This disease is known as =granular lids= or =granular conjunctivitis=.
Although the germ has not been discovered, we know this is an
infectious disease. A roughness and hypertrophy of the conjunctiva
develops. There is development of follicles or granulations. Later
these products are absorbed and cicatrization of the tissues follows.
=Cause.=—Trachoma is found most common in Egypt and Arabia. It spreads
easily in crowded institutions. It is in many instances a mixed
infection with the Morax-Axenfeld bacillus, Koch-Weeks bacillus and the
gonococcus.
=“Trachoma bodies”= have been discovered which are claimed by some to
be a causative factor in the disease. These small bodies are not found
in all cases however.
Spinal lesions of the cervical and upper four thoracic vertebræ will
disturb the blood and nerve supply to the eye which will predispose to
the disease should some of the virus or germs of trachoma be present.
In practically all these cases there is tenderness if not an actual
twist at the second and third thoracic.
=Symptoms.=—A small boy came to our clinics complaining that his
left eye was smaller than the right. No inflammation or swelling
was prominent. The eye looked normal except slightly smaller than
the right. On turning the lid granules in the fornix of that eye
were readily noticed. Trachoma had a good start. The tissues were so
hypertrophied in that region that the eye could not be opened quite
as wide as the other one, hence the impression that that eyeball was
smaller. The granulation often develops so insidiously that the victim
may have the disease for months before he realizes he has a bad eye.
When symptoms appear there may be photophobia, lachrymation, gluing of
the lids from a scanty secretion, pain, and blurring of vision. The
granules are gray, translucent and roundish under the conjunctiva.
Hypertrophy increases to a certain height when cicatrization and
contraction begin. The duration may be years. The more the hypertrophy
the longer the duration and the greater the contraction. (Note here
that treatment should be directed toward combatting the hypertrophy by
establishing circulation).
=Sequelæ.= I merely mention the sequelæ here: pannus, ulceration of the
cornea, trichiasis, dystrichiasis, entropion, ectropion, symblepharon,
xerosis, corneal opacities. For the explanation, pathology and
treatment of these sequelæ not covered in this treatise, see any good
works on diseases of the eye as Weeks, Fuchs or De Schweinitz.
=Treatment of Trachoma.=—In reporting cases of trachoma treated and
cured by osteopathy we should be sure of our diagnosis.
The treatment is antiseptic, hydrotherapeutical, osteopathic and
operative. A saturated solution of boric acid should be used. Argyrol
20% is good if there is much secretion. Nitrate of silver 2% and copper
sulphate are still used in some cases to advantage as claimed by some
physicians. The osteopath should count on careful cleanliness.
Hot compresses over the eyes are often very agreeable.
Operations are often performed for trachoma. The granules are rolled
out with Knapp’s roller forceps, and other methods.
=Grattage= is practiced with some wonderful results. It is done as
follows: Get some fine sand paper and cut it in strips about one-half
inch wide by three or four inches long. Put it in alcohol in a vessel
for ten to fifteen minutes. Pour off all the alcohol except a few drops
that will cling to the vessel by capillary attraction. Touch a match
to the residue. This will burn just enough to make the sand paper
absolutely sterile without burning the latter. Put the patient under
somnoform. Use a small artery forceps to grasp the edge of the eyelid,
roll the lid back over the artery forceps to expose all granulations
clear to the fornix. Use a protector to the eyeball. Now with the
sandpaper quickly scrape or curette away all of the trachoma bodies and
granulations. Repeat the process on the other eye if it is involved.
Wash out well with a saturated solution of boric acid and bandage
the eyes for a few hours. This will cause considerable swelling and
inflammation. Use cold applications and keep the eyes disinfected. I
have seen some very good results from this method.
=Osteopathic.=—Following the sand paper operation a thorough treatment
of the cervical and upper dorsal region would add considerably to the
rapidity of the patient’s recovery and sense of well being. General
tonic treatment is of special benefit in nearly all trachoma cases as
they are subnormal in their general health.
One form of technique which has been used by myself and others
to advantage in these cases is as follows: Sterilize the fingers
carefully, lubricate with vaseline or K. Y. the forefinger of the
right hand. With the left hand raise the upper lid and introduce the
forefinger of the right hand with the thumb above. Catching the lid
between the thumb and finger squeeze and massage the whole structure
clear to the fornix as thoroughly as possible. Repeat the process on
the other eye.
A technique used by Dr. Edwards of St. Louis is as follows: After
sterilizing and lubricating the forefinger lift the lid and introduce
the finger as far as possible into the orbit pushing the fornix back
into the orbit. This stretches all the tissues around the fornix,
opening up a better conjunctival and palpebral circulation. The
ciliary vessels and nerves are stretched and stimulated. It is rather
surprising to one who has not tried it, how far the finger can be
introduced into the orbit.
One set of nerves that should be especially studied and considered in
trachomatous conditions is the cere-brobulbo-spino-sympathetic-ciliary
arc. This has already been elaborated. All spinal lesions should be
carefully diagnosed and corrected.
Dr. T. J. Ruddy’s third finger eye instrument is very useful in these
conditions in restoring normal circulation about the orbit.
See that the nose and throat are normal.