BLEPHARITIS AND AMETROPIA. 
By P. D. KEYSER, M.D., 
SURGEON TO THE WILLS EYE HOSPITAL, PHILADELPHIA. 
(REPRINTED FROM THE PHILADELPHIA MEDICAL TIMES, MARCH 17, 1S77.) 
IN the discussion at the International 
Ophthalmological Congress last Septem- 
ber, on the paper of Dr. Roosa, entitled, 
"On the Relations of Blepharitis Ciliaris 
to Ametropia," I remarked that I had for 
more than two years noticed this connec- 
tion, and have been in the habit of examin- 
ing every case of blepharitis that comes to 
my office for errors of refraction, and have 
never failed to discover some one or the 
other, if not a combination of anomalies. 
To substantiate the correctness of Dr. 
Roosa's remarks as well as my own, I 
present the following statistics of cases 
observed in my private practice the past 
year (1876). 
February 7.-Mr. F., set. 19. Has had bleph- 
aritis the past two years. Lids always worse 
on use of the eyes. 
V = ; after atropine, xxx ; with -(-48 - 
20 
XX* 
Hypermetropia, 
February 25.-Mr. C., set. 28, complains 
that for years he has had trouble with the 
edges of his lids. 
L. E., convergent strabismus i//z; 
L. E., V = - ; 
' c 
R. E., V = LL.; after atropine, ; 
R. E., with +9, V = AA. 
L. E., with 4-9, V = 
Since use of glasses, no return of blepha- 
ritis. 
February 27.-Miss H., set. 15; blepharitis 
the past year. 
V = AL-; after atropia, =jA8_; with +36, - 
Hypermetropia = 
February 29.-Mr. M., set. 24 ; blepharitis 
for the past two or three years. 
V = ; after atropia, A" ; with +36, fe, 
Hypermetropia = ■g1K. 
March 3.-Master J., set. 16 ; the past year 
has been applying his eyes to close and line 
work in a machine-shop, and has noticed an 
inflammation and eruption on the edges of 
the lids. 
V = A°; after atropia, xXx i with +36. 
20 
XX' 
Refraction, hypermetropia, 
March 7.-Master McC., set. 10; edges of 
the lids inflamed the past six months ; always 
worse on attempting to study. 
V - AL ; after atropia, xxx ' "El2* 
20 
XX' 
Hypermetropia, -fa. 
March 17.-Miss G., set. 20; edges of the 
lids inflamed for some time. Cannot read nor 
sew with comfort; pain in the eyes and over 
brow, and in the back of the head. 
V = AL ; after atropia, A8_. 
R. E., +40 ZZ +6oc, 90°. V -~XR' 
L. E., +48 C +6oc, 90°, V=AA. 
Refraction, compound hypermetropic astig- 
matism. 
March 22.-Master G., set. 14; blepharitis 
for three or four years; reads much; lids 
always worse after reading. 
V - ; after atropine, ' +48 
20 
XX* 
Hypermetropia, Tk- BLEPHARITIS AND AMETROPIA. 
2 
March 29.-Mr. D., set. 28. For the past 
five years edges of the lids have been in- 
flamed ; kept pulling the ciliae out, but no 
relief. 
V =xxx' a^ter atroP'ne> lxx ' w'th +2O> 
20 
XX' 
Hypermetropia, 
April 8.-Miss G., aet. 24 ; blepharitis. 
V ■- xx > after atropia, XxX ' 
20 
XX' 
Insufficiency of L. rectus internus, 40. 
May 22.-Mr. C., aet. 23 ; blepharitis. 
V = xx ; after atroPia- xc ' with XX' 
Refraction, hypermetropia, 
June 5.-Mr. McL., aet. 26; blepharitis R. 
E. the past two years ; nothing would cure it. 
R. E., V = EE; after atropia, xxx ' 
xx' 
L. E., V = ; after atropia, 1 emme- 
tropic. 
The R. E. recovered soon after the use of 
the glass, and has remained well ever since. 
June 19.-Mrs. H., set. 25; has had bleph- 
aritis since nine or ten years of age ; has tried 
everything without a successful and perma- 
nent cure. 
V = xxx ' a^ter atr°pia> lXx ' +3°> 
20 
XX* 
In one week after wearing the glasses and 
treatment, the lids were almost well, since 
which time she has had no return of the old 
inflammation. 
July 7.-Mr. B., aet. 26; lids have been in-x 
flamed for some time. 
V = xx 1 after atropia, > +42> 
20 
XX* 
Hypermetropia, 
August 12.-Mr. W., aet. 28; for three or four 
years his eyes have troubled him ; is a bank 
clerk, and every day about noon there comes 
a pain in the head, which remains until fin- 
ished with his duties; edges of the lids are 
much inflamed. 
V - xx ; after atropia, with +16, 
Hypermetropia, 
Since using the glasses, lids have recovered 
their natural look, and there is no return of 
the daily pain in the head. 
October 17.-Master L., set. 14; blepharitis 
the past six months. 
