This disease is sometimes called =purulent ophthalmia= or =acute
blennorrhea=, It is caused from an infection of the conjunctival sac
with the gonococcus of Neisser. Contact with soiled fingers or linen
may transfer the germ.
=Symptoms.=—Within 12-48 hours after inoculation the first symptoms of
redness and irritation occur. This is soon followed by much swelling
and tension of the lids and chemosis of the conjunctiva. There is much
pain and a copious discharge of pus coming from beneath the lids. At
first the pus is yellow or yellowish green.
Later the symptoms begin to subside; there is less tenseness and heat;
the lids can be more readily everted and the discharge ceases after 6
or 8 weeks. The puckered conjunctiva becomes rough and granular.
In these cases the =prognosis= is always grave; more so than in
ophthalmia neonatorum. The eye is almost always marred in some way.
One of the great dangers is involvement and destruction of the cornea.
If the cornea becomes hazy soon after symptoms begin it is not a
good omen. =Ulcers= will likely form and then there is a tendency
to puncture the cornea. In mild cases the cornea may escape without
injury. In severe cases it is likely to ulcerate. If it perforates,
the anterior chamber is emptied and the iris prolapses into the
perforation; adhesions take place and there is healing with reformation
partially of the anterior chamber. An adherent leucoma is the result
with practical loss of vision. There may be a bulging of the cornea
known as anterior staphyloma. The iris and ciliary body may become
involved, causing iritis and cyclitis, or the whole inner structures
may be affected making a =panophthalmitis= with =atrophy= of the
eyeball.
The cornea is affected by the infective material direct or the nutrient
vessels to the cornea at the limbus may be obstructed by the extreme
swelling and pressure.
=Complications= of arthritis, rhinitis, septicemia and endocarditis
may arise. If there is none of these, at least there is a general
debilitated condition which needs attention.
=Treatment.=—The treatment should be =local= and =constitutional=,
The diagnosis should be made quickly from the history, symptoms
microscopically, and local cleansing begun at once and followed
diligently. Excessive discharge should be wiped away with cotton. The
conjunctival sac should be thoroughly irrigated every hour or oftener
if necessary to keep it clean. This is to be done day and night. A
saturated solution of boric acid may be used, or corrosive sublimate
one grain to the pint, or permanganate of potassium solution 1-5000.
The irrigation should be followed by the free use of argyrol 25%. This
procedure will keep the eye clean and be the means often of saving the
cornea from destruction and the eye from blindness.
If there should be ulceration of the cornea a drop of atropine ½%
should be used in the eye often enough to keep the pupil dilated and
the ciliary body at rest.
Osteopathic physicians no less than other physicians should not
neglect this local, careful, persistent, antiseptic cleansing of the
eye in such cases. The osteopathist can do more. He is not limited
to antisepsis even in this kind of work, however important it might
be. The unaffected eye should be carefully protected. Buller’s shield
should be used.
The osteopath should give thorough treatments to the neck and the fifth
nerve.
Supporting treatment to the system according to indications should
be given e. g., bowels, kidneys, nerves, muscles, joints as in
constipation, nephritis, neurosis, rheumatism, arthritis, endocarditis,
septicemia, rhinitis etc.