The aseptic treatment of wounds in ophthalmic surgery / by Angus McGillivray.

  • MacGillivray, Angus.
Date:
1898
Catalogue details

Licence: Public Domain Mark

Credit: The aseptic treatment of wounds in ophthalmic surgery / by Angus McGillivray. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

    8/22 (page 6)
    Special douches have been devised for the purpose of irrigating the upper cul-de-sac, but they are all open to the objection that the nozzle is apt to irritate the conjunc- tiva if employed with any degree of thoroughness. We now content ourselves with the following simple means of dealing with the upper cul-de-sac :—Place the patient’s chin on a level slightly higher than the forehead, and lift the upper eyelid forward off the eyeball ; the saline solution from the douche is thus allowed to pass down into the cul-de-sac and cleanse the part freely without causing irritation or discomfort. [It may be of iuterest to mention in passing, that normal saline solution when dropped into the eye has a soothing effect, whereas ordinary tap water temporarily irritates the eye to some extent.] The instruments are sterilised by being kept submerged in boiling water for two and a half minutes. They are then laid out in the order in which they are to be used on a sterilised cloth, and covered up till required. Operation.—The speculum is now inserted, and the fixation forceps applied just below the cornea. The eyeball is rotated downwards, and the exposed upper corneo-scleral region corresponding to the wound douched with a stream of saline solution. A corneo-scleral inci- sion, with 3 mm. flap and a narrow conjunctival flap, is made with a sharp Grraefe’s knife. After completing the section the fixation forceps is I'emoved, but the patient is enjoined not to rotate the eye upwards until the opera- tion is completed. This avoids the possibility of the wound being contaminated by the margin of the upper eyelid. A narrow iridectomy and a free capsulotomy are performed, and the lens is expelled by spoon and curette, without any difficulty as a rule. After removing any soft lens matter, and replacing the pillars of the iris coloboma, the lips of the wound are freed of any debris by a gentle stream of saline solution. The conjunctival flap is carefully replaced on the sclerotic, and the specu- lum removed. In removing the speculum care should be taken that the upper lid is carefully lifted over the