Course.—­The progress is slow.  It usually takes a number of years before it is “ripe” for operation.  They may remain in the same condition sometimes.  In this kind of cataract both eyes are affected sooner or later, although one eye may be fully matured before the other is much changed.

The result of an operation depends upon the condition of the eye.  The eye should be free from evidence of disease.  “The anterior chamber should be of normal depth.  The pupil should react to light.  There should be a homogeneous (all alike) white or gray opacity immediately back of the pupil, with no shadow from the edge of the pupil (except in cases of sclerosis, already mentioned).  A candle carried on all sides of the patient while the eye is fixed, should be properly located by him.  The tension of the eyeball should be normal.”

The operation is very frequently done and it is very successful.  The patient should be ready and willing to place himself in the charge of the operator and do as he says.

Sympathetic inflammation of the eye.—­(Sympathetic Ophthalmia.)—­A condition in which the healthy eye becomes the seat of a destructive inflammation transferred from the other eye which has been the subject of a similar inflammation usually following a perforating injury of the eyeball.  The injured eye is called the exciting eye; the other, the sympathetic eye.

This is a rare disease, but it may occur when one eye is injured or diseased and on the first indication of trouble in the injured eye the other eye should be closely watched for symptoms of sympathetic trouble so that if can be removed.

Symptoms in the Exciting Eye.—­This is more or less congested and painful; when pressure is made upon the upper lid, it shows tenderness.  The tension is not as strong; the pupil may be blocked with an exudate.

In the Sympathizing Eye.—­There is an inflammation involving the choroid, ciliary body and iris.  There is pain, tenderness, small blocked pupil and sight is poor.

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Course.—­It usually appears between the third week and the sixth month after the original injury.  “The extreme limits are two weeks and twenty years.”  The sound eye is likely to be attacked when the exciting eye is in a state of active inflammation.

Treatment.—­The “exciting eye” should be enucleated (taken out) before any signs of sympathetic inflammation appears in the healthy eye.  If it has appeared, enucleation will be of no value; at all events if there is vision in the exciting eye, the operation should not be done then.

Inflammation of the retina from Bright’s disease (Albuminuric Retinitis).—­The retina is a very delicate structure and we are often able to diagnose Bright’s disease from the peculiar effect it produces upon the retina.