A handbook of local therapeutics / edited by Harrison Allen.

Date:
1893
Catalogue details

Licence: Public Domain Mark

Credit: A handbook of local therapeutics / edited by Harrison Allen. Source: Wellcome Collection.

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    conjunctival discharge, with half a grain of alum. In wounds involving the cornea and iris, a four-grain solution is commonly used. Atropine is useful in most cases of Keratitis, particularly in the acute form, with a painful and irritable condition of the eye. In cases of Indolent Cor- neal Ulcer, or Sloughing of Keratitis, or when the intraocular ten- sion is much increased, eserine sometimes acts better. This subject has been much discussed, but the indications for the use, in corneal affections, of these two drugs, so opposite in their action, are not yet definitely for'- mulated. The surgeon will, in many cases, have to be guided by the teachings of his own experience, or by trial. Superficial ulcerations are best checked by the actual cautery, while in extensive sloughing involv- ing the deeper layers of the cornea, a free Ssmisch incision often offers the only hope of success. Compresses and hot stupes are import- ant aids in the treatment. In the case of a penetrating ulcer or wound near the centre of the cornea, dilatation of the pupil is indicated to pre- vent prolapse of the iris. Atropine is not now nearly so generally used as formerly after Cataract Extraction, and is thought to increase the tendency to prolapse of the iris, particularly in the case of operation without iridectomy. Many surgeons use eserine to draw the iris away from the corneal wound. After the incision is healed, however, atropine is useful by dilating the pupil and contracting the blood-vessels of the iris. If iritis sets in its use is imper- ative. Dilatation of the pupil before the operation is secured by the ap- plication of cocaine, which is now almost universally used for its anaesthetic effect. It is customary to apply atropine both before and after the opera- tion for solution. Atropine acts more slowly on the accommodation than on the pupil. According to Bonders a four-grain solution commences to act in about fifteen minutes, but complete paralysis is not attained until more than an hour and a half. There is a full return of accommodation in eleven days, rather earlier than the restoration of the pupil's action. As, how- ever, there is a decided variation in the susceptibility of different indi- viduals, and a ciliary muscle irritated by excessive strain resists the action of the drug, to be sure of the full effect it is customary to make the appli- cation three times a day for a day or two. Attained in this way the effect does not usually disappear entirely in much less than two weeks. This property of atropine has occasionally a therapeutic value in cases of spasm of the accommodation, or when it is desired to relieve the Effects of Excessive Accommodative Strain by a period of complete rest, but its most important use is in the determination of the refraction. The action of mydriatics in suspending the accommodation is invaluable to ophthal- mic surgeons in their optical work, as the contraction of the ciliary