Chapter XV: Part 15

The older plastic operation is more trustworthy: The skin of the affected lid is pinched up to such an extent in length and breadth, as to correct the entropion and is then excised with sharp scissors or bistuory so as to leave a long elliptical sore. The edges of this are then carefully sutured together and the resulting union corrects deformity. In case the entropion is caused by an old standing cicatrix, it may be necessary, first, to make a careful incision along the edge of the lid so as to separate the tarsus and conjunctiva from the cilia and Meibomian ducts, and then to proceed with the plastic operation on the skin.

TURNING OUT OF THE EYELID. ECTROPION.

In large dogs, in old age, debility, conjunctival swelling, cicatrized
skin of lids, distortions of lids. Symptoms: exposure of palpebral
mucosa, weeping eyes, conjunctival hypertrophy (chemosis). Treatment:
scarify or excise a fold of mucosa, astringent antiseptics, Snellen’s
suture, Diefenbach’s operation, Wharton-Jones operation.

This is much more common than entropion, but much less injurious as the tarsi and lashes do not irritate the conjunctiva. It is especially common in large dogs (hounds, mastiff) and usually affects the inner part of the lower lid. Old age and debility contribute materially to the condition, the lack of tone or paresis being an important factor. It may, however, occur in any animal, from conjunctivitis and swelling of the mucosa, from cicatrices or old standing disease of the skin of the eyelids, or from imperfectly healed wounds leaving distortions of the lower lid. It is most frequent in the lower lid, and the slightest pendulous condition, which detaches the tarsus from the bulb, and exposes a narrow zone of the conjunctiva is considered to be an ectropion.

_Symptoms._ Beside the exposure of the zone of mucosa, there is the overflow of tears, and in old standing and bad cases a hypertrophy of the exposed conjunctiva, which projects as a fleshy-looking mass, and weighs down the lid, with a continual tendency to aggravation.

_Treatment._ Where the main factor seems to be the infiltration of the mucosa this may be reduced by scarification, or by the complete excision of a fold of the membrane. Use an antiseptic wash (boric acid) and the retraction of healing tends to brace up the lid against the bulb.

Snellen’s suture is sometimes employed successfully. A silk thread is armed at each end with a needle, and the needles are passed into the conjunctiva just inside the tarsus and brought out through the skin near the margin of the orbit, where they are tied round a small roll of cotton. Several of these may be inserted side by side so as to extend the whole length of the ectropion and they should be drawn tight enough to correct the deformity. If left some days they will usually determine cicatrices which will overcome the deformity.

The most common operation (Dieffenbach’s) is the excision of a triangular portion of skin from just outside the lower lid and having its base or upper side running horizontally outward from the outer canthus. Then pare the margin of the lower lid for a distance equal to the base of the triangle. Then bring together and suture the skin forming the right and left sides of the triangle, and the raw edge of the lid to the skin that formed the base of the triangle. In this way the triangular sore formed by the operation is completely covered and the margin of the lower lid is shortened so as to brace it up against the bulb.

In case of cicatricial ectropion the Wharton-Jones operation is to be adopted. A V-shaped incision is made in the skin of the lower lid commencing just beneath the tarsus and carried down so that the two lines of incision meet well down beneath the cicatrix. The triangular flap of skin thus made, is detached by a bistuory from the cicatricial tissue beneath, and allowed to shrink upward toward the tarsus. Finally the two edges are sewed together from the angle upward, as far as may be necessary to allow the proper application of the tarsus against the bulb, and the remainder of these edges are sutured to those of the triangular flap.

TUMORS OF THE EYELIDS.

=Warts.= The most common tumors of the eyelids in horses, cattle, and dogs are warts. These are most simply disposed of by seizing them with rat-tooth forceps and clipping them off with sharp scissors curved on the flat. Any bleeding may be checked by a pencil of silver nitrate.

=Sarcoma=, =melanoma=, and =epithelioma= are common in solipeds, especially in the gray and white. They usually form a cauliflower-like mass red and angry and bleed easily. They may occupy any part of the lid, the skin, the dark tarsal margin, the connective tissue or the mucosa, and not unfrequently they involve the eyeball, and the surrounding tissues, even the bones of the orbit.

_Treatment._ These may be excised like warts taking care to remove every vestige of disease. In these cases I have usually found it necessary to remove the entire bulb.

FRACTURE OF THE ORBIT.

_Nature and Causes._ The usual seat of fracture is the orbital process of the frontal bone, yet any portion of the orbital margin may suffer, and even the inner wall or floor of the orbit may be broken by a penetrating instrument. Horses and polled cattle and sheep are especially exposed to the injury, while in horned stock the region is in a measure protected. Carnivora, which have no bony orbital process, are less liable but may still sustain fractures of the remaining parts. Horses and polled ruminants suffer mainly from beating the head on the ground or other solid body in the paroxysms of colic and enteritis, or in nervous affections; horned stock suffer from concussions in fighting and direct blows by the horns. All animals suffer from blows with clubs, kicks and other mechanical injuries.

_Symptoms._ With (and less frequently without) a skin wound, there may be indication of depression, or mobility of the detached segment, or its sharp edge may be felt, through the skin, or by the sterilized finger introduced into the orbit. In case of a penetrating or stab wound, which cannot be followed by the finger, it may be followed by an aseptic probe and any fracture recognized. The conjunctival sac must be first thoroughly washed out with an antiseptic lotion, as the introduction of any septic germs into the osseous wound, is likely to cause a dangerous infection or abscess.

_Treatment._ Simple, slight fractures with blunt instruments are treated by rest and cooling, disinfectant lotions. If foreign bodies or detached particles of bone are found in the wound they should be extracted. Shot that are difficult to find, may be left, as they are often aseptic and tend to become encapsuled. Should they cause abscess they will usually be found in the pus sac and may then be removed. Displaced bones may often be replaced by the finger in the orbit. Sometimes they can be best reached by trephining the frontal or maxillary sinus and introducing a lever through the cavity (Hendrickx). If the sinus has been involved it must be opened in any case. Cadiot advises bandages impregnated with black pitch to fix the bones in certain cases. Antiseptic washes (sublimate 1 ∶ 5000) and antiseptic cotton packing are demanded for all wounds.

