Relapsing traumatic bullous keratitis, with cases / by G. E. de Schweinitz.

  • De Schweinitz, G. E. (George Edmund), 1858-1938.
Date:
[1911]
Catalogue details

Licence: In copyright

Credit: Relapsing traumatic bullous keratitis, with cases / by G. E. de Schweinitz. Source: Wellcome Collection.

Provider: This material has been provided by UCL Library Services. The original may be consulted at UCL (University College London)

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    of these cases and how readily they may be mistaken for some other affection. As to the treatment, it has not differed from that which has been recommended by all authors who liave written upon this subject, namely, some form of cauterization of the erosion, massage with the yellow oxide of mercury and during the proper stage an occlusive bandage, except in one particular, namely, the apparent value of holocain in one case. Certainly it would seem to be a useful drug to alleviate the irritation, and if what we know of its value in other forms of corneal ulceration is remembered, a useful application, as it proved in my -case, directly to the affected area. One of the cases demonstrates, as Jensen points out, that although the cornea usually clears up entirely, it may become infected and a corneal ulcer develop. Indeed, on a few occasions, the infection has been sufficiently great to produce iritis and hypopyon. With regard to the pathology of this affection, as Praun states, Fuchs makes the plausible explanation that the epithelium over the original spot of injury is not regenerated in a normal manner, so that if the occasion arises it can be readily lifted up from its posi- tion, probably in the form of a bleb or vesicle, which collapses, and when the patient is examined the erosion alone is visible. Stood, who has gone into the matter with a great deal of care, comes to the conclusion that a theory advanced by Grandclement and others that the pain depends upon a neuritis of the finest nerve endings in the corneal epithelium, associated with trophic disturb- ances, is not correct. He wishes to find the explanation of these phenomena in the anatomical condition of the deepest cylindrical epi- thelial layer, which is attached by minute tooth-like processes in the furrows of the fibrilla of the anterior elastic lamina, and by this means has an intimate relationship with this tissue. Owing to the injury a certain extent of the epithelium is torn away from its at- tachments and the anterior portion of Bowman's membrane is prob- ably bruised, so that the new-formed epithelial cells which spring forward at the borders of the defect are unable to form the normal attachment to the underlying tissues. During the night the con- ' junctiva of the closed lid comes in contact with this epithelium, and when the lid is opened the poorly detached epithelium is;.toru away and the fine nerve endings are broken. Following this a transuda- tion from the parenchyma of the cornea finds its way through the pores of the lamina elestica which represent the nerve canals, and this produces the bleb-like formation.