Diseases of the Eye

The patient comes with the complaint of the tears running over (epiphora). On careful inspection we notice that the skin in the region of the lachrymal sac protrudes so as to appear fuller than on the other side. This swelling - tumor lacrimalis - is caused by the lachrymal sac being distended by the excessive accumulation of its contents. When pressure is made upon the tumor the contents are evacuated externally throughout the puncta, and appear, in recent cases, under the form of a purulent, in older cases as a mucous or even limpid liquid.

Sometimes, when pressure is made upon the lachrymal sac, the contents are forced not through the puncta but downward through the nose. This is the case when, as exceptionally happens, the nasal duct is freely pervious. Associated with these symptoms, which are an evidence of distention of the lachrymal sac and of abnormality in its secretion, there is usually a contraction (stricture) of the nasal duct. The proof of this is produced when we attempt to explore the duct with a Bowman’s sound, in doing which we come upon a spot where the duct is contracted or even altogether obliterated.

Fuchs, E. & Duane, A. (1899). Text-Book of Ophthalmology; Authorized Translation from the Seventh German Edition. New York: D. Appleton & Company. Pg. 564.

Entered by: Ayushi Chintakayala, 6/11/2020

Chalazion is a chronic affection of the Meibomian glands. It forms a hard swelling which develops very gradually in the lid. In many cases this occurs without any inflammatory symptoms whatever, so that the swelling is not noticed by the patient until it has become quite large. In other cases, however, there are moderate inflammatory concomitants, which, nevertheless, are insignificant in comparison with those which accompany a hordeolum. The tumor keeps constantly enlarging for months until it reaches the size of a pea or a bean; it then bulges the skin far enough forward to produce a perceptible disfigurement of the lid. Upon palpating the tumor we can make out that it is pretty resistant, and that it is intimately connected with the tarsus, while the skin lying over it can be displaced from side to side. Upon everting the lid we find the conjunctiva over the tumor reddened, thickened, and somewhat protruding.

Later on, the tumor assumes a grayish look as seen through the conjunctiva, and ultimately the latter is perforated; then a viacid, rather turbid fluid flows out, which represents the central softened portions of the tumor. But the main portion of the latter, consisting of spongy granulations, remains behind, for which reason the tumor after it has been opened does not at once disappear completely. On the contrary, it diminishes very gradually in size, and meanwhile it is not uncommon for the granulation masses to project like a fungoid growth through the perforation in the conjunctiva. It requires months more for the tumor to disappear completely. [...]

Chalazion affects adults more frequently than children.Not infrequently several chalazia are found at once in the same patient. A chalazion annoys the person who has it by the disfigurement it produces, and also by the condition of irritation which it keeps up in the eye. This condition of irritation is partly the result of the mechanical injury done to the eyeball by the uneven and bulging conjunctiva covering the inner surface of the tumor.

Fuchs, E. & Duane, A. (1899). Text-Book of Ophthalmology; Authorized Translation from the Seventh German Edition. New York: D. Appleton & Company. Pg. 533-534.

Entered by: Ayushi Chintakayala, 6/11/2020

Edited by: Sonia Y. Khan, 8/4/2020

Acute conjunctival catarrh, in the lighter cases, chiefly affects the conjunctiva of the lids and of the region of transition. The conjunctiva of the lids presents a vivid redness and is relaxed. The injection is usually reticulate – i.e., the separate vessels can still be distinguished as such; it is only when the injection is especially dense that the conjunctiva acquires a uniformly red appearance. The surface of the conjunctiva is smooth; catarrh is thus distinguished from some other forms of inflammation of the conjunctiva in which the latter is infiltrated and subsequently hypertrophied, as shown by the unevenness of its surface. The retrotarsal fold (as well as the plica semilunaris) is likewise greatly reddened and is somewhat swollen, while the conjunctiva bulbi shows little or no change.