BRUISES AND WOUNDS OF THE ORBIT.

These may come from the same _causes_ as fractures and though less violent may occasion inflammation which involves the eye or even the brain with fatal results. Thus in horses it has been a cause of infective inflammation, with a fatal extension (Robellet); in cattle a similar inflammation has extended to the cerebral meninges and caused death (Leblanc), and in dogs an advance to the eyeball threatens its destruction (Möller). Short of this necrosis is not uncommon (Rey).

_Treatment._ This does not differ materially from that demanded by penetrating wounds with fracture. A perfect cleansing and antisepsis of the wound is the first demand. A solution of boric acid (4 per cent.) or of mercuric chloride (1 ∶ 5000) liberally applied, and maintained thereafter on soft pledgets of surgical cotton, will often have the best results. All foreign bodies must be carefully removed, lacerated flaps and shreds may require suturing, dead portions excision, and finally abscesses or excessive exudate may require the lance, but cooling, antiseptic lotions and an elevated position of the head, are among the most prominent resorts.

RETRO-BULBAR ABSCESS.

Schindelka has observed this in the horse, in connection with petechial fever. If connected with meningeal abscess it will be necessarily fatal. In favorable cases evacuate the pus as soon as detected and dress with pledgets of cotton saturated with a mercuric chloride solution (1:2000) or other antiseptic.

PERIOSTITIS OF THE ORBIT.

This may be shown by the firm swelling of the bone and, in case a wound has been formed, by the contact of the probe with the denuded, hard, rough bone. When thus exposed or necrosed on the surface, or when an exostosis has formed, the bone may be laid open and scraped down to the healthy tissue, and then dressed with antiseptic pledgets.

TUMORS OF THE ORBIT.

These may be of different kinds, as =sarcoma=, =encephaloid=, =osteoma= and =actinomycosis=. They demand thorough surgical treatment, except perhaps in the case of the latter, which may recover under iodide of potassium. Emmerich records an extensive sarcoma of the orbit in a cow, weighing six pounds and extending into the nasal sinuses, and chambers, and implicating the cerebral meninges. Möller records cases of sarcoma and carcinoma of the orbit in horses and dogs, and Leblanc in cattle. Melanosarcoma is not uncommon in the orbits of gray horses which are changing to white.

Exotoses are common around the orbits of cattle.

If such growths do not show on the surface they cause a more or less unsightly protrusion of the eyeball, owing to the presence of the neoplasm in the depth of the orbit, and the removal of the bulb becomes a necessity.

DISEASE OF THE LACHRYMAL GLAND AND DUCTS. DACRYO-ADENITIS.

Even in man these parts are remarkably free from disease, while in the lower animals, we have literally no record of such conditions. Inflammation of the gland (dacryo-adenitis) would be manifested by a sensitive swelling under the outer part of the orbital process, and upper eyelid and by lachrymation, and obstruction of the gland duct and by a tense transparent rounded swelling inside the lid. A fistula is possible from a penetrating wound of the lid in the same situation. In both of the latter conditions an opening made through the palpebral conjunctiva will allow the discharge of the tears in the proper place, and healing of any external wound may be hastened by suture or plaster.

OBSTRUCTION OF THE LACHRYMAL PUNCTA. ATRESIA. INFLAMMATION.

Congenital atresia of these puncta has been recorded in foals, by Hollmann and obstruction as the result of inflammation, by Lafosse, Verjaus and Tyvaert, and of the entrance of the seeds of bromus by Stockfleth.

Apart from congenital atresia and impaction of foreign bodies the _symptoms_ are those of conjunctivitis, with escape of tears over the face (epiphora). Injection of aseptic water into the lower puncta and its escape by the upper, and by the nasal orifice, will determine the patency or otherwise of the various channels.

_Treatment_ consists in astringent collyria to check the inflammation, in the removal of any foreign body, in the dilation or slitting of the lachrymal canaliculi, and in case of complete atresia, in incising the lachrymal sac. Slitting of the canaliculi is accomplished by a small probe pointed bistuory (canaliculus knife). The lid is drawn away from the carnucle, and the probe point inserted at first downward, then inward and backward, and when it is well inside the sac the handle is brought to the vertical and the walls of the duct slit open.

In case of atresia Leblanc recommends to seize the inner canthus with rat tooth forceps so as to include the structures about the sac and to plunge the bistuory directly into the sac. Then by the aid of a whalebone staff he passes three silk threads through the duct and fixes them in place by attaching them to a copper ring at each end. This is retained in place and moved daily until the passage has been definitely healed and its permanency assured.

WOUND AND FISTULA OF THE LACHRYMAL SAC.

The lachrymal sac, which receives the tears from the canaliculi, is situated in the infundibulum at the upper end of the lachrymal canal and is in great measure protected against external injuries by the prominent orbital edge of the lachrymal bone. Yet violent blows with or without fracture, sometimes lead to rupture of the mucous walls and the formation of a fistula. Wounds made with penetrating bodies, more or less pointed are also liable to involve the sac. The fistulous orifice may be through the skin at the inner canthus or through the mucosa by the side of the carnucle. The cutaneous opening may be a minute orifice from which tears and muco-purulent matter escapes, to mat together the hairs on the side of the face. Sometimes there is a reddish elevation, the size of a pin head, and in fistula through the mucosa this is the rule, and the orifice is elevated so that the tears flow out over the face. For the symptoms of the attendant catarrh of the sac see below. In infected cases with obstruction of the lachrymo-nasal duct, it has been known to extend to the bone and even to open into the sinuses, or tooth follicles. (Gerard, Leblanc).

The condition is found in horses, cattle and dogs.

