CHAPTER XII
Common Diseases of the Eye

IN addition to "errors of refraction," there are certain diseases of the eye and its appendages which require special mention, since these are quite frequently met with, and their treatment is often limited, in orthodox practice, to purely local measures, neglecting the constitutional treatment which is usually so necessary, and also the measures for relief of eye strain which we are advocating.

The eye is made up, as we have seen, of numerous parts, and each of these parts may become diseased; thus we have diseases of the iris, conjunctiva, retina, eyelids, optic nerve, etc., as the case may be. We shall mention the most important of these, giving their chief causes and most effectual means of cure in each case.

Congestion of the Conjunctiva. This often results, in a mild form, after exposure of the eyes to smoke, or even to strong winds. The conjunctiva is, however, nearly always inflamed in measles, and frequently in scarlet fever and smallpox. Occasionally a diphtheric membrane is formed over it, either with or without an accompanying infection of the throat. These, however, are exceptionally severe cases. In most instances, a more or less readily curable congestion results—partly from the causes mentioned, and partly from the general physical condition of the patient. If the blood is full of impurities, it aggravates the congestion. These cases are relieved from within by those hygienic and cleaning measures which tend to purify the blood stream, and carry away poisonous material.

As regards the external treatment of the eye, frequent eye baths in moderately cold salted water will be found beneficial. These may be followed by the application of cold wet cloths to the eyes, changing them as frequently as occasion may require. The patient must keep the eyes closed as much as possible.

Catarrhal Conjunctivitis, or "Catarrh of the Eye," results largely from a prolonged continuation of conditions similar to those which produce congestion. Those suffering from this complaint often feel as though sand were in the eyes. It is frequently met with in large cities, where dust and smoke tend to keep the eyes inflamed. The eyes are often found glued together on awakening. The mucous membrane of the eye is affected in much the same way as those of the nose and throat, and often at the same time.

Constitutional and local treatment, as advised for congestion, with complete rest for the eyes, is unquestionably about the best remedy for this trouble. When the lids are swollen and the eyes red and hot, an eye bath in salted water may be employed to advantage several times a day. If inflammation is especially severe, a weak solution of boric acid, ten grains to an ounce of water, may be employed. Poultices, eye waters and remedies of that sort should be avoided. Burning of the lids can nearly always be alleviated by an eye bath.

Granular Conjunctivitis: Trachoma: Granulation of the Eyelids.—All these are names for the same malady, which is merely a severe form of the two former complaints. Violent inflammation of the eye, which is covered with numerous nodules, is the principal characteristic. It is a tedious and obstinate complaint, unless treated in a prompt and efficient manner. The inner surface of the lids often becomes thickened and rough, like sandpaper, and, by constant friction, impairs the transparency of the cornea. Trachoma is very contagious and in all cases precautions should be taken to avoid communicating the disease by allowing the smallest particle of the discharge from the eyes to come into contact with a healthy eye. Appropriate antiseptic treatment will be helpful. An eye-wash made from sulphate of zinc—about one grain to an ounce being the usual strength—is often effective in terminating the symptoms of this trouble,, though this suggestion does not in any way eliminate the necessity for careful constitutional treatment.

Purulent Conjunctivitis is often found in the newly born, and results from gonorrheal infection from the mother. It often produces blindness, unless promptly treated with nitrate of silver under proper medical supervision. This should be followed by the strictest care and cleanliness. The discharge, which is thick and yellowish, and, in bad cases, very copious, is undoubtedly and virulently contagious. Fortunately, the disease is rarely met with among adults.

Styes are a very painful species of small boils which form generally on the edge of the eyelids. The disease usually follows more or less the course of ordinary boils, and is nearly always brought about through constitutional causes, general debility, a disordered stomach, impure blood, etc., though eye strain is the usual immediate cause. If treatment is begun at the first sign of the appearance of the styes, they may be absorbed without suppuration, but if well started, relief may be secured more speedily by allowing them to come to a head. Hot compresses will hasten this desirable end. Usually they will open themselves when ready to discharge the pus, though in some cases it is necessary to open them with a lance. A permanent cure can be effected only by adopting constitutional treatment and learning how to use the eyes properly, thus avoiding strain. It is hardly necessary to say that strict cleanliness and adequate drainage of the parts are essential in this condition. The practice of eye relaxation and of central fixation should be observed by every one subject to styes.

Diseases of the Cornea. These are troublesome and often difficult to treat and still more difficult to diagnose properly by an unqualified practitioner. Says Dr. Black, in his work on the eyes:

"Diseases of the cornea may destroy or impair its transparency, or the ulcers that are frequently formed may extend through its substance, allow the aqueous humor to escape, and involve the iris. Even when such ulcers heal most favorably, they leave a permanent scar in the form of a white speck. Inflammation of the cornea is usually painful and accompanied by distressing sensitiveness to light. It occurs most frequently in persons whose health has been subjected to some depressing cause, or in children who have inherited a delicate constitution. Many of the latter are subject to repeated attacks for years, but the tendency to their recurrence generally disappears before adult life, and if care be taken to prevent each attack from leaving a permanent mark, the eyes may finally remain sound and strong. . . . A large, white opacity of the cornea is often mistaken for cataract, and not many years ago, when a knowledge of diseases of the eye was not so general as now, this mistake was sometimes made by physicians, and such patients were sent hundreds of miles to have the cataract removed."