The severe cases are distinguished from the lighter ones by the fact that the process invades the conjunctiva bulbi [and sometimes the cornea, too. These severe forms occur especially in epidemics of conjunctivitis]. The redness and swelling of the palpebral conjunctiva are greater, and moderate edema of the lids is often present at the same time. The conjunctiva of the eyeball shows both a dense reticulate reddening and a slight degree of swelling. Very frequently [especially in the form causes by Koch-Weeks bacillus] we find in the midst of the reticulate injection red-colored spots – i.e., small hemorrhages, ecchymoses of the conjunctiva – produced by the rupture of small vessels. The severer cases, in which the conjunctiva is affected throughout its entire extent, are designated under the name of ophthalmia catarrhalis, to distinguish them from the lighter forms, which are named simply conjunctivitis catarrhalis; and if at the same time there is a specially marked swelling of the retrotarsal fold, as occurs particularly in the epidemic form, it is called “tumid catarrh.”

Inflammation of the conjunctiva is accompanied by increased conjunctival secretion. This secretion appears under the form of flakes of mucus, swimming in the abundant lachrymal fluid. The more intense the inflammation the greater the secretion, and the more the character of the latter changes from mucous to purulent. Violent cases of ophthalmia catarrhalis, therefore, are in their inception often hard to distinguish from an acute blennorrhea of slight intensity, although, of course, the subsequent development of the case makes the diagnosis clear. The secretion which exudes from the palpebral fissure dries at night upon the edges of the lids and glues them together.

The subjective symptoms consist of photophobia, and itching and burning of the eyes. The intensity of the annoyance given depends naturally upon the degree of inflammation. Violent pain, however, is but rarely present, and then, as a rule, is excited , not by the catarrh itself, but by its complications (especially ulcers of the cornea). […] A very troublesome sensation frequently present is that of a foreign body being in the eye, and is caused by flakes and filaments of tough mucus in the conjunctival sac. If such filaments lie upon the cornea, they produce the disturbances of sight which the patients sometimes complain. These are distinguished from visual disturbances of more serious character by the fact that clear vision is immediately restored by brushing the mucus of with the lids. It is a characteristic feature of catarrh that all its disagreeable characters are least pronounced in the morning, and afterward gradually increase until they reach their highest point in the evening.

Fuchs, E. & Duane, A. (1889/1919). Text-book of Opthamology: Authorized Translation from the Twelfth German Edition (6th ed., pp. 139-140). Philadelphia: J. B. Lippincott Company.

Created by: Taha Jilani, 06/11/2021

Entered by: Rachel Johnson, 08/29/2021

In chronic conjunctival catarrh the changes objectively perceptible are on the whole but slightly pronounced. A moderate degree of redness of the conjunctiva is present, either over the tarsus alone or in the retrotarsal fold also. The conjunctiva is smooth and not swollen; it is only in old cases that hypertrophy with thickening and a velvety appearance of the conjunctiva is developed. The secretion is scanty and makes itself chiefly apparent by a gluing together of the lids in the morning. The whitish scum often found at angles of the lids is produced by the lachrymal fluid being beaten up with the secretion of the Meibomian glands into a sort of a foamy emulsion, as a result of the frequent blinking of the lids. The constant moistening of the skin at this spot often leads to the formation of excoriations. In many cases the secretion, instead of being increased seems even to be diminished. […] In fact, the subjective symptoms are generally so characteristic that the diagnosis of chronic conjunctival catarrh can easily be made from them alone. The discomfort of the patient is usually greatest at night. The heaviness of the lids, scarcely noticeable in the daytime, becomes at night so marked that the patient has difficulty in keeping the eyes open; he has the feeling of being sleepy. An annoying sensation of there being a foreign body – like a speck of dust – in the eye, is produced by the scanty secretion which remains in the conjunctival sac in the form of mucous filaments, and if these filaments lie upon the cornea the sign is interfered with, or rainbow colors make their appearance about a candle flame when looked at. Further unpleasant sensations of various kinds are described, as, for example, that the eyes burn and itch; that they are dazzled by the light; that, more-over, they are tired out quickly by working; that they blink often, etc. In the morning the lids are somewhat stuck together, or a little yellowish dried secretion is found to have collected in the inner angle of the eyes. In other cases there is an annoying sensation of dryness, and the eyes can be opened only with difficulty, the patient, at the same time, having feeling as if the lids were stuck to the eyeball because of the lack of moisture (catarrhus siccus). These troubles, so various in their nature, do not always by any means bear definite relation to the objective conditions.

[…] Chronic conjunctival catarrh is one of the most frequent of ocular diseases, chiefly affecting adults, and especially persons somewhat advanced in age.

