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R a d i u m 39
In addition to the local treatment usual in such cases, the patient was
referred to Dr. H. K. Pancoast for radium therapy, four treatments
being applied over a period of the two succeeding months. Considerable
reaction was evoked by this treatment, and several weeks following the
last application styes appeared in the lids which persisted for several
months and were followed by a dropping out of many of the cilia, none
of which have ever returned. The radium, however, has exercised a
very beneficial effect upon the disease, greatly lessening the symptoms
in the four years succeeding. Last summer, the eyes were but slightly
injected and the conjunctiva smooth and free from granulations. Refraction
was as follows:
O.D. + S. 1.5 O + C 0.62 ax. 1700 = 5/5
O.S. h C 0.S7 ax. do" = 5/5
Arnold Knapp tells me that be. too, has seen unfortunate sequel l«
after radium, though his case happened to be one of trachoma. He
writes:
"The case received a radium treatment on April 15th. with a very
severe reaction 2 days later and pain beginning 4 weeks later. The lids
were red, conjunctiva was congested, cornea? dull and vascularized like
a keratoglobus. Vision was reduced to movement of hands. This condition
has persisted for 3 years, and the question of enucleation has come
up. The diagnosis of trachoma was uncertain, as the right eye had not
been affected. Was first seen in 1919. The upper palpebral conjunctiva
was red. fleshy,with irregular, gray follicles with a well-marked pannus.
The radium caused the loss of the eyelashes and of the eyebrows, and
the thickening and reddening of the lids, with the changes in the conjunctiva
and cornea just described.
"I forgot to say that the patient was treated for some time with
tuberculin, on the sup|>osition that the condition was tuberculosis, and
as the process did not improve, radium was advised."
In both of these cases it is not unlikely that the sequella? arose from
a too protracted or powerful application of the radium. In any event.
in a number of other cases treated for me by Dr. Pancoast no such serious
consequences arose. In closing, I shall read a recent communication
to me from Dr. Pancoast regarding his ex|>erience with radium in
vernal conjunctivitis.
"I have received your letter requesting a statement in regard to our
views concerning the treatment of vernal conjunctivitis. The results
under radium treatment with us have been, on the whole, very satisfactory.
We do not use x-rays for the purpose because radium can be much
more easily controlled and especially the penetration.
"Our method is to evert the lids and treat the entire conjunctival
surface which is involved and at the same time protect the eyeball against
any unnecessary exposure. If the bulbar conjunctiva is involved, one
must be very careful in regard to the dosage because of the reaction
which results, and the dose is usually an amount less than that for the
lids. The reaction to radium is rather intense and we always prefer to
treat cases during the quiescent period of winter rather than to add the
discomfort of a radium reaction to that which the patient already has
from the activity of the disease. It is very important not to give too much
treatment and to get too much cicatrical tissue. The main difficulty encountered
in cases in which the lids alone are involved is in removing
the condition from the region of the upper border of the cartilage in
the upper lid.