_Treatment._ In fistula resulting from simple traumatism, nothing more may be requisite than rest and soothing astringent applications. Sutures are sometimes resorted to but are liable to cause itching and do more harm than good. It is above all important to keep the lachrymo-nasal duct patent, and for this purpose a lead or silver stilet, or a thick catgut suture may be worn in the canal until healing has ensued.

CATARRH OF THE LACHRYMAL SAC. DACRYOCYSTITIS.

Connected above through the canaliculi with the conjunctiva, and below through the lachrymal duct with the nasal chamber this cavity is liable to be more or less implicated in all cases of nasal catarrh and conjunctivitis, (strangles, canine distemper, influenza). If the lachrymal duct is obstructed so that the tears accumulate in the sac, the tendency to catarrh is further enhanced by the distension and weakening of its walls, and by the propagation of bacteria which have entered with the tears, and find in them a favorable and abundant culture medium; the diameter of the sac in the horse being about ⅔rds. of an inch. The presence of foreign bodies is another cause.

_Lesions. Symptoms._ Swelling at the inner canthus, which raises the carnucle above the normal level, and the escape of tears over the lower lid are the most prominent symptoms. If the swelling is pressed it subsides, the contents, clear or purulent, escaping through the lachrymal duct, to the nose, or through the puncta and accumulating in the inner canthus or flowing over the cheek. The hair beneath the inner canthus is matted together, or drops off leaving bare patches. Wolff found in one case, a distension of the sac to over two inches in breadth, and 1⅔ inches long. To the swelling there is soon added conjunctival inflammation, closure of the puncta by swelling and the escape of all tears over the face. Suppuration supervenes in the sac, and in the larger animals the pent up pus often makes its way outward, causing destructive ulceration of the walls of the canaliculi and puncta, or of the walls of the sac, the skin, or even the subjacent bone. In this way fistula results. Caries of the bone and penetration of the molar alveoli may ensue. (Girard, Leblanc).

_Treatment._ The first object must be to secure a free drainage into the nose. The evacuation of the sac by compression having been accomplished, an astringent solution may be injected through the nasal opening of the lachrymal duct. If the canal is pervious the sac will be re-filled and will swell out as before. The injection may be 0.5 per cent. sulphate of zinc, 1 per cent. acetate of lead, 0.3 per cent. nitrate of silver, 1 per cent. tannic acid, 2 per cent. boric acid, or 0.02 per cent. corrosive sublimate. Cocaine may be added in the proportion of 5 per cent. The injection may be repeated thrice a day at first, then twice, and finally once as the catarrh subsides.

If the injection fails to reach the sac, thoroughly sterilized, flexible probes may be used, increasing the size as they can be passed without too great pressure.

Or the puncta and canaliculi may be injected as in the human subject, the conjunctiva having been first anæsthetized by cocaine, or general ether or chloroform anæsthesia having been induced. The slitting of the puncta and canaliculi may be resorted to, as spoken of under atresia.

The frequent passage of a sound is usually resorted to, and a stilet may even be worn, but there is always danger of resulting thickening and narrowing of the duct, and, if healing can be secured without this measure, it is to be preferred.

STENOSIS OF THE LACHRYMO-NASAL DUCT.

Obliteration of the lachrymal duct may occur from stricture of the canal, the result of wounds or other irritants: from pressure by the inflamed mucosa in nasal catarrh or strangles: from polypus or osseous tumor in the nose: from actinomycosis or other disease of the bones.

The one manifest _symptom_ is the escape of the tears on to the face. To complete the diagnosis, injection of one punctum will cause distension of the lachrymal sac.

_Treatment._ This may be attempted by bougies. In the _horse_ a small sound, metallic or whalebone bougie, thoroughly sterilized and smeared with aseptic vaseline, or oil, is inserted from the nasal opening and carefully passed on into the sac. In the _dog_ the nasal opening cannot be reached and the bougie must be passed by the puncta and lachrymal sac. To secure the requisite dilation, it is usually necessary to probe the passage daily, using a larger probe when the first passes easily, until the canal has been sufficiently dilated.

A second resort is to distend the canal by a liquid injection thrown into the nasal opening. This will succeed when the obstruction is only caused by concretions in the canal.

A somewhat similar resort is the insufflation of the duct by means of a finely pointed tube inserted from below into the nasal orifice of the duct.

Still another method is to make a new opening for the escape of the tears into the nose. When the stenosis is at or near the nasal opening of the duct, an artificial opening is easily made and usually satisfactory. Under anæsthesia, a sterilized silver probe is passed through the upper punctum, the sac and canal. When it meets definite obstruction its position is ascertained inside the nose, and an incision is made so as to allow its escape. The constant escape of tears tends to prevent it from closing up again, but it is well to examine into this until it has thoroughly healed. A silk thread worn in the duct and held in place by a copper or aluminum ring on each end may be resorted to.

Attempts have been made to establish a new outlet by boring through the lachrymal bone into the nose, but without a permanent success. It has also been advised to obliterate the lachrymal ducts and sac, on the one hand and to excise the lachrymal gland on the other, but the proposed cure is worse than the disease.

DISEASE OF THE LACHRYMAL CARUNCLE.

The caruncle is inflamed in conjunctivitis. When this inflammation leads to hypertrophy it is known as _encanthis_. This is a common condition in _dogs_ and the caruncle may increase to the size of a pea or acorn, and by compressing the canaliculi it leads to a profuse overflow of tears on the cheek. At first there is the acute congestion of conjunctivitis, but later there may be induration and pallor.

The _treatment_ of this condition consists in astringent and sedative collyria in the early inflammatory stages, and later in the ablation of the hypertrophied mass. The caruncle is seized with a pair of rat-tooth forceps and snipped off with curved scissors, the free bleeding being afterward checked by cold water.

In cases that seem, by reason of excessive vascularity ill adapted to this method, the hypertrophied mass may be tied at its base with a stout silk thread so as to cut off the supply of blood, and cause it to slough off. A collyria of boric acid (4 per cent.) or mercuric chloride (0.02 per cent.) may be used to prevent infection.

