IODINE IN THE TREATMENT OF CORNEAL

ULCERS.

BY J. LAWTON HIERS, M.D., SAVANNAH, GA.

Mr. President and Gentlemen:

When I was requested by the chairman of the Committee on Program to prepare a paper to be read at the present session of the Medical Association of Georgia, it occurred to me that I could not present anything of more interest than my experience with iodine in corneal ulcers, for which I would humbly asked to be credited as the first to have used it successfully in the treatment of ulcers of the cornea. It is not my purpose to go into a detailed history of corneal ulcers, but to give you the one point aimed at— viz., the successful treatment of both phlyctenular and traumatic ulcers of the cornea with iodine. The local action of iodine, as we well know, is caustic, antiseptic, a local stimulant and a mild counter-irritant, promoting the absorption of inflammatory products. Now, with this knowledge of its action, we are enabled to understand that when iodine is applied to an ulcerating surface of the cornea, the germs of infection are destroyed and the products of inflammation caused to be absorbed, thereby instantly converting the ulcer into a recent injury which readily heals under antiseptic precautions. By this treatment we not only lessen the days of our patient's suffering, but we cut short a malady which otherwise might have resulted in great damage-yea the complete destruction of one of the most useful members of the human body. My experience thus far proves very conclusively that the

opacity resulting from an ulcer of the cornea is very much less when treated with iodine than when treated with the usual remedies.

As regards the preparation of iodine, I prefer the officinal tincture. My method of applying it is, first, to cocainize the eye to complete anesthesia. I then introduce an eye speculum and scrape the ulcer thoroughly with a spud or some convenient instrument, dry the part thoroughly, then, with just a few fibers of absorbent cotton twisted tightly around a small probe or applicator, which has been previously dipped in the undiluted tincture of iodine, I apply it thoroughly to the ulcer, being careful, however, to dry off the excess, allowing none of the iodine to come in contact with the healthy parts of the eye, after which I bathe the eye with sterilized water or boric acid solution, and treat it as I would a recent injury of the

cornea.

My. first experience with iodine in the treatment of corneal ulcers was on September 29, 1895.

On September 21, 1895, Maggie L., a chambermaid, aged nineteen years, presented herself at my office for treatment. On examination, I found her suffering with a phlyctenular ulcer of the cornea, about two mm. in diameter and about three mm. from the sclero-corneal margin, which had already penetrated about one-half the thickness of the cornea. The superficial vessels were very much injected, lachrymation profuse and the eye quite painful; her physical condition robust; family history good. I immediately cocainized the eye and cauterized the ulcer by means of actual cautery. I then washed the eye out with a saturated solution of boric acid and instilled two drops of a one per cent. solution atropia sulphate, prescribing for her a saturated solution of boric acid, which was used freely to bathe the eye at intervals, and a mixture containing atropia sulphate grs. iv., boric acid grs. v., aquæ distillata

room.

to make one ounce, using one drop three times a day, giving the patient absolute rest and keeping her in a dark This treatment was continued, and at the end of the fifth day all inflammation had subsided, but the ulcer was not yet quite healed, and by the seventh day the inflammation had reoccurred. I again cocainized the eye and cauterized the ulcer as before. Hoping that a change in treatment would be beneficial, I discontinued the atropia and prescribed eserine grs. 1, aq. 1 oz., one drop three times a day, and hot application at intervals of three hours. The eye immediately began to improve, and by the end of the fourth day ulcer had closed to the size of one mm., when the eye again became inflamed and the ulcer began to slough. I then resolved to try iodine. I cocainized the eye to complete anesthesia, introduced an eye speculum, scraped the ulcer with a spud and applied the officinal tineture of iodine, by the aid of a few fibers of absorbent cotton twisted on a small probe. I then wiped off the excess with a bit of dry cotton, and washed the eye out with a saturated solution of boric acid. I put my patient to bed and applied small pads of absorbent lint saturated with a solution of boric acid grs. xv., to aq. dist. oz. 1, changing them at short intervals, and at the end of twenty-four hours the uleer was entirely healed.

October 14, 1895, Mr. N. B., aged twenty-three years, carpenter, was struck in the right eye with a small chip of wood. After two days' treatment with home remedies he

called to see me. On examination I found him suffering

with a central traumatic ulcer of the cornea. I immediately cocainized the eye, scraped the uleer and applied the iodine as above stated, after which I washed the eye out with sterilized water, applied a small pad of absorbent cotton and a light gauze bandage, which was saturated, at short intervals, with a saturated solution of boric acid. On the following day my patient being so much improved, I

continued the same treatment, and at the end of forty-eight hours he was entirely well.

I desire to state that since September 29, 1895, I have treated eighty-seven cases of phlyctenular and traumatic ulcers of the cornea with the tincture of iodine, varying my after treatment to meet the indications of each case. In six cases three applications of iodine were necessary to effect a cure; in seven cases two, and in seventy-four one only was sufficient.

DISCUSSION ON DR. HIERS'S PAPER.

Dr. J. M. Crawford, Atlanta: I have never used tincture of iodine in the treatment of corneal ulcers. I do not doubt but what it is a good plan, and particularly the scraping. Using cocaine, then scraping the ulcer, makes it aseptic, puts it in a good condition, then binding the eye up to the lid with a pledget of cotton and keeping it still. I do not see why such treatment should not be beneficial. Having had a great many cases of corneal ulcers under treatment heretofore, I should say the treatment would be very beneficial. I have been delighted with the doctor's paper along this line.

Dr. George Horine, Americus: While I have never had any experience in treating corneal ulcers with tincture of iodine, I think we are indebted to the doctor for his paper, and I think that he has put the profession in general under great obligations to him, and particularly those of us who treat eye diseases, because we know some corneal ulcers give a great deal of trouble and are frequently intractable. His success with iodine seems remarkable. hope that I shall at some time in the near future have an opportunity to try this remedy in cases of corneal ulcer.

I

Dr. M. M. Stapler, Macon: An ulcer of the cornea is like an ulcer anywhere else, with the exception that a corneal ulcer has not as rich a blood supply as we have in other

parts of the body. We can proceed upon the same lines in ulcer of the cornea that we can elsewhere, with the exception that we must try to avoid the formation of scar tissue, treating the diseased portion with as little destruction to the surrounding tissue as possible. Most of the corneal ulcers we have will yield to antiseptic treatment, to bichloride of mercury or to yellow ointment, if kept clean and then washed by boric acid and the usual aseptic treatment. I have never tried iodine in these cases. It may be a good thing, but the great object to be attained in the treatment of corneal ulcers is to prevent scar tissue. The more scar tissue, the less the vision; the smaller the scar tissue, the better vision we have and less astigmatism.

Dr. Hiers (closing the discussion): I have nothing further to add, except to thank the gentlemen for their hearty commendation of my paper, and to answer a point brought out by Dr. Stapler, namely, that one of the great objects in using iodine is to lessen the amount of scar tissue. My experience in the treatment of corneal ulcers with iodine has been that we get a much quicker result, and, in so doing, we have less scar tissue, because, in the majority of cases, where we use the actual cautery we are compelled to have a greater amount of sloughing. On this account I prefer the iodine.

I sincerely hope my colaborers will have as good results with iodine as I have had.