeling of a foreign body in the eye; burning; itching and
dryness in many cases.
This condition is one of the most frequent of eye diseases in adults;
may be senile catarrh in advanced age. It is frequently complicated
with blepharitis, ectropion, epiphora and ulcerations of the cornea.
=Treatment.=—The osteopathic treatment depends on the findings in the
osteopathic examination. No case of chronic catarrhal conjunctivitis
should be treated without a thorough examination of the whole spinal,
rib and innominate mechanism. Careful and detailed adjustment should be
made of any lesions that might disturb the ciliary arc, the other nerve
connections, the blood supply or the body equilibrium.
This does not mean that local treatment of the eye should be neglected
in any way. Any measure that will aid in getting rid of local pathology
as quickly as possible should be ours. Where there is abundant
secretion, silver nitrate 1% to 2% solution put on the conjunctiva
with a brush when the lids are turned, or argyrol 20% to 25% dropped
into the eye are among the best antiseptics for local use. If the
diplobacillus is present zinc sulphate ½% solution is indicated.
The nose, nasopharynx and pharynx should never be overlooked in this
disease.