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lids, but may extend to the eyeball when the eye becomes "bloodshot" and the condition more serious. For the sake of convenience we may speak of a mild form of sore eye, as congestion of the eyelids, and the more severe type, as true conjunctivitis (see p. 18).

CONGESTION OF THE EYELIDS.-This may be caused by smoke or dust in the atmosphere, by other foreign bodies in the eye; frequently by eye-strain, due to far- or near-sightedness, astigmatism, or muscular weakness, which may be corrected by an oculist's (never an optician's) prescription for glasses. Exposure to an excessive glare of light, as in the case of firemen, or, on the other hand, reading constantly and often in a poor light, will induce irritation of the lids. The germs which cause "cold in the head" often find their way into the eyes through the tear ducts, which connect the inner corner of the eyes with the nose, and thus may set up similar trouble in the eyes.

Symptoms. The eyes feel weary and "as if there were sand in them." There may be also smarting, burning, or itching of the lids, and there is disinclination for any prolonged use of the eyes. The lids, when examined, are found to be much deeper red than usual, and slightly swollen, but there is no discharge from the eye, and this fact serves to distinguish this mild type of inflammation from the more severe form.

Treatment. The use of dark glasses and a few drops of zinc-sulphate solution (one grain to the ounce of water) in the eye, three times daily, will often cure


the trouble. If this does not do so within a few days then an oculist should be consulted, and it will frequently be found that glasses are needed to secure freedom from irritation of the eyes. In using " eye-drops the head should be held back, and several drops be squeezed from a medicine dropper into the inner corner of the eye.

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CONJUNCTIVITIS; CATARRHAL INFLAMMATION OF THE EYES.-In this disorder there is discharge which sticks the lids together during the night. The inner surface of the lids is much reddened, the blood vessels in the lining membrane are much enlarged, and the lids are slightly swollen. The redness may extend to the eyeball and give it a bloodshot appearance. There is no interference with sight other than momentary blurring caused by the discharge, and occasionally there is very severe pain, as if a cinder had suddenly fallen in the eye. This symptom may occur at night and awaken the patient, and may be the reason for his first consulting a physician.

One eye is commonly attacked twenty-four to thirty-six hours before the other, and even if it is thought that the cause is a cinder, in case of one eye, it can hardly be possible to sustain this belief in the case of the involvement of both eyes. There is a feeling of discomfort about the eyes, and often a burning, and constant watering, the tears containing flakes of white discharge.

When the discharge is a copious, creamy pus or

matter," associated with great swelling of the lids and pain on exposure to light, the cause is usually a germ of a special disease, and the eyesight will very probably be lost unless a skillful physician be immediately secured. Early treatment is, however, of great service, and, until a physician can be obtained, the treatment recommended below should be followed conscientiously; by this means the sight may be saved. This dangerous variety of inflammation of the eyes is not rare in the newborn, and infants having red eyes within a few days of birth should immediately receive proper attention, or blindness for life will be the issue. This is the usual source of that form of blindness with which babies are commonly said to have been born.

All forms of severe inflammation of the lids are contagious, especially the variety last considered, and can be conveyed, by means of the discharge, through the agency of towels, handkerchiefs, soap, wash basins, etc., and produce the same or sometimes different types of inflammation in healthy eyes. Therefore, if the severe form of conjunctivitis breaks out among any large number of people, as in schools, prisons, asylums, and almshouses, isolation of the patients should be enforced.

"PINK EYE."-This is a severe epidemic form of catarrh of the eye, which is caused by a special germ known as the "Koch-Weeks bacillus." The treatment of this is the same as that outlined below. The germ of pneumonia and that of grippe also often cause con


junctivitis, and "catching cold," chronic nasal catarrh, exposure to foul vapors and gases, or tobacco smoke, and the other causes enumerated, as leading to congestion of the lids, are also responsible for catarrhal inflammation of the eye.

Treatment. In the milder attacks of conjunctivitis the treatment should be that recommended above for congestion of the lids. The swelling and inflammation, in the severer types, are greatly relieved by the application of the cold-water compresses, advised under the section on "black eye," for an hour at a time, thrice daily. Confinement in a dark room, or the use of dark glasses, and drops of zinc sulphate (one grain in an ounce of water) three times a day, with hourly dropping of boric acid (ten grains to the ounce of water) constitute the ordinary treatment.

In inflammations with copious discharge of creamy pus, and great swelling of the lids, the eyes should be washed out with the boric-acid solution every half hour, and a solution of silver nitrate (two grains to the ounce of water) dropped into the eye, once daily, followed immediately by a weak solution of common salt in water to neutralize the nitrate of silver, after its action has been secured. The constant use of ice cloths, already mentioned, forms a necessary adjunct to treatment. The sound eye must be protected from the chance of contagion, arising from a possible infection from the pus discharging from its mate. This may be secured by bandaging the well eye, or, better,

by covering it with a watch crystal kept in place by surgeon's plaster.

In treating sore eyes with discharge, in babies, the infant should be held in the lap with its head backward and inclined toward the side of the sore eye, so that in washing the eye no discharge will flow into the sound eye. The boric acid may then be dropped from a medicine dropper, or applied upon a little wad of absorbent cotton, to the inner corner of the eye, while the eyelids are held apart.

Hemorrhages occurring under the conjunctiva (or membrane lining the inner surface of the lids and covering the front surface of the eyeball) may be caused by blows or other injury to the eye, by violent coughing, by straining, etc. Dark-red spots may appear in the white of the eyeball, slightly raised above the surface, which are little blood clots under the conjunctival membrane. No special trouble results and there is nothing to be done except to wait till the blood is absorbed, which will happen in time. If the eyes water, solution of zinc sulphate (one grain to the ounce of water) may be dropped into the eye, twice daily. Hot applications are beneficial here to promote absorption of the clot.

EYE-STRAIN.-Eye-strain is commonly due to either astigmatism, nearsightedness, farsightedness, or weakness of the eye muscles. The farsighted eye is one in which parallel rays entering the eye, as from a distance, come to a focus behind the retina.


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