=Tumors= of the Caruncle are met with, such as fibroma (Wörz), Sarcoma and Melanosarcoma. For all alike the complete extirpation of the neoplasm is demanded.

WOUNDS AND INFLAMMATION OF THE MEMBRANA NICTITANS.

Like other parts of the ocular apparatus, the third eyelid and gland of Harder are subject to accidental injuries of various kinds. What is worse, ignorant persons seeing the cartilage and membrane projected over the eye in ophthalmias and tetanus, have mistaken it for a morbid product and deliberately cut it off in part. The condition of the organ may be ascertained by parting the lids with the fingers and pressing gently on the front of the eyeball, when the nictitating membrane will be fully exposed.

If detached portions cannot be restored, but threaten to slough, or cause distortions or unsightly and irritating neoplasms they should be seized with forceps and snipped off with scissors. Otherwise the treatment consists in soothing astringent and anodyne Collyria as in conjunctivitis.

TUMORS AND HYPERTROPHY OF THE MEMBRANA NICTITANS.

Neoplasms of this organ may occur in any quadruped or bird and may be recognized by the swelling of more or less of its substance, by the unevenness of its free margin, or by distinct outgrowths from its surface. They are especially common in dogs and pigs and may be fibrous, epithelial or otherwise. The treatment is purely surgical and in case of a malignant neoplasm should demand the removal of the entire organ.

ADENOMA OF THE GLAND OF HARDER.

Cases in dogs have been recorded by Fröhner and Schimmel, and it might be expected in other carnivora, ruminants, pigs, rabbits and birds. The treatment is by excision with forceps and scissors, and subsequent treatment with an antiseptic zinc lotion.

FOREIGN BODIES IN THE CONJUNCTIVAL SAC.

Frequency: seeds, glumes, awns, dust, sand, wood, metal; exudate; in
conjunctival pouch, under nictitans, in puncta. Filaria lachrymalis.
Symptoms: closure of lids, epiphora, congestion, inflammation,
infection. Treatment: local anæsthesia, forceps, lead pencil, pin’s
head, collyria.

So common are foreign bodies in the conjunctival sac of the domestic herbivora, that in any case of epiphora, hyperæmia or inflammation of the mucosa, the first care should be given to see that the condition is not caused by the presence of such an irritant. In animals fed from high racks, seeds and glumes of the gramineæ, awns of barley, and dust of various kinds often get into the eye and stick fast. Under other conditions, insects, particles of sand, dust, wood, metal, etc., prove equally injurious by their presence. Awns and chaff are particularly liable to adhere to the mucosa and even to become covered by an exudate, which renders them more firmly adherent. Other objects lodge under the eyelids, or membrana nictitans, or in folds of the mucosa. Their entrance into the lachrymal puncta has already been referred to. The larger and more rounded bodies are likely to be washed off by the excessive flow of tears, assisted by the movements of the nictitating cartilage, but flat glumes, or awns stick too closely to the surface, while the smaller objects become entangled beneath the lids, or hair, or in the folds of the mucous membrane. The filaria lachrymalis may be the cause of trouble.

_Symptoms._ There is closure or semi-closure of the lids, the escape of a profusion of tears over the cheek, and active congestion or hyperæmia. A careful examination with everted lids, or even with raised nictitans will usually reveal the foreign body. If overlooked or neglected the hyperæmia rapidly advances to active inflammation, with or without an infective complication. Foreign bodies blown into the eye, as a rule carry with them more or less bacteria, and, if these have any tendency to pathogenesis, the irritation of the mucosa easily paves the way for their colonization. Thus, any grade or form of conjunctivitis may supervene upon the introduction of a foreign irritant.

_Treatment._ Nearly all such bodies are most easily and certainly removed by a pair of fine forceps. It may be necessary to first anæsthetize the eye with a 5 per cent. solution of cocaine. The clean tip of the finger passed under the lid and nictitating membrane is a safe and effective method. Less effective methods are to pick up the offending body on the point of a lead pencil, or a small, blunt metallic spud, or with a pin’s head covered with a clean pocket handkerchief. This may be followed by an antiseptic (boric acid) collyria, with or without cocaine or morphia.

WOUNDS OF THE CONJUNCTIVA.

These occur in all domestic animals, but are especially frequent in dogs and cats from scratching with the claws. In clumsy handling of the eyelids, the mucosa is wounded by ragged and uneven nails. Injuries and stings by insects which are attracted by the reflection from the eye constitute a specially grave lesion, often proportionate to the nature of the poison instilled.

_Symptoms._ There are usually closure of the eyelids, with exudation and thickening of the conjunctiva especially in the vicinity of the wound, a free flow of tears, mingled it may be with blood, and the visible evidence of the lesion on the exposure of the injured part. If the cornea is implicated, even the pupil is contracted, showing photophobia.

_Treatment._ Slight noninfected wounds will heal readily under simple astringent collyria, following upon the removal of any cause of mechanical irritation. A solution of corrosive sublimate, 1:5000, or of boric acid, 4 per cent. may be used. If photophobia exists ½ per cent. of atropia sulphate or 1 per cent. of cocaine hydrochlorate will usually give relief. Extensive wounds may require sutures, and sloughing tissue may be excised with fine curved scissors. Excessive granulations may be removed in the same way. For stings use a potassium permanganate solution (2 grs. to 1 oz). Violent inflammation may be met by a laxative and by leeching the periorbital region.

BURNS OF THE CONJUNCTIVA.

Burns may occur in all domestic animals from acids, alkalies, quicklime, carbolic acid, boiling liquids, etc. The cornea usually suffers, being the part most exposed. The caustics cause swelling, blanching and finally exfoliation of the epithelium, or even of the superficial layers of the cornea. In burns by hot liquids vesication may be present. If the destruction extends deeply into the cornea there may be escape of the aqueous humor and destruction of vision. If less penetrating, there may still develop vascularity, and permanent opacity by reason of the formation of a cicatrix or a change of structure in the layers of the cornea, or, in dogs especially, adhesion of the cornea to the eyelids (symblepharon). In the early stages there is closure of the eyelids, with swelling, profuse lachrymation, and photophobia.