Fuchs, E. & Duane, A. (1889/1919). Text-book of Opthamology: Authorized Translation from the Twelfth German Edition (6th ed., pp. 147-148). Philadelphia: J. B. Lippincott Company.

Created by: Taha Jilani, 06/11/2021

Entered by: Rachel Johnson, 08/29/2021

In an individual who suffers from blennorrhea of the lachrymal sac, a violent inflammation may suddenly develop in the region of the sac. The skin in its vicinity is then reddened and greatly swollen; the swelling also extends to the lids, and even to the conjunctiva, in which there is chemosis. The inflammation is accompanied by fever and violent pain, so that the patient is deprived of sleep for several nights. After some days the skin at the apex of the swelling takes on a yellowish discoloration, and finally becomes perforated, when quite a large quantity of pus is evacuated. Upon this the pain abates and soon ceases altogether, and the swelling also rapidly goes down.

Later on there is discharged from the perforation a fluid which at first is purulent, afterwards mucous, and at length perfectly clear like water. Ultimately nothing but the tears which are forced into the lachrymal sac run out again through the perforation, which latter is hence called a lachrymal fistula. As long as the lachrymal fistula remains open the patient is safe from any new attack of inflammation. But if the fistula closes up and the tears again accumulate in the lachrymal sac, a recurrence of the dacryocystitis may ensue.

Dacryocystitis consists in a purulent inflammation of the connective tissue surrounding the lachrymal sac. This inflammation leads to purulent disintegration of the submucous tissue with the formation of an abscess which ruptures externally. Dacryocystitis is accordingly a phlegmon. Blennorrhea of the lachrymal sac, on the contrary, is a catarrhal inflammation of the mucous membrane itself, in which the purulent secretion of the latter is deposited upon the surface only.

The connection between the two diseases consists in the fact that blennorrhea of the sac precedes the development of the phlegmon and gives rise to it; for the blennorrheal sac is filled with decomposed secretion, and it only requires the presence of a small defect in the epithelial covering of the mucous membrane of the sac to enable the microorganisms of the secretion to penetrate into the submucous tissue, where they excite suppuration and cause dacryocystitis.

Fuchs, E. & Duane, A. (1899). Text-Book of Ophthalmology; Authorized Translation from the Seventh German Edition. New York: D. Appleton & Company. Pg. 570.

Entered by: Ayushi Chintakayala, 6/11/2020

The prodromal stage […] is characterized first of all by attacks of obscuration of vision. […] as if there was a cloud or smoke concealing objects from him. If there is a light in the room, he sees a ring about it having the colors of the rainbow. […] frequently a feeling of tension in the eye, or a dull frontal headache […] anterior chamber is somewhat shallower […] pupil is more dilated […] tension of the eye is distinctly increased. […] lasts several hours, after which the eye returns once more completely to the normal condition […] attacks at first make their appearance at pretty long intervals (of months or weeks) […] become constantly more frequent […] they always cease when the patient falls asleep […]
The cause of an acute attack - […] congestion of the venous system […] mental emotions, particularly those of a depressing character; and, lastly, dilatation of the pupils. […] attack manifests itself by violent pain radiating from the eye […] in the head, the ears, and the teeth, which may reach an intolerable pitch. They deprive him of appetite and sleep; not infrequently vomiting and fever […] The field of vision is considerably narrowed, and mostly on the nasal side. […] accompanied by inflammatory symptoms […] After some days the pain diminishes […] eye becomes free from discoloration [...] vision never again reaches the same height […] overdistention of the anterior ciliary veins remains; the anterior chamber is shallower and the iris is narrower […] tension is permanently increased. […] Then a new attack sets in […] the sight at length becomes entirely extinct. […] The eye is completely blind […] the distended anterior ciliary veins […] form a bluish-red circle of dilated vessels. The cornea is shining and transparent, but insensitive […] iris is reduced to a narrow gray marginal band […] The dilated and rigid pupil is greenish, or of a dirty gray. the optic disk is deeply excavated, the eye as hard as stone. Later on […] cornea becomes cloudy and covered with peculiar glassy-looking deposits. […] the lens becomes cloudy […] the patient still constantly believes that he perceives light, especially under the form of a luminous haze […] attacks of pain keep making their appearance at intervals in the blinded eye. […] After the eye has been hard for years it at length becomes softer, smaller, and atrophic. […] 
Glaucoma almost always attacks both eyes […] second eye follows months, or even years, after that of the first. […] frequently between the fiftieth and seventieth year […] women more than men, especially women in whom the menopause occurs before the time. […] strongly myopic eyes are to be regarded as having almost complete immunity […] Furthermore, rigidity of the vessel walls (arterio-sclerosis) and habitual constipation predispose to glaucoma. […] many families in which glaucoma is inherited.