It is hardly necessary to point out that, though "delicacy of constitution" might predispose certain person to this disease, the actual causes are an overloaded circulation, poor digestion, poor light, excessive use of tobacco and alcohol, etc.

This being the case, the treatment for all forms of these diseased conditions is obvious. A rigid diet, preceded, if possible, by a few days' fasting; plenty of water-drinking; eye baths; fresh air; exercises which tend to build up and strengthen the general bodily tone, etc., are all essential. Plenty of good light and sunshine are imperative at all times.

Iritis, or inflammation of the iris, often destroys the sight by closing the pupil and shutting off the light from the interior of the eye. It may be accompanied by inflammation of the conjunctiva, and hence be overlooked until well developed. It should always be suspected when, in an acute affection of the eye, the sight is decidedly diminished and there is some pain in the ball, and particularly in the brow, the latter being always more severe at night. The cause is usually syphilis or rheumatism, and one of the chief aftereffects to be feared is the permanent contraction of the pupil. Local treatment is of little avail, but the application of hot and cold cloths alternately to the eye will usually assuage the pain. The patient should be careful not to use the eyes more than is absolutely necessary.

Cataract is a disease of the crystalline lens, in which this body gradually loses its transparency. The pupil thus loses its natural blackness, the whitish surface of the opaque lens being seen just behind it. Cataracts are not "on the eye," as is commonly supposed, but in it. Until lately, it has been contended that the surgeon's knife was the only remedy, but other methods of treatment are now coming in, and it is highly probable that as soon as these newer methods become more widely known and recognized by the medical profession, operations will not be found necessary in any but advanced cases.

There are two kinds of cataracts—the old, hard cataract, and the so-called "soft" cataract. In the majority of cases the lens becomes hard and stonelike, and sight is restored by removing it, the operation having been successfully performed in many instances. In such well-advanced cases, it is probable that all the physical culturist can do is to encourage such a condition of good health that the operation can be well borne, and keep the blood as pure as possible, to carry on the good work of repair afterwards. By preserving the health, however, and using the eyes properly, cataract may be prevented; and prevention is better than cure here as elsewhere. In their earlier stage, cataracts have been permanently cured by hygienic treatment and eye education.

The reason for this is simple enough. It is this: The lens is composed of a number of transparent layers superimposed one upon another—like a number of sheets of glass laid flat one upon another. When these all lie flat and even, the light can penetrate them all equally and without interference; but if they become separated or warped, then the light-rays are bent and warped, and the otherwise transparent medium becomes more or less opaque. This is what happens in the case of cataract. By improper use of the eyes these delicate layers are disarranged. Instead of lying flat, some of them are bent or warped, preventing the free passage through them of the light-rays. If this state has been permitted to continue long enough a degenerative change within the eye takes place. When this happens, probably the only relief procurable is by removal of the lens, and thanks to the advance of modern surgery, this may now be done in the majority of cases with relative safety.

Both clinical and experimental proof that this theory is correct is forthcoming. If you take a bullock's eye, and squeeze it, you can instantly produce cataract—with the typical white, glassy look in the pupil. As soon as the pressure is removed, the eye again becomes normal. The little "plates" have been bent and warped, and functional cataract has been produced. This theory of cataract is also sustained by the fact that such patients actually do get well, under the influence of eye education, whereas formerly there was considered to be no help for them. All they could do was to wait, in gradually increasing blindness, until the lens was "ripe" for removal.

Constitutional causes also contribute to the production of cataract. The lens has to be nourished, like any other part of the body; but if the circulation is sluggish and the blood impure and lacking in its normal water content, the layers dry out, becoming not only less transparent, but more liable to disarrangement by the abnormal pressure of the outside muscles associated with errors of refraction.

The regime which sufferers from incipient cataract should adopt, therefore, is the following: Comply strictly with all the laws of health, including an abstemious diet with plenty of fruit, green vegetables, and water, and no alcohol; take regular exercise and use all other methods of improving the circulation; use eye baths and similar local measures of relief; and practice daily the exercises necessary to relax the external eye muscles.

These methods have, in many cases, either cured or greatly relieved the condition, or checked its progress, the results depending on the condition of the eye at the beginning of the treatment, the general health of the patient, his mental responsiveness, and the amount of time available for eye training. If they are adopted at the very beginning of such cases, there is every reason to believe that the majority of cataracts can be overcome in their initial stages, and before they develop to the point where they become organic.

