MIXED FORMS OF TRACHOMA AND 
SPRING CATARRH 
BY 
CHARLES H. MAY, M. D. 
OF NEW YORK. 
CHIEF OF CLINIC, EYE DEPARTMENT, VANDERBILT CLINIC, AND 
INSTRUCTOR IN OPHTHALMOLOGY, COLLEGE OF PHYSICIANS, 
NEW YORK; ASSISTANT OPHTHALMIC SURGEON MT. 
SINAI HOSPITAL, NEW YORK; PROFESSOR OF 
DISEASES OF THE EYE AND EAR, COLLEGE 
OF PHYSICIANS AND SURGEONS, 
BOSTON, ETC. 
RBPBINTED'FROM 
ANNALS OF OPHTHALMOLOGY AND OTOLOGY, Vol. V, No. 1,/ 
January, 1896. [Reprinted from Annals of Ophthalmology and Otology, January, 1896 ] 
MIXED FORMS OF TRACHOMA AND SPRING 
CATARRH. 
By Charles H. May, M. D., 
OF NEW YORK. 
CHIEF OF CLINIC, EYE DEPARTMENT, VANDERBILT CLINIC, AND 
INSTRUCTOR IN OPHTHALMOLOGY, COLLEGE OF PHYSICIANS, 
NEW YORK; ASSISTANT OPHTHALMIC SURGEON MT. 
SINAI HOSPITAL, NEW YORK; PROFESSOR OF 
DISEASES OF THE EYE AND EAR, COLLEGE 
OF PHYSICIANS AND SURGEONS, 
BOSTON, ETC. 
OUR knowledge of the disease of the eye known as 
" spring catarrh," (" vernal catarrh," " circum-cor- 
neal hypertrophy") is limited to symptomatology; we 
know little or nothing concerning etiology or effective 
treatment. The disease has been described as occurring in 
three forms: (1) The most frequent, in which both the 
hypertrophy at the limbus and the papillary changes 
(granulations) of the palpebral portion of the conjunctiva 
exist; (2) in which only the circum-corneal hypertrophy is 
present; and (3) in which the ocular conjunctiva remains 
normal, but the palpebral presents flat granulations. 4 
with blue-stone for two months; then finding that he was unable 
to call regularly, he was given a gr. ss. to one ounce solution of 
silver which he was to apply three times a week. He was not 
seen again until July 8th, when he presented every symptom of 
spring catarrh, including well-marked circum-corneal hypertrophy; 
his lids were about in the same condition as when he had discon- 
tinued the copper treatment; there was only a trace of pannus. 
When next examined, August, 1890, he had the symptoms of 
spring catarrh, but in a less marked form as compared to the 
previous summer, and his objective signs were decidedly less 
pronounced. He had been treated at one of the eye dispensaries 
for trachoma during the previous winter, and blue-stone had been 
applied every other day. He had no pannus. 
The patient changed his residence after this and was not seen 
until February, 1895. There were no evidences of spring catarrh, 
but merely a picture of chronic trachoma, the conjunctiva of the 
lids being velvety with slight cicatricial changes here and there ; 
he had very little inconvenience from the condition of the lids 
and reported that during the previous two summers there had 
been no exacerbations in symptoms, and that as far as he could 
see, his eyeballs presented the same appearance as in winter. 
Case. III. M. Gr., male, 19 years of age. May, 1891. Has had 
granulations since childhood; and been treated off and on with 
blue-stone by two different specialists. His lids presented the 
ordinary appearances of chronic trachoma with slight cicatricial 
changes ; the upper portion of each cornea showed a crescentic 
area of pannus ; at the limbus at each side of the cornea there 
was a well-marked hypertrophied area ; there was a great deal of 
congestion of the ocular conjunctiva. Upon questioning, he said 
that his symptoms were always worse during summer, but this he 
attributed to the fact that he spent his summers at the seashore 
and ascribed the exacerbation to the " glare from the sun and 
the salt in the air." The picture was an unmistakable one of a 
combination of trachoma and spring catarrh. The blue-stone 
treatment was employed during the entire summer and the follow- 
ing winter with constant improvement ; as soon as the cold 
weather set in the injection of the ocular conjunctiva and the cir- 
cum-corneal hypertrophy disappeared, but the condition of the 
lids changed very slowly. 5 
The writer has seen this case several times a year ever since. 
He has all the signs of chronic trachoma during the winter, and 
in summer those of spring catarrh are added ; both objective and 
subjective symptoms have become less marked with each succes- 
sive summer. During the past summer he complained very 
little. 
Case IV. W. M., male, 7 years of age. April, 1892. Com- 
plained of congestion of eyeballs, of watering, of smarting and 
itching sensations of lids during the previous summer; these 
symptoms disappeared during the winter ; now they are begin- 
ning to be felt again. Has been treated for trachoma with blue- 
stone during the past winter by another oculist. His symptoms 
are now less severe than they were during the same period of the 
previous year. Examination showed a trachoma-like condition 
of the lids; no pannus; considerable ocular congestion and 
moderate circum-corneal hypertrophy. The case was regarded as 
a mixed one of trachoma and spring catarrh, and treated with 
blue-stone until he left for the country in June. In the fall he 
reported that, though his subjective symptoms had been annoy- 
ing, they had been much less marked than the previous summer. 