Fuchs, E. & Duane, A. (1899). Text-Book of Ophthalmology; Authorized Translation from the Seventh German Edition. New York: D. Appleton & Company. Pg. 367-371.

Entered by: Ayushi Chintakayala, 7/18/2020

[…] the increase of tension set in very gradually, so that no inflammatory phenomena are produced. The eye either looks quite normal externally, or it gives evidence of the lesion affecting it in the greater prominence of the distended anterior ciliary veins, and also in a somewhat dilated and sluggish state of the pupil. The tension of the eye is shown by palpation to be elevated, but not to any considerable degree. […] At these times a slight, smoky cloudiness of the cornea is also sometimes present […] Finally, there are cases of glaucoma simplex in which the tension is never found distinctly increased. […] an examination shows the presence of a total excavation of the optic nerve, the depth of which corresponds to the duration of the process. […] gradual diminution of the sight, and in many cases also by transient slight attacks of obscuration, like those belonging to the prodromal stage of inflammatory glaucoma. The decrease in vision expresses itself in a contraction of the field of vision, as well as in a diminution of the central visual acuity. The latter often develops late, when the field of vision has already become very small, so that no infrequently the patients are still in a condition to read or carry on fine work, while they are scarcely able to go about any longer alone. Before this point is attained, generally a long time (even many years) has elapsed […] The blinded eye may either remain always sound externally, or those inflammatory attacks which are characteristic of inflammatory glaucoma may occur […] Glaucoma simplex always attacks both eyes […] sometimes occurs in young people, and attacks men as frequently as women. It is also found in myopic eyes, which have a sort of immunity against inflammatory glaucoma.

Fuchs, E. & Duane, A. (1899). Text-Book of Ophthalmology; Authorized Translation from the Seventh German Edition. New York: D. Appleton & Company. Pg. 373-374.

Entered by: Ayushi Chintakayala, 6/11/2020

Hordeolum externum is produced by suppuration of one of Zeiss’s glands. There is first noticed an inflammatory edema of the affected lid, which in violent cases may even extend to the conjunctiva bulbi. Upon careful palpation there is discovered in the swollen lid a spot which is distinguished by greater resistance and by special sensitiveness to touch. It lies near the border of the lid, and corresponds to the inflamed gland. In the next day of two the swelling at this spot increases, and the skin over it grows red, afterward shows a yellowish discoloration, and finally is perforated near the border of the lids with a discharge of pus.

After the evacuation of the pus the inflammatory symptoms rapidly abate, the small abscess cavity soon closes, and the entire process comes to an end. In spite of the fact that the duration of the disease is but a few days, the affection itself is still very burdensome to the patient on account of the pain, which often considerable, in the tense and greatly swollen lids. Added to this is the fact that many persons have quite a number of repeated attacks. Hordeolum internum is much rarer than hordeolum externum. It consists in a suppuration of one of the Meibomian glands, and is hence also called hordeolum meibomianum.

The course of the disease is, on the whole, the same as that of the hordeolum externum; but as the Meibomian glands are larger than those of Zeiss, and are enveloped in the firm connective tissue of the tarsus, the inflammatory symptoms are more violent, and it takes a longer time for the pus to be evacuated. The pus at first, as it is shut in in the affected gland, appears upon eversion of the lid as a yellowish spot shining through the conjunctiva. Afterward it breaks through the conjunctiva or is evacuated through the orifice of the gland. Perforation through the skin occurs only as an exception, in contradistinction to hordeolum externum, in which this is the rule. […]

Hordeolum is found principally in young people, particularly if they are anemic or scrofulous constitution and at the same time suffer from blepharitis. The latter, by causing accumulation of scales and crusts upon the border of the lids, favors the multiplication of the bacteria that are always present there, and which can thence readily penetrate into the orifices of the glands. An additional factor is the swelling of the border of the lid, which may cause occlusion of the excretory ducts of the glands.