IV = XX: after atropia, xxx; with +42, 3E- 
Refraction, hypermetropia, 
October 19.-Mr. A., set. 31 ; for several 
years eyelids have been red and scaly. 
V= after atropia, dim, +48% 90°, 
Xx sharp. 
Simple hypermetropic astigmatism, +48°, 
axis 90°. 
October 30.-Master A., aet. 15 ; blepharitis 
five years' duration. 
V - J after atropia, with +48, 
Hypermetropia, 
November 7.-Mr. S., aet. 30; blepharitis 
one and a half years. 
V - ; after atropia, xxx ' w't^1 O.' 
November 10.-Miss P., aet. 20; for a year 
past, blepharitis. 
V = x°;; after atropia, 3°-; with +30, 
November 15.-Miss W., aet. 19; blepha- 
ritis for over two years. 
V = xy 1 after atropia, ; with +36, 
Hypermetropia, 
December 6.-Mr. J., aet. 27, has had in- 
flammation of the edges of the eyelids for six 
years ; has undergone much treatment with- 
out any benefit. 
V = XX ; after atropia, ; with +24, 
Since the use of the glasses, eyes have im- 
proved steadily, and are now almost well. 
December 8.-Mr. H., aet. 21 ; blepharitis 
the past year. The lids are better when not 
using his eyes. 
V = ; after atropia, ; with +30, 
Hypermetropia, -fa. 
The accommodation was paralyzed in all 
the cases before the examination was made, 
so that a complete result could be obtained. 
It will be noticed that all the cases were 
hypermetropic, and in a very great ma- 
jority of them of a low degree ; only two 
being astigmatic. 
I have never seen a case of marked 
blepharitis get entirely and permanently 
well under the ordinary treatment until the 
defect in refraction has been corrected, 
although the remedies used would improve 
and apparently cure the disease, but in a 
short time a relapse would occur, and the 
shorter would be the time for the relapse, 
if the eyes were used steadily and much at 
fine or close work. 
Exact observation of such cases is what 
is needed now, and accumulations of ex- 
perience may show the fact of ametropia BLEPHARITIS AND AMETROPIA. 
3 
being in many if not all cases the direct 
cause of blepharitis. 
In the case of date June 5, above de- 
scribed, the hypermetropta was the cause 
of the blepharitis without doubt, as the 
lids of the one eye only were affected, and 
this was the hypermetropic one, while the 
other was normal and no defect of refrac- 
tion could be found. 
In my clinic during the same time there 
were twenty-four cases of blepharitis, all of 
which could not be examined under the 
action of atropia, but by the ophthalmo- 
scope were determined, five hyperme- 
tropes of -fa, five of -fa, one of fa, three of 
one of -fa, one of fa, one of T'g, and 
one presbyope of four not determined, 
of which one was only two years old, two 
of three years, and one four years of age. 
The question would naturally arise, 
" How can ametropia be a cause of bleph- 
aritis?" 
That ametropia of any kind or form 
causes in all acts of vision a strain more or 
less upon the eye, which creates a fulness 
or hypersemic condition of the neighbor- 
ing parts, is a well-known fact, as is seen in 
many such cases by red and congested con- 
junctiva and edges of the lids. In cases 
where the strain is such as to create a con- 
tinued hyperaemia of the edges of the lids, 
the extremely fine ducts and external open- 
ings of the small sebaceous glands (Zeiss's 
glands) that are to be found in the canals 
and follicles of the ciliae become closed by 
pressure from the swelling of the tissue and 
vessels surrounding them, and having no 
outlet for the natural secretions, which are 
now increased by the hyperaemic condi- 
tion, a choked status is formed, and in- 
flammation and suppuration take place, as 
is noticed in the little pus bead that is found 
encircling the cilia and extending down 
the canal to the gland. 
Rest of the eyes, with proper local treat- 
ment, removes in time this suppurative and 
inflammatory action and apparently the 
whole disease is cured ; but on resuming 
active use of the eyes the same condition 
of hyperaemia returns, with eventually the 
whole former trouble. 
But when the ametropia is corrected, and 
the strain on the eye removed, there will 
be no .return of the condition of hyper- 
aemia, and a perfect cure of the blepharitis 
can be made. 
Since the meeting of the congress I have 
looked over the following recent works on 
ophthalmology: Stellwag, Wecker, Gale- 
zowski, Schweigger, Wells, Graefe und 
Saemisch, Tetzer-Gruenfeld, Von Graefe's 
Archiv, Zehender's Monatsblatter, Oph- 
thalmic Hospital Reports, Annales d'Ocu- 
listique, Journal d'Ophthalmologic, Ar- 
chives for Ophthalmology and Otology, 
Donders on Accommodation and Refrac- 
tion, and Nagel's Jahresbericht, without 
finding any mention of this connection of 
ametropia and blepharitis. So that Dr. 
Roosa is the first to publish the fact and 
call attention thereto, although, without 
any communication with him, I have 
known and acted upon it in my practice 
for more than two years, and brought it to 
the notice of some of my colleagues. 
1630 Arch Street, January 22, 1877.