Excerpt from On the Comparative Value of Caustics and Astringents in the Treatment of Diseases of the Conjunctiva, and on the Best Mode of Applying These Remedies

The tendency of this affection is towards a disappearance of the symp toms at the end of a few days, even when no treatment is employed. Therefore, no active remedies of caustic or astringent nature are needed, and they tend to delay rather than hasten the recovery. Calomel or other insufflations are Similarly useless. All annoying remedies are moreover objectionable on account of' the age of the majority of the patients. Simple lotions, cold or tepid, with water, or milk and water, may be used. Two or three times a day, a few drops of a solution of ten grains of borax in an ounce of water, or of camphor water, may be dropped into the eye from a teaspoon or a drop-tube. This usually proves a soothing and refreshing collyrium, grateful rather than painful to the patient, and appears to have a sufficiently astringent and stimulating effect to pro mote absorption of the papulae. Although the ordinary duration of these small pimples rarely exceeds ten days, it is not uncommon, whatever treatment has been employed, to find successive crops of them, at inter vals of a week or two. This disposition seems to be best obviated by continuing the use of the borax collyrium, once or twice a day, for some time after recovery, so as to modify the condition of the conjunctiva. Where the papulae are slow in disappearing, the application of a crayon of alum, once in a day or two, to the inner surface of the lower lid, is often useful and is nearly painless. The astringent reaches the affected Spot as the lid returns to its place, and seems sometimes to excite a more rapid resolution. The papulae themselves should never be directly touched with caustic or astringent crayons or solutions.

Very rarely, the disease takes a more chronic form, the papulae being as large or larger than a split pea, and sometimes umbilicated at the centre. Though persisting longer, and for a time intractable to treatment, the prognosis is always favorable. Tonic general remedies, and some times change of air, are useful adjuvants to the mild local applications. Solutions of atropia have of late been too much in vogue in the treatment of this form of disease. Though far less dangerous than the strong caus tic remedies which were formerly indiscriminately employed, yet an unnecessary resort to them has grave disadvantages. In cases of corneal ulceration they may be of much service, in lessening the irritability and photophobia; whilst. In these less serious conjunctival affections their action upon the pupil does but increase the intolerance of light, and, by exciting strong contractions of the lids, creates a disposition to cor neal ulceration as an effect of friction.

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