Fuchs, E. & Duane, A. (1899). Text-Book of Ophthalmology; Authorized Translation from the Seventh German Edition. New York: D. Appleton & Company. Pg. 532-533.

Entered by: Ayushi Chintakayala, 6/11/2020

Paralysis of the sympathetic is characterized by a series of symptoms […]. The pupil is contracted through paralysis of the fibers which dilate it - a fact which is particularly manifested in the non-dilatation of the pupil when the eye is shaded. The difference between the diameter of the pupil in the two eyes is hence much more striking in a feeble than in a bright light. The palpebral fissure is smaller in consequence of drooping of the upper eyelid. […] The eyeball itself often seems to have sunk back into the orbit and to be less tense. An important symptom is the difference in the fullness of the vessels on the two sides of the face […] the paralyzed side being paler, cooler, and no longer sweating […]. The causes of sympathetic paralysis are usually the coarse lesions, and most frequently pressure from tumors of the nerve in the neck, such as goiter or enlarger lymphatic glands. More rarely it is caused by traumatisms (among which are fractures of the clavicle) and by operations […]. Among central diseases lesions of the spinal cord, such as tabes or injury of the uppermost part of the cervical cord, have been observed as the cause of sympathetic paralysis. In many cases it is impossible to find a cause. The paralysis, in addition to the inconsiderable disfigurement due to the slight ptosis, causes no annoyance, and not infrequently is first discovered accidentally by the physician. It is commonly incurable.

Fuchs, E. & Duane, A. (1899). Text-Book of Ophthalmology; Authorized Translation from the Seventh German Edition. New York: D. Appleton & Company. Pg. 333.

Entered by: Ayushi Chintakayala, 12/21/2020

Hydrophthalmus is a disease of childhood. The eye is of unusual size […]. The thin sclera is bluish […] the cornea is larger and more bulging than normal […] and either clear and lustrous or, as in inflammatory glaucoma, dull and diffusely clouded. The anterior chamber is unusually deep, the iris is tremulous, and the papilla, after the process has lasted a pretty long time, is deeply excavated. The tension of the eye is considerably increased. The disease may come to a stop spontaneously, or may continue until it produces blindness. In the former case, the increase of tension subsides after a time; the enlargement of the eyeball persists, indeed, but does not increase, and the eye retains a moderate amount of sight, the degree of which is mainly dependent upon the condition of the optic nerve. In the second case, the enlargement of the eye keeps on - sometimes until quite extraordinary dimensions are attained - and in the mean time complete blindness ensues.
The disease is either congenital or develops in the first years of infancy, and generally in both eyes. Heredity plays an important part in its production. […] The extensibility of the sclera in childhood renders it possible for the heightened pressure to result in enlargement of the eye as a whole. In the eye of the adult, however, the rigidity of the sclera permits of its expansion through increase of pressure only at its weakest spot - namely, at the lamina cribrosa.

Fuchs, E. & Duane, A. (1899). Text-Book of Ophthalmology; Authorized Translation from the Seventh German Edition. New York: D. Appleton & Company. Pg. 367-371.

Entered by: Ayushi Chintakayala, 12/21/2020

When the irido-chorioiditis is at its height the lids are markedly swollen with edema; the conjunctiva is intensely reddened and likewise very edematous, so that it often forms a chemotic swelling round the cornea. The latter is dull, and has a slight diffused cloudiness. The aqueous, too, is cloudy, and shows a hypopyon deposited at the bottom of the anterior chamber. In the iris are found signs of a violent inflammation, such a discoloration, swelling, and posterior synechiae. If the cloudiness of the cornea and the aqueous permits, a yellowish glimmer is recognized in the pupil, arising from the exudate behind the lens. Coincidently with these symptoms violent pain is present in the eye and its vicinity, sight is completely lost, and slight fever is often also present.

The course, in the less violent cases, is such that after a few weeks the inflammatory symptoms gradually abate. The eye, whose tension in the beginning was elevated owing to the great amount of exudation, becomes softer and soon smaller also, and at length passes into a state of atrophy. But in the violent cases suppuration of the eyeball - panophthalmitis - ensues. The edema of the lids increases so much that the eye can scarcely be opened. The eyeball, in addition to the appearances of irido-chorioiditis above described, displays marked protrusion (exophthalmos) combined with abolition of its motility. The pain is almost intolerable, and not infrequently tormenting phototopsiae are present. High fever exists and vomiting frequently occurs, especially at the beginning of the disease.

