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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    and quite smooth in some parts and in others occupied by small, pale, tough, fii-m papillary granulations, looking like coarse sand. These are most abundant and largest at and above the retro-tarsal fold of the upper lid. They often remain in this state for years, probably for life. Hitherto the three elements in the disease, follicular granulations, hypertrophied papillae and diffuse (? adenoid) infiltration of the con- junctiva and subconjunctival tissues, have all been more or less completely appreciable by obvious differences. Although the rela- tive amount of each change has been seen to vary largely, still the sago-grain (lymphatic follicle) granulation is the primary and essential constituent in every one. In the severer forms of granular ophthalmia, although the sago- grain granulation is an equally important primary change, the morbid action extends so largely to the papillae and the other con- junctival structures that it is often quite impossible to distinguish between follicular and papillary granulations. The papillae, which in an early stage of disease are increased more in length than width, become in the more aggravated conditions gradually thickened, until they form rounded masses indistinguishable either by size, colour, or apparent consistency from the true sago-grain bodies, In some cases the papillae may be seen in all stages of enlargement on different parts of the same lid at the same moment. The sub- conjunctival tissues now always become more or less infiltrated with inflammatory material. The appearance of the conjunctiva at this stage, its surface thickly studded with large florid succulent rounded granulations, needs no description. It is in this state that most of the patients seek hospital relief. The final absorption of the effused products in these bad cases is always accompanied by the condensation of a part of it into firm, white, tendinous cicatricial tissue. It is unnecessary to describe in detail the form and arrangement of these scars, further than to mention that the chief one is almost always found as a linear patch or band midway between the inner and outer ends of the upper lid, between the centre and the free border of the tarsus and parallel with the latter. The precedence taken by this part in the retrograde changes is no doubt connected with the fret that it is the least vascular part of the lid. This point, as has been already mentioned, is beautifully shown in many upper lids when in a state of moderate chronic congestion. The depth of scarring depends chiefly on the degree to which the subconjunctival tissue has been implicated in the inflammatory process. Bad results from changes in the curvature of the lids and permanent shortening of the conjunctiva are likely to follow in proportion to the depth of the scar, and in proportion as it affects the oculo-palpebral fold. It must be distinctly borne in mind that scarring is the natural termi-