Compresses

COMPRESSES, a form of applying therapeutic agents, having a comparatively limited range of application. Compresses are used either for the purpose of a purely thermal effect on a pathological process, for which simple water of a specific temperature may serve, or they are a type of medicinal treatment and then consist of solutions of various medicinal substances; being in a heated or cooled state, the latter can exert both effects simultaneously. At the present time, compresses have retained their use mainly in the therapy of certain skin and, to some extent, eye diseases. In the former specialty, they are used almost exclusively for the treatment of weeping and itching skin afflictions of an eczematous nature, for which the following are most often used: lead water in an undiluted state, Buro-v solution (diluted 1–2 tablespoons per glass of water), and a solution of silver nitrate (1:1,000) at room temperature. In ophthalmic practice, compresses have a significantly wider application for the purpose of both purely thermal and medicinal effects on a pathological process. The validity of the former is proven by observations such as the fact that the temperature of the conjunctival sac changes in the corresponding direction just a few seconds after the application of hot or cold compresses to the skin of the eyelids and quickly returns to normal upon the cessation of their action; the same thing, only to a lesser degree, is observed in the orbit behind the eye itself. Furthermore, it has been noted that under the influence of hot compresses, the protein content in the aqueous humor increases, and the diffusion of applied medications within the eye is also enhanced. The methodology of applying compresses depends on whether it is desirable to act only on the eyelids, or through them on the closed eye, or directly on the anterior surface of the eye itself and its mucous membrane. If the intention is to act through the external integuments, compresses are applied in the form of small pads made of gauze or absorbent cotton, immersing them in water of the required temperature or in a specific solution, then they are slightly wrung out and applied to the closed eyelids, preferably while the patient is in a lying position. The pads must be changed every 1–2 minutes, given that the temperature of the liquids used, which for cool and cold compresses ranges from room temperature to icy, and for warm and hot ones from 25° to 50°, is lost very quickly. Such a procedure is performed 2–3 times a day for 20–30 minutes. Since the skin of the eyelids is often quite sensitive to prolonged moisture (it macerates), it should be lubricated beforehand with fat (petroleum jelly). If the solutions used must be brought into direct contact with the anterior segment of the eye itself or its mucous membrane, then such compresses can also be applied in the form of a so-called "eye bath" (Fig. 1 and 2). The latter is a small device

adapted to the oval of the eye slit, with concave edges, which are sometimes also bordered with a thin layer of rubber. Such a bath is filled with the appropriate solution at room temperature or lukewarm and is pressed tightly against the edges of the orbit, after which the patient's head is tilted back, the eye slit is opened, and the liquid comes into contact with the eye itself and the mucous membrane covering it and the posterior surface of the eyelids; repeated blinking movements of the latter, as well as excursions of the eye itself in all directions, facilitate the access of the applied solution to all corners of the eye slit and the folds of the conjunctival sac. The duration of each session, during which the contents of the bath are changed 1–2 times, ranges from 5 to 10 minutes depending on the patient's subjective sensations.

As for the general indications for the use of compresses in eye diseases, they are resorted to primarily where it is required to weaken or, conversely, activate an inflammatory process; furthermore, when there is a need for a prolonged disinfectant or astringent effect on the diseased membranes of the eye, as well as for the neutralization of all kinds of toxic substances entering the eye, and finally in those cases where one counts on enhanced diffusion of various therapeutic agents into the eye during prolonged contact directly with its anterior surface. In particular, hot compresses are especially readily prescribed for all kinds of purulent, inflammatory processes of the skin of the eyelids or their glands (styes, meibomitis, furuncles, phlegmonous dacryocystitis, etc.), especially when, on the one hand, an energetic thermal effect is required, and on the other, it is undesirable to apply a hermetic dressing of a warming compress to the eye to avoid increasing pathological secretion from the mucous membrane. In chronic ulcerative processes on the edges of the eyelids with the formation of dense crusts, they are often used for the purpose of softening the latter for subsequent removal. In addition to the appendages of the eye, hot compresses are often used for diseases of its anterior segment, especially for afflictions of the cornea, sclera, and iris, with the goal of enlivening blood circulation, accelerating the absorption of pathological exudates, and weakening painful sensations. Conversely, cold compresses are especially indicated for all kinds of acute inflammations of the mucous membrane of an infectious nature, such as, for example, in acute conjunctivitis, acute trachoma, gonorrhea, diphtheria, etc.; incidentally, in the latter two infections, cold compresses should not be used only in the very first period of the disease, i.e., in the stage of infiltration (in this stage, cold can lead to tissue necrosis). In acute conjunctivitis, the beneficial effect of cold compresses can also be explained by the fact that, by lowering the temperature in the conjunctival sac to a certain limit, they thereby create unfavorable conditions for a whole range of bacteria that require a specific temperature of the environment. Cool compresses on the eyelids are widely practiced for many chronic diseases of the conjunctiva, as they significantly alleviate various unpleasant subjective sensations (heat, heaviness, etc.). Compresses applied for the same diseases in the form of eye baths also yield excellent results, exerting an astringent and antiseptic effect directly on the mucous membrane itself and having an advantage over conventional treatment with drops due to the duration of contact of the therapeutic agent with the diseased surface and the penetration of the solution into all folds of the conjunctiva. On the same basis, compresses in the form of baths are used for the treatment of burns of the anterior segment of the eye by various chemical substances, as well as for some deep diseases of it, such as, for example, in incipient cataract, in anticipation of increased diffusion of medicinal substances from solutions into the eye. Among the liquids used for compresses in eye diseases, besides water, infusions of aromatic herbs are sometimes used, such as, for example, chamomile, or the infusion of ordinary tea, which is especially popular in everyday life, possessing mild astringent properties, as well as solutions of medicinal substances of an astringent, antiseptic, absorbent, or neutralizing nature (lead compress, alum, boric acid, etc.). A. Strupov.