Glaucoma is a disease which frequently results in blindness and about which little is known. It is thought that an excess of fluids in the eye makes the ball tense and hard, and exerts injurious pressure upon its delicate contents. In acute cases, it is intensely painful, and rapidly destroys sight by pressure upon the optic nerve. In its earliest stage, its progress has been checked by the removal of a piece of the iris, or of tapping or incision through the sclerotic coat, but the operation is very uncertain in its results and sometimes seems to make the condition worse. When the optic nerve is once affected other complications arise.

In no other disease is early diagnosis and treatment more important, and many of its victims have been condemned to blindness by delay. No one with a violent pain in the eye and head, particularly if it is accompanied by flashes of light, rainbow colors and dimness of vision, should allow himself to be lulled into a sense of security by thinking it is "neuralgia."

Although the ultimate and true causes of glaucoma are as yet unknown, the thing to do, immediately it has been diagnosed, is to adopt a very abstemious diet, following a fast of a few days, if possible; use all those measures which tend to build up the general health; discard glasses if possible, and practice the various methods of eye education. Frequent cold eye baths may also be useful. In all cases a specialist should be consulted at once, if the victim has not the courage to adhere to the treatment suggested here.

Diseases of the Choroid and Retina. These diseases can be detected only by means of the ophthalmoscope, but may be foretold by increasing dimness of vision. They usually develop painlessly, and hence are as insidious as they are unfortunate. Long continued eye strain is one of the causes of these conditions. The excessive use of tobacco and alcohol is also, probably, an important factor; hence the necessity of giving them up completely when treatment is begun. Syphilis and kidney disease are common causes.

Atrophy of the Optic Nerve. This is a very serious progressive disease, resulting in total blindness. Syphilis is a frequent cause, and it goes without saying that such condition would be impossible in a healthy body, or in one wherein the seeds of disease had not been sown.

The Hereditary Transmission of Eye Diseases. There is evidence to show that a certain number of eye diseases—or rather the tendency to these diseases—may be acquired by means of heredity. In color blindness this is particularly marked, as well as in certain peculiarities or conformations of the eyes. Actual diseases are probably not inherited, and errors of refraction are probably acquired in each generation. A tendency to gouty or rheumatic iritis, it has been contended, may be inherited; but here again it is probable that no more than the tendency is ever passed on in this way. A peculiar affection, "retinitis pigmentosa," which is recognized, with the ophthalmoscope, by the presence of black spots upon the retina, shows a marked tendency to hereditary transmission. It also occurs in several members of the same family, though there may be no history of it in the family. The prominent symptoms are "night blindness" and a gradually increasing contraction of the field of vision. (This is also a characteristic of certain forms of hysteria.) It is also probable that "nyctalopia," or the reverse condition—ability to see in the dark—is to some extent hereditary. But it may be laid down as a general rule that eye diseases—like all other diseases—are not hereditary, but are acquired by each generation, and by each individual for himself or herself.

Eye Headaches. As already mentioned, the eyes and the whole nervous system are very intimately connected; and it is well known that a constant strain upon the eyes will induce a general condition of strain, nausea, backache, etc., in addition to frequent and sometimes severe headaches. Some physicians have gone so far as to assert that true and organic diseases have been induced in this manner; but this view is no longer generally held by the medical profession. Hewetson, Noyes, Weir Mitchell and others, however, have published numerous facts showing the close connection between defective eyesight and headache, with general nervous and physical impairment of the health; and when we consider the constant strain involved, the reason for this is obvious. Some of the early symptoms are a feeling of fatigue and tension, especially above the eyes, with indistinct and confused vision in reading, writing and other close work. Following this, slight headaches will be experienced, at the base of the brain; and these will be followed or accompanied by nausea, vertigo and general nervousness. Other physical and mental symptoms may follow. When these appear, it is high time to begin treatment of the eyes.

The usual treatment in cases of this kind is a prescription for glasses; and there is no doubt that relief has often been obtained by their use.

Such measures, however, are only palliative and not ultimately curative. When the external muscles are squeezing the eyeball out of shape, glasses may correct some of the results of that condition, and by so doing may make the patient more comfortable; but they can not relieve the fundamental trouble. On the contrary, as has already been shown, they must make it worse. The only real remedy is to be found in the methods described in "Errors of Refraction; Their Cure." In the absence of such treatment glasses may prove useful, in some cases. In others they fail entirely. If it seems necessary to resort to them, and there can seldom be any legitimate excuse for such a course, they should be carefully fitted by a competent oculist and should not be worn any more than is absolutely necessary, as they serve to confirm the eyes in their bad habits. Eye headaches can often be relieved in a short time by proper hygienic methods. It is hardly necessary to say that the general health should be built up. Massage of the back of the neck and head will often bring material and instantaneous relief from the pain, and cold wet compresses to these parts will soothe and relieve the local congestion. A salt eye bath often relieves.

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