Part 62

The symptoms consist in swelling, redness, distortion, and often extensive infiltration of the lid, sometimes eversion with exposure of the reddened conjunctiva, usually abrasion, contusion, puncture or laceration, semi-closed eye, the upper eyelid being comparatively immovable (ptosis), and the formation of scabs, sloughs, or abscess. There may be extreme tenderness, or, more commonly, intense itching. Where eczema exists there may be found minute shot like papules at times surmounted by small vesicles and the skin disease is continuous backward upon the face. When abscess forms, the rounded swelling and manifest fluctuation will betray its presence. Usually the eye waters and the side of the cheek is wet and the hairs matted by a whitish coagulated lymph and mucus.

Treatment. In the early stages without scabs, sloughs, or abscess, antiseptic astringent lotions are in place. Weak solutions of zinc sulphate, boric acid and morphine may be kept applied on a light bandage. Or silver nitrate 1 gram to 1 oz. water may be applied daily with a fine brush.

When scabs and crusts have formed they may be softened by the application of almond oil, and then removed. The surface may then be dusted with a bland antiseptic powder such as: zinc oxide 10 parts, salicylic acid 1 part; or boric acid and starch equal parts; or iodoform; or xeroform. Or unctuous applications may be used; zinc oxide 10, salicylic acid 1, vaseline 10; or iodoform 1, vaseline 5. Or a watery application may be used, such as the silver lotion or that of pyoktannin 1:1000.

For eczema yellow oxide of mercury 1, to vaseline 10, has an excellent reputation. It may be alternated with pyoktannin.

When abscess has formed it should be excised in a line parallel to the free border and the resulting cavity injected with the silver or the pyoktannin solution.

In all cases the patient must be fastened as for wounds of the lids so that he cannot rub the eye.

For eczema and other skin diseases the special treatment appropriate to the disease should not be omitted.

ŒDEMA OF EYELIDS.

In anthrax, malignant œdema, disease of heart, kidney or liver, distomatosis, trichiniasis, wasp stings, urticaria, petechial fever. Treatment: correct general disorder, remove local irritant, antiseptic astringents.

An œdematous condition of the eyelids with or without inflammatory conditions may be due to local disease or it may be the result of more general disorder. In anthrax districts any of the herbivora, but especially cattle and sheep, are liable to a diffuse anthrax of the eyelid with a special petechial or brownish condition of the palpebral conjunctiva. Malignant œdema and other local bacteridian affections affect the loose textures of the eyelid in a similar manner, but with extrication of gas and crackling under pressure. Such cases are complicated by local inflammation. When in the absence of inflammation the lids pit on pressure, one should seek for some disease of the heart, kidney or liver, also for indications of similar dropsical effusions in other parts of the body. Distomatosis and, to a less extent, pulmonary and duodenal strongylosis are especially common factors in sheep. In distomatosis (liver rot) a simultaneous dropsy is often present in the intermaxillary space, the chest or the abdomen. The puffiness of the eye is especially marked in the palpebral conjunctiva, and is exposed by everting the eyelid over the tip of the finger. In trichinosis in man and less frequently in swine, dropsy of the eyelid is often present at the end of the first week. Other swellings of the lids partaking more of the nature of inflammation, result from the stings of wasps, hornets and other insects, from urticaria (in horses especially) and from petechial fever in solipeds.

In treating such cases the general disorder, if present, must be first attended to, then the removal of any local irritant, and finally the antagonizing of any local inflammation or infection. Astringent and antiseptic lotions are especially called for.

EMPHYSEMA OF THE EYELIDS.

This has been already referred to as occurring in malignant œdema, black quarter and other gas producing infections. It may also come from lacerations made in puncturing the lachrymal sac, and from fracture of the margin of the orbit—the air entering the connective tissue in this case from the cavities of the nasal sinuses. The lid feels puffy and crackles when pressed and apart from a general infection it requires only soothing and antiseptic dressings.

DISEASE OF THE MEIBOMIAN GLANDS. BLEPHARADENITIS. SEBORRHŒA.

This is a blepharitis of the edges of the lids which are swollen, red, and incrusted along their margins with scabs and sebaceous concretions. When this scurf is removed the skin is found to be red, tender and glistening. The glands are the seat of congestion, and produce a modified secretion in excess, which dries into crusts instead of preserving its normal oleaginous consistency. As these glands open into the follicles of the eyelashes, their walls are implicated and shedding of the lashes is a common result. It may be assumed that this affection is often associated with the proliferation of microbes in the glands and gland ducts, while in other forms the presence of acari is the controlling factor. Wilson found the demodex folliculorum in the Meibomian glands of the horse, and Oschatz in those of the sheep.

Treatment. Smear the margins of the lids with vaseline and when the crusts have been thoroughly softened wash them off with Castile soap and warm water. Then dress the margin with the ointment of the yellow oxide of mercury 1, in vaseline 10. If demodex is suspected they may be squeezed out and the lids washed frequently with spirits of wine as a solvent.

HORDEOLUM. STYE. ACNE.

Like acne of the skin in general, this consists in inflammation and suppuration of a hair follicle and sebaceous gland. The whole lid or a large part of it may be swollen, but by stroking it with the finger, a hard, rounded, very tender spot will be detected and as the disease advances this develops a minute collection of pus. A specially wide orifice favors the entrance of the pus microbes, and the onset of the disease. It has been noted in dogs (Fröhner).

For abortive treatment Fick recommends dry heat from a pocket handkerchief or a heated teaspoon. If pus is present it must be evacuated, and recurrence guarded against by cleanliness and antiseptics. Use pyoktannin solution (1 ∶ 1000), or mercuric chloride (1 ∶ 5000) or yellow oxide of mercury ointment.

CHALAZION.

This is a pea like tumor growing from the tarsal cartilage, its flattened side toward the mucosa, which is red and angry, and its round surface toward the skin. When manipulated between the fingers it moves with the tarsus. It is usually of slow growth and may continue for years apparently unchanged. Some have thought it tuberculous, but its true nature is uncertain. Warner records the disease in the horse.

Treatment consists in incision and removal of the tumor, curretting of the cavity, and after antiseptic douching, suturing the lips.

TUBERCULOSIS OF THE EYELID.

Described by Jewsejenke in the lower lid of birds, this is manifested by small, hard round knots, covered by bluish red, or yellowish red skin, and when incised showing a characteristic miliary tubercle, with bacilli and sometimes a caseated centre. It is treated by incision, curretting and caustics.

TURNED IN EYELASH. TRICHIASIS.

Sometimes an eyelash grows inward so as to impinge upon the front of the eyeball, or even to extend between this and the eyelid. The condition exists in entropion but trichiasis is rather the deviation of one or two cilia by reason of their false direction, individually. It may occur as the result of a pre-existing inflammation affecting the edge of the lid and the follicle, and the offending hair is not only badly directed but small and shrunken as well. On this account it is not always easy to recognize it, and accordingly in cases of conjunctivitis without apparent cause it is well to examine carefully with the aid of oblique focal illumination.

Treatment consists in pulling out the offending hair with ciliary forceps, avoiding bending it lest it break off short and become at once more irritating and more difficult of extraction. In case the hair grows anew in the same direction extract it anew and destroy its root with the electric cautery.

ENTROPION. TURNING IN OF THE EYELID.