These symptoms keep on until the purulent exudate in the interior of the eye makes an exit for itself by breaking through the sclera. Perforation takes place in the anterior division of the sclera. The conjunctiva is seen to bulge forward at some spot, showing the yellowish, discolored sclera through it, until finally sclera and conjunctiva are perforated and the purulent contents of the eyeball are slowly extruded. After perforation has occurred the pains soon cease, the eye becomes softer, and ultimately shrinks up to a small stump (phthisis bulbi). It takes at least six to eight weeks for this result to be attained and for the eye to become perfectly free from pain.

Fuchs, E. & Duane, A. (1899). Text-Book of Ophthalmology; Authorized Translation from the Seventh German Edition. New York: D. Appleton & Company. Pg. 347.

Entered by: Ayushi Chintakayala, 6/11/2020

Neuritis of the papilla of the optic nerve manifests itself externally by no signs except that the pupils are dilated, to correspond with the diminution or absolute abrogation of the sight. Ophthalmoscopic examination shows in the papilla of the following evidences of inflammation:

The color of the papilla is altered, being either white, gray, or reddish, and it is often mottled with white spots or with extravasations of blood. The outlines of the papilla become indistinguishable, the exudation extending beyond them into the adjoining retina; hence, too, the papilla appears of greater diameter than normal. The blood-vessels of the retina are altered, the arteries being thinner, while the veins are distended, in consequence of the compression of the vessels by the swollen optic nerve. The veins of the retina become exceedingly tortuous, especially where they pass down upon the retina over the edge of the swollen papilla; and wherever their coils dip pretty deeply into the clouded tissues they look hazy, or seem to suffer an actual interruption in their course. The most important symptom is the swelling of the papilla, shown by its projecting above the surrounding retina. The subjective symptoms consist in a disturbance of vision. This in most cases is very considerable; when the neuritis is severe, complete blindness is usually present. Nevertheless, cases of marked swelling associated with normal sight do also occur (in choked disk).

A characteristic sign of many cases of neuritis are sudden and momentary obscurations of sight, repeated many times a day. Contraction of the field of vision is frequently found, sometimes under the form of hemiopia. Neuritis runs a chronic course. It takes months for the inflammatory signs to disappear, and then they are replaced by the symptoms of atrophy. The papilla grows paler, its outlines become once more clearly visible, and the vessels upon the papilla and in the retina are narrowed. This atrophy (neuritic atrophy, as it is called) is the greater the more intense the preceding neuritis; and the degree of the atrophy determines whether the vision grows better again after the inflammation has run its course, or remains permanently enfeebled, or is annihilated altogether. In any case, the prognosis of neuritis is serious.

Fuchs, E. & Duane, A. (1899). Text-Book of Ophthalmology; Authorized Translation from the Seventh German Edition. New York: D. Appleton & Company. Pg. 482.

Entered by: Ayushi Chintakayala, 6/11/2020

That disease of the eye-ball is termed staphyloma, in which the cornea loses its natural transparency, is elevated upon the eye, and gradually projects beyond the eye-lids in the form of an oblong tumour of a whitish or pearl colour, which is sometimes smooth, at other times tuberculated, attended with a total loss of fight. This disease not unfrequently attacks infants a little after their birth, and is most commonly a sequela of the puriform ophthalmia; or it appears in consequence of the small-pox, and what is extraordinary, never during the eruptive or suppurative stage of that disease, but on the desiccation of the pustules, and even after the crusts have desquamated. In a great number of cases, when the staphyloma has arrived at a certain elevation upon the cornea, it becomes stationary, or only increases in exact proportion with the eye-ball ; in others the small tumour gradually increases in all its dimensions, and in such a disproportion , with respect to the rest of the eye ball, that it ultimately projects considerably be yond the eye-lids, occasioning great uneasiness and deformity… the continual exposure of the eye -ball to the contact of the air, and the particles floating in it, the friction which the cilia make upon it, and the incessant discharge of tears upon the adjacent cheek, are causes sufficient to occasion the eye to become gradually painful and inflamed, and sympathetically to affect the found one ; and finally to produce an ulceration of it , together with the lower eye - lid and the cheek upon which it rests.

