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Granular Lids.These granulations arise as the result of a purulent inflammation of the eyes, or as the continuation of an ordinary inflammation. In some cases they seem to result simply from the continued irritation of the eyes which occurs in a far-sighted individual who is compelled to employ the eyes constantly in fine work. Granular lids are not usually found among people in robust health and good sanitary condition; they are most frequently met with among people who live in closely-crowded quarters, neglectful of sanitary requirements. They are, therefore, more frequently seen among the poorer classes, especially those whose general health is evidently impaired. They may exist for a considerable time without giving any more annoyance than a slight sense of roughness in the lids, and perhaps a little tendency of the lids to stick together in the morning. In the majority of cases, however, there is increased discharge from the eyes, and a constant feeling as if there were sand in the eyes. The severity of these symptoms is increased by exposure to a cold wind, or to the glare of the sun as reflected from snow or from the surface of water. Symptoms.-The patient's attention is at first attracted by a feeling of heat and fullness in the eye, and by a sensation as if there were particles of sand or other foreign bodies constantly irritating the surface of the eye. There is also increased sensibility to light, and usually a discharge of watery liquid which causes the lids to stick together in the morning. The edges of the lids are red and somewhat thickened, and in advanced cases the upper lid is apt to droop somewhat. The little bodies which are situated in the inner surface of the upper lid lie in contact with the cornea ; the constant movement of the lid over the globe causes constant irritation of the cornea by the friction of the granulations. After a time this irritation is shown by a cloudiness and whitish appearance of the cornea, which is limited to that part of the eye covered by the upper lid. It is therefore only when this lid is raised, or when the patient directs the eye downward toward the floor that this whiteness becomes visible. After a time the surface of the cornea also becomes uneven and rough, and ulcerations may be produced. In many cases bright red streaks are seen across the upper part of the cornea, consisting of blood vessels. Occasionally the eyes troubled with granular lids become suddenly inflamed in a high degree; the lids are then intensely red, swollen and puffed, and may be kept spasmodically closed in consequence of the excessive sensitiveness to light; an attempt to open them is extremely painful, and is accompanied by a gush of tears which sweeps out strings of mucus. Careful management and appropriate treatment usually succeed in removing the granulations, and as a result in restoring the the clearness of the cornea, if the affection has been of only short duration, we may hope for complete or almost perfect recovery in ^very respect. The prospect is, however, worse in old cases ; the mucous membrane of the eye becomes much changed in quality. It is no longer red and soft, but becomes white and hard like a scar. The result of this is frequently that the edge of the upper lid is drawn inward toward the globe of the eye, so that the eyelashes constantly rub against the surface of the cornea. The effect of this irritation is, of course, to aggravate the condition of the cornea and to diminish the prospects for ultimate recovery. Treatment*-Few affections of the eye are so obstinate and troublesome in treatment as this granular condition of the lids. Numerous plans of treatment have been employed with more or less success, though none of them can be relied upon in all cases. It must be remembered that in the majority of instances the patient's general condition is unsatisfactory; he requires tonics, judicious and generous diet and fresh air. These are just the remedies which the majority of such patients cannot procure, since these individuals are generally poor and are compelled to live in poor sanitary relations. The local treatment consists in the application of some substance which will destroy the granulations and restore the mucous membrane to a healthy condition. For this purpose several different remedies are used ; the most popular is perhaps the " blue stone " or sulphate of copper. Every second day the lid is turned upward so as to expose the granular surface ; this is then carefully dried and the granulations are touched with the sulphate of copper. Nitrate of silver, the acetate of lead and other caustics of varying strength have been employed for the same purpose. It is not necessary to enter into details of treatment, since success cannot be expected in inexperienced hands. In obstinate cases surgeons have sometimes resorted to a bold and somewhat perilous expedient. This consists in setting up a severe inflammation of the eye by introducing into it a drop of matter from a case of purulent inflammation of the eyes in another individual. For this purpose the matter is taken from an infant suffering with purulent inflammation. In a day or two the eye becomes the seat of a violent inflammatory process, which is, of course, carefully watched and controlled by the surgeon. In* many instances it is found that when the inflammation subsides the granulations have disappeared. This method will, of course, be undertaken only by a surgeon, and, indeed, it is now not so popular with medical men as was formerly the case. For within the last year experience has shown that granular lids can be in a great majority of cases easily and rapidly cured by the application of a substance known diSjequirity. This remedy is too powerful for harm as well as for good to be entrusted to non-professional hands. But first, if you want to come back to this web site again, just add it to your bookmarks or favorites now! Then you'll find it easy! Also, please consider sharing our helpful website with your online friends.
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