By some this disease is considered an =eczema= of the conjunctiva.
This will at least enable us to get an idea of the conjunctival
pathology. What is said of phlyctenular conjunctivitis applies largely
to its corresponding disease of the =cornea-phlyctenular keratitis=.
Scrofulous ophthalmia is applied by some because so many of these
phlyctenular patients have =scrofula=. Herpes conjunctivæ is used as a
name because of the small blisters or blebs that form in the beginning
stage. Little red eminences develop near the limbus (sclerocorneal
junction). They are cone shaped, slightly elevated about the
surrounding tissue. There may be one or several, usually not more than
one or two. After a few days the cone breaks and on top appears a small
gray ulcer. There is further breaking down and the cone disappears
leaving an ulcer on level with the conjunctiva. Vessels are congested
about it. There may often be noted an area of small vessels, fan like
in shape, running from the outer region of the conjunctiva to the ulcer
or phlyctenule.
=Etiology.=—This is a disease of frequent occurrence in children,
mostly among the poor classes. Such things as eczema, dirt, adenoids,
scrofula, rhinitis, malnutrition, abuse of tea and coffee and
exanthematous disease are mentioned by oculists as causes. I have
no doubt any or all these conditions predispose to phlyctenular
conjunctivitis.
De Schweinitz in “Diseases of the Eye,” 1916 edition, p. 242, says:
“The exact cause of ocular lesions, or phlyctenular eruption, has not
been determined.”
I have met Dr. De Schweinitz and heard him lecture on the eye. I
consider him one of the best eye specialists in the country. His
experience and study with the eye dates over many years and his book
has gone through eight editions. He is professor of ophthalmology in
the University of Pennsylvania; Ophthalmic Surgeon to the Philadelphia
Polyclinic Hospital, the Philadelphia General Hospital etc., etc.
His opinion represents the summary of the investigation of the
ophthalmic profession the world over and through all the past down to
the present time. “The cause of phlyctenular conjunctivitis is not
known.”
=Bacteriology.=—At times in the ulcers have been found the
staphylococcus pyogenes aureus and albus. They are also found in a
normal conjunctival sac. They could not with logic be taken as a
causative factor; at least they would be only secondary.
If oculists and other students of the eye all had a good deep
osteopathic vision to throw light upon these problems many causative
factors would take on a new meaning. Such supposed causes as have
been mentioned, e. g. eczema, adenoids, rhinitis and malnutrition may
easily be secondary to the osteopathic lesions. Micro-organisms may be
enabled to act because of trophic and circulatory disturbances to the
conjunctiva through disturbed nerve connections from lesions in the
cervical and upper dorsal regions. Herpes zoster is purely a trophic
nerve disturbance manifestation on the skin as blebs or blisters with
more or less neuritis. Any lesion that would affect the integrity of
the function of the fifth cranial nerve might easily manifest itself as
herpes of the conjunctiva.
We believe the osteopathic lesion is primary and fundamental in the
causation of most of our phlyctenular conjunctivitis. Of course
insanitation, scrofulous diathesis and the exanthemata play their role.
A good diagnostician should figure out the relative importance. The
history, onset and examination will usually eliminate these conditions.
=Symptoms.=—Lachrymation, photophobia, blepharospasm and injected
vessels are the chief symptoms. There is pain as well as fear of light.
The child fights examination.
The attack subsides in ten to fourteen days unless there is
multiplicity of blebs. Some patients have repeated attacks for months
or years. Many of these cases in medical clinics keep coming for months
with repeated attacks. Never leave out careful osteopathic treatment.
=Prognosis.=—This is favorable for a final cure. If there should be
multiple blebs and frequent recurrence and the cornea is invaded,
the prognosis is not good for perfect sight. The pathology goes deep
enough to affect Bowman’s membrane of the cornea disturbing the
substantia propria. This causes a macular condition of the cornea which
impairs sight.
=Therapy.=—Diet should be bland; the eyes should be protected from
irritants; yellow oxide ointment should be used in the eye once a day
or 10% argyrol. The ointment is preferred. Moist warm compresses on
the eye are comforting. A boric acid wash in almost all conjunctival
trouble is good. If there is much irritation giving a suspicion of iris
involvement a drop of atropine ½% should be used. The general regimes
of living should be regulated.
Osteopathic treatment should be directed toward building up the general
health and correcting all lesions, especially that may have a specific
bearing on the eye trouble. Such lesions will be found more often at
the first, second and third thoracic, but may be anywhere from there to
the occiput.