Chapter III: Conjunctival Tuberculin Test

1. SYNONYMS: Eye Test; Ophthalmic Test; Wolff-Eisner's Test; Calmette's
Test.

2. APPARATUS AND DILUTIONS NECESSARY:

1 cc. pipette graduated to 1/10 cc.

10 cc. pipette graduated to 1/10 cc.

10 cc. glass cylinder

Medicine dropper

Koch's Old Tuberculin

1/2% and 1% dilution of Old Tuberculin in .85% sterile normal salt
solution.

To make 1% dilution, add .1 cc. Old Tuberculin to 9.9 cc. of diluent.

3. APPLICATION OF TEST:

Patient sitting, with head thrown back

Lower eyelid drawn slightly down and toward the nose--to form a small
pouch of the lid;

One drop of 1% or 1/2% instilled in that pouch and the lower lid moved
up gently over the eye until the lids meet;

Eye kept closed for one minute or so.

4. REACTION:

Onset in 12 to 24 hours (may begin earlier); acme in 24 to 36 hours;
duration of reaction--3 to 4 days or even longer (in severe cases).
Some reactions are of short duration. 3 grades of reaction,
according to Citron:

1. Reddening of caruncle and palpebral (lid) conjunctiva.

2. More intense reddening, with involvement of ocular (eyeball)
conjunctiva, and increased secretion.

3. Very intense reddening of the whole conjunctiva, with much
fibrinous and purulent secretion, etc.

5. TIME OF INSPECTION:

12 and 24 hours after instillation; then once a day.

6. CAUSE OF REACTION:

Hyperaemia and exudation resulting from interaction between
_instilled tuberculin_ and _antibodies in conjunctiva_
(bacteriolysin, according to Wolff-Eisner).

7. INTERPRETATION OF REACTION:

Wolff-Eisner maintains that positive conjunctival tuberculin
reaction means _active_ tuberculosis, a conclusion accepted by
but a few.

8. FIELD OF APPLICATION OF CONJUNCTIVAL TUBERCULIN TEST:

_Should not be used_; connected with _danger_ to the eye.

Conjunctival test used very rarely at present.