_Treatment._ The first object is to remove or neutralize the offending body. Thus sulphuric or other mineral acid would demand a free irrigation with a 1 per cent. solution of carbonate of soda or potash. For alkalies, carbonated water, or a 4 per cent. solution of boric acid may be employed. For lime, Gosselin recommends free irrigation with saccharated water. The first step, however, should be to wipe out the particles of lime with a soft rag soaked in oil.

The pain may be met by a solution of cocaine (1 per cent.), or atropia ½ per cent. In addition, we may irrigate with cold water or apply weak antiseptic collyria, and employ derivation by the bowels or the skin.

SIMPLE ACUTE CATARRHAL CONJUNCTIVITIS.

Causes: irritant gases, smoke, dry air, dust, pollen, microbes,
insects, seeds, chaff, awns, sand, dust, quicklime, coal dust, hairs,
whips, canes, branches, stubble, fences, nails, claws, teeth, iodine,
chlorine, bromine, formalin, turpentine, rain, hail, sleet, glare of
sun, ice, snow, white sand or clay, filaria, acari, infectious
diseases. Symptoms: closed lids, epiphora, redness diffuse on lids,
ramified on sclera, projected nictitans, milky flocculent discharge,
later purulent, matted lashes or tarsi. No photophobia. Fever
variable. Lesions: exudate: cell proliferation: papillæ enlarged:
desquamation: swollen lymphoid bodies: hyperplasia: abscess: ulcer.
Treatment: remove cause, sterilized syringing, antiseptic and
astringent collyria, sublimate, zinc sulphate, lead acetate,
pyoktannin, silver nitrate, morphia, atropia, cocaine, vaseline,
cupping, leeching.

Under this head may be noted the simple forms of conjunctival inflammation, which result from direct injuries, irritant gases from manure, smoke, very dry air, dust, pollen, and in which no specific nor contagious element is a prominent feature. Strictly speaking, all purulent conjunctivitis are probably infecting, as all may be held to be associated with the presence of pus microbes. As early as 1864, de Graefe said every inflammation of the conjunctiva which “secretes, is inoculable and therefore transmissible,” and Warlomont concurs, saying that “conjunctival ophthalmias have one character in common: all can produce a secretory product which, when brought in contact with a sound conjunctiva, is capable of provoking the different affections of this mucosa.” The exposure of the conjunctiva of man and beast alike, to the germs borne on the dust or carried in liquids or on solids, renders this structure preëminently susceptible to infection, while the lachrymal and mucous secretions furnish a favorable culture medium. Fortunately in the lower animal the danger of infection is greatly reduced, since there are comparatively few opportunities for the transference of the germ through water, soap, sponge or towel, to which man is exposed, not only in public lavatories but even in private families. Thus in the animal the single case remains isolated and in a sense sporadic, only because there have not been the means of transferring and inoculating the morbid product.

_Causes._ The contact of mechanical and chemical irritants of all kinds, insects, seeds of gramineæ, chaff, particles of fodders, barley and other awns and spikes, grains of sand, dust, quicklime, coal dust, smoke, hairs, blows with whips, canes, branches, stubble, fences, etc. Also erosions caused by nails, claws, teeth, and by falls must be considered.

Irritant gases and vapors whether from accumulation of manure in the stables, or from chemical products of fires and factories are direct causes. The mere exposure for some time to the warm, dry air from a furnace is injurious to the mucosa, and the emanations from certain medicines, iodine, chlorine, bromine, formaline, turpentine are strongly irritant.

Exposure in a cold draught, or in a blast of cold rain or hail, or even to a cold dry wind, in the case of hunting dogs working much in water, are potent factors.

The glare of the sun through a window at the front of a stall, or from a white surface of snow, ice or water or even from white sand, lime or clay is an active cause. The overdraw check exposing the eyes directly to the sun is often injurious. We must include the irritations caused by the filaria lachrymalis and by various lesions already described—trichiasis, entropion, ectropion, stenosis of the lachrymal duct, etc.

In certain animals a distinct predisposition exists, often as the result of a previous attack, and such are readily attacked under slight disturbing causes.

It should not be forgotten that hyperæmia and even inflammation of the conjunctiva, often accompanies different infective diseases—strangles, influenza, contagious pneumonia, rinderpest, canine distemper, etc.

_Symptoms._ The discharge of tears and the closure more or less complete of the eyelids are among the earliest and most marked symptoms. The general conjunctiva is congested and that on the inner side of the lids especially, so as often to hide the individual vessels, while on the sclerotic portion they usually remain distinct, tortuous and freely movable with the mucosa upon the sclera beneath. The membrane is more or less infiltrated, swollen and opaque. In two or three days this has increased so that the lids are visibly swollen, and completely closed, or the paw is projected over the cornea. The discharge has become milky or flocculent, and mats the cilia together, or holds the eyelids closed. Unless the cornea has been directly injured it usually remains clear, and there is no photophobia nor contraction of the pupil. The lids, however, are tender and nervous animals show active resistance to any attempt to examine the eye. In aggravated cases a free muco-purulent discharge takes place, and the red, swollen mucosa projects between the eye and the tarsus, constituting _chemosis_. In such circumstances the inflammation may extend to the cornea causing opacity and photophobia or to the iris and choroid or other deep-seated parts.

In the milder forms of the affection there may be little or no hyperthermia, while in severe attacks the febrile reaction may be considerable.

_Lesions._ The non-traumatic cases which are not complicated by varied wounds and injuries, show exudation and cell proliferation in the palpebral conjunctiva and to a less extent in the bulbar. The conjunctival papillæ are swollen and become visible to the naked eye and in aggravated cases stand out like fungous masses. The superficial layer of cylindroid epithelium is found swollen, opaque and sometimes desquamating. The lymphoid bodies which are most abundant in the depth of the conjunctival sac, are infiltrated, swollen, and bulging in reddened masses.

