The principles and practice of ophthalmic medicine and surgery / By T. Wharton Jones.
- Thomas Wharton Jones
- Date:
- 1863
Licence: Public Domain Mark
Credit: The principles and practice of ophthalmic medicine and surgery / By T. Wharton Jones. Source: Wellcome Collection.
Provider: This material has been provided by the Harvey Cushing/John Hay Whitney Medical Library at Yale University, through the Medical Heritage Library. The original may be consulted at the Harvey Cushing/John Hay Whitney Medical Library at Yale University.
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![The eyelids may be the seat of najvus maternus, of warts, and of different kinds of tumors. Lastly, they may be found cancerous. In regard to the tarsal borders of the eyelids, it is to be premised that they are broad surfaces. The border of the upper eyelid is about one-twelfth of an inch broad; that of the lower about one- fifteenth. The edge bounding the border anteriorly corresponds to the insertion of the eyelashes and is round. The posterior edge is much sharper and more defined than the preceding, and is the place where the delicate integument of the border of the eyelid is continued into the palpebral conjunctiva. On the border of either eyelid be- tween the two edges or boundaries just described, but nearer the pos- terior than the anterior, and parallel to them, there is observable, on close inspection, a row of minute pores—the excretory mouths of the Meibomian follicles. Fig. 1. The tarsal border of the eyelids may be found inflamed, perhaps ulcerated (ophtlialmia tarsi), in which case the eyelashes will be in- crusted partly with dried Meibomian discharge, partly with the dis- charge from the ulcers. Hordeolum, or stye, is another form of in- flammation of the free margin of the eyelids. Inflammation and abscess of the Meibomian follicles simulates the appearance of stye externally, but is a rarer occurrence. The eyelids, at their edges, or close to their edges, may present small tumors, thickening, and callosity, unattended by any great degree of inflammation, viz., chala- zion, tylosis, &c. The eyelashes are sometimes the seat of phtheiriasis, which is apt to be overlooked, except a closer examination be made [in which the eye will require the assistance of a magnifying glass.—Ed.]. Mada- rosis, or loss of the eyelashes, is at once recognized. The eyelashes are often found in greater or less numbers turned in against and irritating the eyeball, constituting trichiasis and distichia- sis. The surgeon should always take particular care to assure him- self, therefore, of the direction of the eyelashes in cases of chronic ophthalmia; and in order to do so, and to see properly the broad sur- face of the tarsal border, and the state of the Meibomian apertures, the eyelids should be slightly everted by gentle pressure with the point of the finger on the skin of the eyelid, the eyelashes being kept between the finger and the skin. By this means it will generally be at once seen if any of the eye- lashes are growing in against the eyeball. Sometimes, however, such eyelashes are so pale and fine, that they are apt to escape notice. The presence of these may often be detected by attention to the fol- lowing point when they might otherwise be overlooked—the tears, of which there is in such cases generally more than usual, rise up around the pale, misdirected eyelashes, and between the eyelid and eyeball, by capillary attraction, and occasion a marked reflection of light at the place. [By causing the patient to move the eye from side to side, when searching for these hairs, they will be more readily recognized, as it is far more easy to see them against the dark-colored iris, than against the sclerotic coat of the eye. It is necessary to examine also, not only for eyelashes that may be turned in, but also hairs that](https://iiif.wellcomecollection.org/image/b21018327_0051.jp2/full/800%2C/0/default.jpg)