Scarpa, A. (1818). A Treatise on the Principal Diseases of the Eyes. (pp.425-427). London : printed for T. Cadell and W. Davies, Strand.

Created by: Sara Ahmed, 06/12/2021

Entered by: Rachel Johnson, 08/29/2021

[…] Is an inflammation of the conjunctiva, which originates by infection, and produces an infectious purulent secretion. It is distinguished from acute blennorrhea principally by its chronic course, in which is developed a hypertrophy of the conjunctiva, that forms the most characteristic symptom of trachoma. From the roughness of the conjunctiva, caused by this hypertrophy, the disease has, in fact, received its name.

The disease almost always attacks both eyes. […] The patients complain of sensitiveness to light, of lachrymation, and of sticking together of the lids; pain and visual disturbances are also often present. The examination of the eye shows that the latter is less widely opened, partly because of photophobia, partly because the heavy upper lid hangs lower down. After everting the lids, we see the conjunctiva of the tarsus and also that of the fold of transition reddened and thickened; its surface at the same time has become uneven to a varying degree. These changes are to be referred to a hypertrophy of the mucous membrane, which occurs under two different forms.

The first form consists in the development of the so-called papillae. These are elevations newly formed on the surface of the conjunctiva, which consequently appears velvety, or, if papillae are large, appears studded with coarse granules, with small nodules, or even with raspberry-like projections. The thickening of the conjunctiva being so great that the subjacent Meibomian glands are no longer visible through it. This kind of hypertrophy, which is called the papillary form, is found exclusively in the tarsal conjunctiva. It is always most clearly pronounced on the upper lid, which therefore must be everted in making the diagnosis of the trachoma.

The second form of hypertrophy is characterized by the presence of the trachoma granules. There are gray, translucent, roundish granules, showing through the most superficial layers of the conjunctiva, which they push up to form hemispherical swellings. On the account of their translucent seemingly gelatinous character, they have been likened to the eggs of frog spawn or to grains of boiled sago. They are found principally in the retrotarsal folds, in which they are imbedded in such numbers that, when the lower lid is drawn down, the fold projects as an elastic swelling, at the summit of which we sometimes see granules arranged in rows like a string of pearls. […] Trachoma granules are often found in the semilunar fold, more rarely in other parts of the conjunctiva of the eyeball.

The conjunctiva of the eyeball is, in light cases, unaltered, but when the irritation is more intense shows a coarsely reticulate injection. The conjunctiva discharges a purulent secretion, the quantity of which is more abundant in the fresh cases and in those attended with marked symptoms or irritation. In older cases, on the contrary, and in those which run a more sluggish course, it is very scanty.

In the subsequent course of the disease, the hypertrophy of the conjunctiva gradually increases, growing steadily greater, until it has reached a certain height, which is not the same in all cases. Then it disappears again, step by step, while a cicatricial state of conjunctiva with contraction takes its place. In this way the trachoma is cured in the sense that the specific morbid process has come to an end. Nevertheless, the conjunctiva has not become normal again by any means; on the contrary, it bears upon it lasting marks of the disease that has passed namely, the signs of a cicatricial contraction which, in many instances entails other, additional consequences, such as we will group together under the phrase “the stage of sequelae of trachoma.”

[…] The disturbance of sight, of which many patients complain, is founded upon a complication affecting the cornea, and appearing under two different forms, pannus and ulcerations, which very frequently occur tougher. […] The beginning of the disease shows a clinical picture which varies with the inflammatory symptoms accompanying the fundamental lesion. In the majority of cases the disease sets in which moderate symptoms of irritation – photophobia, lachrymation, pain – which augment with increase in objective changes. Not infrequently, however, trachoma develops so insidiously that for a long time those whom it has attacked are not aware of it.

Fuchs, E. & Duane, A. (1889/1919). Text-book of Opthamology: Authorized Translation from the Twelfth German Edition (6th ed., pp. 162-172). Philadelphia: J. B. Lippincott Company.

Created by: Taha Jilani, 06/11/2021

Entered by: Rachel Johnson, 08/29/2021