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By J. L. C. Martin–Doyle (Auth.)

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T h e r e is g r e a t p a i n a n d m a r k e d ciliary injection. I t s a d v a n c i n g edge is crescentic in s h a p e a n d i t t e n d s t o progress across t h e cornea, increasing b o t h in a r e a a n d d e p t h . Perforation is a v e r y c o m m o n occurrence. T R E A T M E N T . — A s for h y p o p y o n , w i t h special e m p h a s i s on carbolization of t h e ulcer. Saemisch's section is somet i m e s necessary in u n r e s p o n s i v e cases. 3 . P h l y c t e n u l a r U l c e r .

U L C E R A T I O N S 1. S i m p l e C o r n e a l U l c e r s a r e b y far t h e m o s t c o m m o n of all corneal diseases a n d a r e a l m o s t a l w a y s of exogenous origin. ULCERATIONS 29 I n view of t h e high b a c t e r i a l c o n t e n t of t h e n o r m a l conjunctival sac, it is r a t h e r r e m a r k a b l e t h a t corneal ulceration does n o t occur m o r e often. T h i s is explained b y t w o facts : (1) t h e corneal e p i t h e l i u m is v e r y r e s i s t a n t t o infecting organisms ; a n d (2) t h e a n t i b a c t e r i a l c o n t e n t of t h e lysozyme in t h e t e a r s is m o d e r a t e l y high.

T h e i m m e d i a t e effect of perforation on t h e ulcer is good a n d t h e lessening of t h e i n t r a - o c u l a r pressure p e r m i t s a freer flow of l y m p h t h r o u g h t h e corneal tissues, w i t h c o n s e q u e n t i m p r o v e m e n t in its n u t r i t i o n a n d powers of resistance. T h e ulcer m a y heal v e r y r a p i d l y . I t is, however, t h e r e m o t e effects of perforation t h a t m a k e it a n e x t r e m e l y serious complication. T h e s e effects m a y b e as follows :— i.

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