Other lesions in the nature of granular or follicular hyperplasia, abscess and corneal new growth and ulcers may follow, but will be better considered under separate headings.

The tendency of simple uncomplicated conjunctivitis is to recovery which may be completed in a week or ten days. In case of contused wounds, abscess, ulcer, special infection in a lymphatic subject like the ox, the affection is more likely to be prolonged or followed by grave lesions.

_Treatment._ The first object must be to remove the cause, hence foreign bodies, displaced lids or cilia, irritant gases, excess of light, cold draughts or exposure, etc., must be sought and corrected. For the removal of the foreign bodies, fine forceps or various common articles (hair pin, lead pencil, a pin head, a folded clean handkerchief, or even the clean finger) may be used. In case of wounds especially, they should be first sterilized. Boiled water which has been cooled to luke warm may be used from a sterilized syringe.

Locally antiseptic and astringent collyria (sublimate solution—1:5000), zinc sulphate—1:1000, lead acetate, alum, tannin, silver nitrate, etc., are valuable and may even be thrown under the eyelids from a syringe with a finely rounded nozzle and many orifices. Even a 2 per cent. solution of silver nitrate may be applied in the conjunctival sac twice daily, or as being less irritating, a solution of pyoktannin (1:1000). If the irritation is great a soft rag wet with the solution may be attached to the headstall of the bridle and hung loosely over the eye, care being taken to prevent drying. A few grains of morphia added to the collyria will be specially soothing. Irrigation of the eyelids or bathing for ten or fifteen minutes at a time with luke warm water, will often greatly relieve. When the eyelids become agglutinated during sleep or prolonged closure, as in the small animals, cleanse with a tepid sublimate solution, and smear with vaseline. In severe cases local depletion may be resorted to. The hair may be shaved off from an area of 2 inches below the orbit, and a cup applied for ten minutes. Scarification may or may not be resorted to. Or a leech may be applied to the same part.

A laxative often proves an excellent derivative especially useful in costive conditions.

CHRONIC CONJUNCTIVITIS.

Sequel of acute. Same causes. Old horses, young foals, damp lands,
night dews, frosts, eczema, follicular scabies. Lesions: swelling of
lymph bodies in conjunctival pouch, general congestion, chemosis,
hypertrophied papillæ, clouded cornea; Symptoms: as in acute form but
less intense. Treatment: Remove cause, irritants, damp soils, stables,
etc., glare of light, heat, etc., astringent antiseptic lotions,
atropia, mercury oxide, counter-irritation, setoning, cupping,
leeching.

This is generally recognized by veterinary writers as a sequel of the acute form, though it may begin _de novo_, from slight persistent causes of irritation. Habitual exposure to fierce light, dusty roads, ammoniacal and other gaseous emanations, and at other times to the dust from musty fodders in a high rack, trichiasis, entropion, ectropion, and indeed any continued irritation may start the disease or keep it up. Leblanc says it is especially common in _old horses_ and _young foals_ pastured on low damp grounds, bottom lands and lake shores, and in worn out work oxen which have been exposed to cold night dews, or frosts. In this respect it resembles the recurring ophthalmia of the horse which prevails especially in lymphatic subjects. In _dogs_, Leclainche has observed it associated with eczema or follicular scabies of the lids.

_Lesions._ Besides the general congestion of the mucosa, there are liable to be special lesions in the depth of the conjunctival sac at the point where the mucosa passes from the eyelid to the sclerotic, causing uneven swellings from infiltration in this region. The lymph bodies or follicles in this part are swollen and project as small red or grayish nodules visible when the eyelid is everted, and at other times the whole infiltrated conjunctiva projects between the lids constituting the condition known as =chemosis=. The papillæ conjunctivæ are also hypertrophied, so as to become visible to the naked eye, and ulcers may be present on the mucosa. The cornea is often clouded blue or milky, or it may have become in part vascular and reddish, or even ulcerated. A more or less abundant muco-purulent discharge is always present.

_Symptoms._ The inflammation is usually moderate in degree, the eyes water without being habitually closed, the hairs are lost from the cheek, which is habitually wet, the lids are swollen, and like the cilia tend to stick together after sleep, and the whole mucosa is visibly infiltrated and congested, but usually especially at given points, as in the _cul de sac_, on the lids or membrana nictitans. Unless the animal has been treated with irritant dressings, there is much less pain on manipulation than in acute conjunctivitis. On everting the lids the folliculitis in the _cul de sac_ and the circumscribed swellings become apparent. The membrana nictitans is partly projected over the cornea, and the eyeball usually appears smaller by reason of its retraction within the orbit.

In cases of eczema, or demodectic mange, the lesions of the skin of the eyelids will furnish the key to the trouble.

_Treatment._ The first object must be to remove the cause which tends to keep up the malady. Foreign bodies, musty hay fed from high racks, dusty roads, excess of light, windows in unsuitable places, damp stalls or pastures, and local parasitism must be corrected. In case of persistent chemosis keeping up the inflammation, and which will not subside under the usual astringent lotions, the hernial mucosa may be excised. (See chemosis.)

The usual astringent lotions may be employed, sulphate of zinc (2:100), sulphate of copper (1:200), alum (5:100), tannin (10:100) to which may be added sulphate of atropia. In place of being simply applied to the surface of the lids, or the cornea, it is usually desirable to inject it into all parts of the cul de sac beneath the upper and lower lids and beneath the nictitating membrane. Alum 4 grs. and boric acid 3 grains, in water 1 oz. make a good combination. As the mucosa becomes accustomed to one agent, we may change for another. Thus in addition to the above, silver nitrate (2:100), and lead acetate (2:100) are often useful as alternates. In obstinate cases red or yellowish oxide of mercury in vaseline (5:100) may be applied inside the lids and on their margins.

Counter-irritation is often desirable, in the horse a blister of cantharides or mercury biniodide to cover a spot as large as a silver dollar above the anterior end of the maxillary spine (zygomatic), or a stout silk thread as a seton inserted in the same place. In the dog the blister may be applied on the temporal region.

