On granular disease of the conjunctiva and contagious ophthalmia / by Edward Nettleship.

  • Nettleship, Edward, 1845-1913.
Date:
[1874-1875]
Catalogue details

Licence: Public Domain Mark

Credit: On granular disease of the conjunctiva and contagious ophthalmia / by Edward Nettleship. 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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    tioned at the inner and outer ends of the lid; in other cases they are limited, or almost so, to the central part of the tarsus. Occa- sionally only one or two are present on the whole upper lid. They are generally smaller, and almost always flatter, than the gra- nulations at the canthal parts of the lid or than those on the lower lids. These small sago-grains on the upper lid cannot be mistaken for the enlarged and congested papillae by which they are surrounded and which give to the conjunctiva the appearance of the finest sand- paper. They are, however, not by any means always present on the general surface of the upper tarsus, for in a considerable pro- portion of cases there is nothing to be seen but uniform congestion and the finest sandy roughness of this part. This congestion may be uniformly capillary, the larger vessels being quite hidden, or the larger vessels may be the more obvious, there being then coarse congestion without much alteration of the normal smoothness of the conjunctiva. It is worth noticing that the congestion affects last and when not uniform is slightest at, a small linear part of the tarsus situated midway between the two ends and about 2 mm. from its ciliary border. The large vessels all converge to or radiate from this area, which is exactly the part where, as we shall see later, scarring begins in severe cases of granular lid. In the later stage of a slightly or moderately granular upper lid there is a varying amount of subconjunctival thickening, considerable papillary enlarge- ment, usually much congestion and many whitish more or less promi- nent sago-grains. In the place of some of the latter small slightly depressed pale streaks or dots are often to be seen, indicating absorp- tion of previously existing granulations. The whole lid at this stage has a peculiar mottled colour and irregularity of surface which are highly characteristic. The relative development of the papillary and sago-grain changes vary greatly in cases of the degrees above described. In a good many instances all the papillse are so much elongated as to form a surface like the pile of velvet, different patches or rows of papillse often separating from one another and leaving fissures which appear at first sight to be cracks in the mucous membrane.' There may be no sago-grains visible on the upper lids even if any are pre- sent, and those on the lower lids may be almost or quite hidden by the velvety hypertrophy of the papillae. That the essential element in the disease, even in these cases, is the sago-grain granulation _ is I think certain in almost all cases. In most early cases sago-grains are obvious enough on the lower lids at least, and in many of these velvety cases they reappear much more clearly during conditions^of partial cure when the papillse have much diminished in size. The natural ending of the velvety type of cases is in a gradual condensa- tion of the over-grown papillse, followed by shrinking and devascu- larisation. There is at last left a pale surface, perhaps partly scarred