In the winter the eyeballs had an almost normal appearance, but 
the granulations remained of the same size ; he complained some 
of a feeling of sand beneath the lids, and the latter were treated 
with copper for six weeks. 
He has had no treatment since then (February, 1893,) and 
each summer his symptoms have been decidedly less marked 
than the summer before. Examination of his lids in March, 
1895, showed nothing beyond slight evidences of trachoma here 
and there. During the past summer he gave no evidences of 
spring catarrh, and he did not complain of any symptoms refer- 
able to the eye. 
Case V. H. W., male, 10 years of age. June, 1893. For the 
past three years complains of watering, heavy feeling, burning 
and itching ; all these symptoms are worse during warm weather, 
and subside almost completely during winter. During the pres- 
ent summer (1893) his symptoms have been worse than ever. 
There is a great deal of congestion of the conjunctiva of the 
globe and considerable hypertrophy at the limbus. Granulations 
of the palpebral conjunctiva of both eyes are of very large size. 6 
The granulations were expressed with Knapp's roller forceps 
(under ether), and during the balance of the summer the symp- 
toms were very much less marked, the lids remaining free from 
granulations, but the- congestion of the ocular conjunctiva and 
the circum-corneal hypertrophy remaining about the same. 
The following summer (1894) the symptoms returned, but both 
objective and subjective manifestations were much less pro- 
nounced. The granulations had reappeared and the roller 
forceps was employed a second time. The balance of the 
summer was spent in comparative comfort. 
July, 1895. The boy reported that he suffered no annoyance 
whatever ; there were no granulations, but there was a little cir- 
cum-corneal hypertrophy and some congestion of the ocular con- 
junctiva. 
Case VI. E. C., female, 8 years of age. July, 1895. During 
the past three years patient has complained of itching, burning 
sensation and watering, and eyes have been " blood-shot." These 
symptoms occur only during the summer, and disappear with 
cooler weather. Examination showed both upper and lower lids 
covered with papillary granulations; there was circum-corneal 
hypertrophy at the inner and outer part of the limbus of both 
eyes, more marked externally ; the upper part of the right cornea 
presented a narrow crescent of pannus. The patient was treated 
with blue-stone three times a week for three months. At the end 
of this time the pannus had disappeared almost completely. 
During the continuance of the treatment, even during the hot 
weather the symptoms, both objective and subjective, showed 
slow but steady improvement. 
These six cases have proven to the writer that there are 
mixed forms of trachoma and spiing catarrh, cases which 
probably are originally trachoma, and suffer from the 
additional signs and symptoms of spring catarrh during the 
warm weather. This conclusion is based upon a study of 
the course of the cases and strengthened by the existence 
of pannus in some, and by the fact that marked improve- 
ment followed the use of blue-stone or the operation of 
expression in all. We know that in simple cases of spring 
catarrh such treatment has no effect upon the tedious pro- 
gress of the disease and even aggravates the symptoms 7 
when used during the exacerbation. Such cases are not 
amenable to any form of treatment known to us, and persist 
for many years despite every means at our command. 
In every one of the cases reported, on the contrary, the 
use of blue-stone appears to have had a very favorable effect 
upon the course of the disease; such a result also followed 
the employment of the roller forceps. Such achievements 
can only be attributed to the association with trachoma. In 
the October, 1895 number of the Archives of Ophthal- 
mology , Gradle reports having used expression in two cases 
of the palpebral form of spring catarrh with temporarily 
good results. 
Spring catarrh has the same relation to the eye which 
rose cold and hay fever have to the nose. Just as the 
latter affections may occur in cases in which the nasal 
mucous membrane is normal, and also in cases in which this 
membrane is pathologically changed, so the analogous 
ocular disease may implant itself upon a normal or a 
trachomatous conjunctiva. 
The writer has been treating some cases-of simple spring 
catarrh by means of the constitutional treatment recom- 
mended by Bishop in hay fever (preliminary treatment 
with salicylate of sodium, treatment during the attack with 
dilute sulphuric acid). This treatment was used in too 
small a number of cases, and was begun too late during the 
past summer to warrant any definite conclusions at the 
present time; but the results during this limited period 
were sufficiently favorable to justify further trial. 
Conclusions: 
1. There exists a mixed form of trachoma and spring 
catarrh in which the symptoms of the latter are added dur- 
ing the prevalence of warm weather. 
2. The existence of the slightest evidence of pannus or 
of cicatricial changes in the lids strengthens this diagnosis. 
3. The use of the treatment for trachoma (blue-stone or 
expression) exerts not only a good effect upon the trachoma, 
but also modifies the course of the spring catarrh in a 
decidedly favorable manner. 8 
4. When such an association of these two diseases is 
suspected, the treatment of trachoma should be instituted 
since we are not at the present time aware of any method 
which will shorten the lengthy duration of spring catarrh. 
5. It seems probable that constitutional treatment on the 
lines now adopted in hay fever will be productive of more 
success than we have hitherto had with the local treatment 
of ordinary cases of spring catarrh. 
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