Cupping or leeching beneath the eye, or phlebotomy from the angular vein of the eye may prove useful. Great care should be taken to prevent further injury by rubbing.

PURULENT CONJUNCTIVITIS. BLENNORRHŒA.

More purulent and more infective through dust, tongues, rubbing posts,
kennels, swill; a class due to different microbes. Prevalence in dogs,
swine, horses, sheep, goats, cats. Symptoms: acute conjunctivitis with
excess of pus, follicular swelling and enlarged lymph bodies in cul de
sac. Diagnosis. Treatment: Astringent and antiseptic lotions, injected
often: silver nitrate: pyoktannin.

The forms of conjunctivitis in which there is an abundant production of pus are usually relatively more inoculable and therefore more liable to pass from animal to animal in a casual manner. Infection takes place through the dried up discharges floating as dust, but more directly by means of the tongue when the animals lick each other, and through posts against which they rub the head. Animals smelling or licking the infected genital organs and then the eyes of their fellows may convey it readily. Dogs occupying the same kennel successively, contract the disease (Guilmot). Swine feeding from the same trough and plunging the face into swill up to the eyes are especially subject to infection. In speaking of such infections one must be understood to refer to a group and not to one specific disease, as that will vary with the particular pus microbe present, and with the virulency of such microbe in the particular case. In keeping with the greater fertility of microbes in the warm season, these affections have been more commonly met with in summer than in winter, and where the animals are kept in filthy surroundings rather than otherwise. This is above all true of swine. Möller records a wide spread epizootic of gonorrhœal ophthalmia in dogs in Berlin and environs in 1883. In different cases, however, he failed to induce disease in the eyes by direct inoculation with the preputial secretion. Heinman equally failed with the gonococcus of man in inoculations on the eyes of rabbits, and dogs. Fröhner, however, succeeded in infecting the eye of the dog by applying the gonorrhœal discharge of man.

Infecting inoculable, purulent ophthalmia has been reported in the horse (Vermast, Sobornow, Blazekowic, Menard, Möller, Leclainche), in sheep (Repiquet), and in goats (Mathieu). Again Blazekowic found in an infectious ophthalmia of horses, dogs and cats a microbe which was like that of malignant œdema.

The _symptoms_ are those of conjunctivitis with especially free production of pus, and a tendency to chemosis or to follicular inflammation in the depth of the conjunctival sac, with irregular swellings of the lymph bodies. The pus accumulates in the inner canthus, inside the lids and along their margins, and tends to mat them together. The diagnosis depends on the rapidity and severity of the course of the malady, on the depth of the congestion and on the profuse suppuration.

_Treatment._ Astringent and antiseptic lotions are especially indicated. Mercuric chloride (1 ∶ 5000), boric acid (2 ∶ 100), creolin (1 ∶ 100), salicylic acid (1 ∶ 1000), silver nitrate (1 ∶ 200). It is not however enough that these should be applied externally; they should be freely injected under the lids at all points so as to act on the deepest portions of the conjunctiva, and this should be repeated once or twice daily. Or they may be applied with a soft brush. In a specially virulent outbreak silver nitrate (2 ∶ 100) or pyoktannin (1 ∶ 1000) solution may be used. Setons and blisters, laxatives and cooling diuretics may be employed as in the severe types of simple conjunctivitis.

INFECTIOUS CONJUNCTIVITIS IN HERBIVORA. ENZOOTIC OPHTHALMIA.

Causes: infection, pollen, soil emanation, winter or summer; cases of
extension by infection. Cattle, sheep, goats, ponies. Accessory
irritants. Symptoms: severe purulent conjunctivitis. Papillary and
follicular hypertrophy, uniform redness, protruding head, opacities,
erosions, ulcers, photophobia, staphyloma. Treatment: rest, darkness,
coolness, elevated head, purgative, diuretics, sedatives; locally
solutions of pyoktannin, sublimate, silver nitrate, boric or salicylic
acid, atropia, puncture.

_Causes._ This affection which attacks at once or in rapid succession a large portion or the whole of a herd or flock, is by many held to be infectious while others attribute it to irritant pollen or soil emanation. Its origin from vegetation in flower is held to be supported by its greater frequency in summer than in winter, and the few outbreaks seen in winter are attributed to pollen preserved in the hay. But other things being equal, organized germs are preserved, multiplied and diffused to a greater extent in the hot season so that the origin of the disease from a purely microbian source is at least equally plausible. Certain outbreaks indeed show the transmission of the infection in a most unequivocal manner. A cow suffering from the affection was brought into a stable occupied by a herd previously sound, and in a few days the cow standing next her was attacked, and thereafter a number of others in rapid succession. A small number of cattle from the Buffalo Stock Yards, but which had sore eyes on their arrival in Tompkins Co., N. Y., were placed in a sound herd and the disease spread rapidly to the other members of the herd. Similarly in both sheep and cattle the writer has seen the disease prevail in one herd or flock, while the adjacent herd or flock, separated only by a good stone wall and subject to exactly the same condition of soil, water, exposure, vegetation and pollen has entirely escaped. Kaiser has seen it introduced into a herd by a bull; Fünfstück saw a herd of 300 head attacked in a few days, and Klink 20 out of a herd of 40 head in 14 days. Trumbower has never seen an animal suffer a second time. This is the common experience and would suggest an acquired immunity, yet the comparative rarity of the disease forbids a positive conclusion, without further experience. Menard saw an outbreak among the ponies in the Jardin d’Acclimatation, and as many as fourteen weeks later in the same gardens it attacked the bovine animals.

In sustaining the doctrine of infection, however, we must not altogether ignore accessory causes. Like other affections of the eye, this has seemed to appear especially in low, damp lands, bottom lands, deltas, marshy borders of lakes and level prairies, so that a general lack of tone or a lymphatic constitution may be held to predispose. Nor is it necessary to ignore the influence of pollen, dust and other irritants, which though they may not cause the specific disease, yet prepare the way for its attack by reducing the resisting power of the tissues.

