Progressive keratitis sicca is described in two patients, one of whom lost on eye. The other patient became blind as a result of lichen planus of the conjunctiva. Autoimmunity is briefty discussed and the apparent therapeutic effect of asathioprine in these patients is described.
Systemic administration of drugs is unnecessary when treating diseases of the conjunctiva; these are best instilled in soluble form into the conjunctival sac to achieve a therapeutic concentration. The efficacy of eye drops is determined by their duration of action, which depends primarily on the intrinsic properties of the dissolved drug and on the basal rate of tear secretion. The flow is higher in young people who therefore need drops instilled more frequently. Any drug which penetrates the conjunctival epithelium is immediately carried away in the blood vessels.A bottle of eye drops once opened, sooner or later" becomes contaminated. Therefore, single dose containers of all drugs used in ophthalmology should be available. The plastic multi-dose bottles of eye drops at present in use should be discarded a month after opening. Both used and unopened bottles should be thrown away after the expiry date marked on them. Patients should be warned not to contaminate the dropper nozzle. There is less risk of this if the drop is instilled when lying down. In cold climates, particularly when treating children, the drops should be warmed to body temperature.Intensive treatment is best and patients who instill drops frequently are surprised by the quick cure. Treatment should cease 48 hours after the condition seems better. Failure to give this advice results in the unnecessary referral of many patients, in whom instructions to stop all local treatment often results in the rapid relief of the remaining complaints.
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