_Symptoms._ These are the phenomena of severe purulent conjunctivitis. Closed eyes; profuse secretion of tears, sometimes mixed with blood, changing in a few days to a thick, purulent, white or yellow secretion, which collects in masses inside the lids, along their margins, in the inner canthus and on the cheeks, gluing together the cilia, lids and hairs. When separated the lids show a mucosa of an uniform deep red, covered with pus, and irregularly swollen according to the amount of infiltration. Papillary and follicular hypertrophy are marked features, and the nictitans projects excessively over the eyeball. In many cases the cornea becomes opaque and in some instances erosions occur which may cause perforation or loss of the eye. In other instances the ulcers heal with the formation of cicatrices, or the weakened portion of the membrane yields under the internal tension and staphyloma supervenes. In such cases the pupils are contracted.

The disease is usually attended by marked hyperthermia, the secretions, including the lacteal, are materially decreased, appetite and rumination are impaired and the animal leaves the flock or herd. The disease affects cattle and sheep, and Menard and Hoffmann add horses and goats.

_Treatment._ This must be primarily antiseptic, but without neglecting constitutional disorder. Rest in a dark, cool stall, with the head elevated by tying to a high point. Give at once an active purgative 1½ lb. Glauber salts in 4 quarts warm water, and follow up with cooling diuretics and sedatives (saltpeter ½ oz. and tincture of aconite 20 drops, thrice a day). If the temperature runs very high a few doses of acetanilid or phenacetin may be given. Locally use silver or other antiseptic collyrium.

_Locally_ use pyoktannin solution (1 ∶ 1000) or mercuric chloride (1 ∶ 5000) injecting under the lids so as to bring it in contact with the whole diseased surface. A cloth wet with the same solution may be hung over the eye. Boric acid (1 ∶ 100), salicylic acid (1 ∶ 1000), or silver nitrate (1 ∶ 100) may be substituted for the above when they seem to be losing their efficacy.

Ulcers are treated by pyoktannin or silver nitrate solution applied daily with a soft brush. Keratitis will demand atropia. Abnormal tension or staphyloma will demand puncture of the cornea. Improvement may be expected in a few days and recovery in a week or ten days.

VARIOLOUS CONJUNCTIVITIS.

In cow pox, horse pox, and above all sheep pox, the infection sometimes falls on the conjunctiva, giving rise to the formation of the specific eruption on that membrane. The coexistent eruption on other parts of the body (udder, heels, hairy portions of skin) of the specific variolous eruption, furnishes the means of a satisfactory diagnosis. The lesions in the eye develop rapidly to an extreme severity. The lids are swollen and closed, lachrymation abundant, and early mixed with pus, and when exposed the conjunctiva is strongly congested with circumscribed areas of elevation. In cow pox these are circular in form, raised above the surrounding mucosa, having a deep red areola and a paler, flattened center. In _sheep pox_ the elevations have the same general character, but are liable to be more numerous and confluent, and tend to permanent opacities, cicatrices, and perforations of the cornea with loss of the eye. Short of perforation, internal inflammations are not uncommon.

_Treatment._ At the outset this form may be aborted by the application of silver nitrate solution (2 ∶ 100) or sodium hyposulphite (1½ ∶ 100). Otherwise the local treatment is like that for simple conjunctivitis, cooling astringent and sedative lotions, and if need be, derivatives and eliminants.

APHTHOUS CONJUNCTIVITIS. PHLYCTENULAR CONJUNCTIVITIS.

Closely allied to the last, are those cases in which vesicles appear on the conjunctiva. In exceptional cases these are seen during an epizootic of foot and mouth disease, while in other instances they are associated with eczematous eruptions on other parts of the body, particularly in dogs. In the human subject conjunctival vesicles are often associated with tuberculosis, but this has not been recorded of animals so far. The disease usually makes a rapid eruption, with symptoms of extreme inflammation, and its duration is largely determined by the general disease.

Beside the local _treatment_ by astringent or antiseptic and sedative collyria it may be desirable to correct the hepatic, digestive or other disorder on which the eczema depends, or to improve the general health by a course of bitters or even of cod liver oil.

DIPHTHERITIC CONJUNCTIVITIS IN BIRDS.

Hens, ducks, pigeons. Local inflammation, fibrinous exudate,
concreting or becoming cheesy, necrotic, sloughy. Beneath the mucosa
red, raw; without epithelium, but excess of lymphoid cells, some only
muco-purulent, gravity varies. Grave cases inoculable on birds, mice,
rats and rabbits. Bacillus diptheriæ avium, morphology and biology.
Pathogenesis. Prevention: exclude germ; cleanliness; pure air; pure
food; pure water. Quarantine strange fowls, keep flocks apart, seclude
manure, segregate sick, disinfect. Treatment: Antiseptics; boric acid;
sublimate: ichthyol; silver nitrate. Infection to man.

A disease of the mouth, fauces, nose and eyes, associated with the formation of false membranes, has been long recognized in birds (hens, ducks, pigeons, etc.), and is known to bird-fanciers by the names of roup, and diphtheria. The disease is characterized by the presence of a local inflammation in patches, associated in the early stages, with a free serous discharge, but, later, with the formation of white, or grayish, fibrinous exudate, which may be at first firm and smooth, later soft and cheese like, and still later in many cases more or less necrotic and sloughing. In Dr. Moore’s experience this is more common on the conjunctiva than on the nares or fauces. The interior of the eye was not involved in the inflammation. Beneath the false membrane the mucosa was devoid of epithelium and the underlying tissue was red, raw and angry, bleeding readily when handled, and infiltrated with an excess of lymphoid cells.

The lesions however were by no means constant. In some even of the fatal cases, the exudate was merely muco-purulent, while in others the false membrane was quite abundant.

The gravity of the affection also varies in different outbreaks or in the same outbreak at different times. Sometimes it runs a very rapid and fatal course, while at others it becomes chronic and comparatively dormant and the great majority recover.