Diseases of the eye : a treatise contributed to the second edition of Holmes's System of surgery / by James Dixon.

  • Dixon, James, active 1870.
Date:
1870
Catalogue details

Licence: Public Domain Mark

Credit: Diseases of the eye : a treatise contributed to the second edition of Holmes's System of surgery / by James Dixon. Source: Wellcome Collection.

Provider: This material has been provided by UCL Library Services. The original may be consulted at UCL (University College London)

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    The enlargements which call for removal, on account of the deformity they occasion, are chiefly staphylomatous projections of the cornea or the sclerotic. Under the former term are commonly included projections which have really little or no corneal tissue within them, being formed of the iris coated over with fibrous tissue, after the true cornea has been partially or wholly destroyed by ulceration or sloughing. The sclerotic staphylomata, as they are called, are produced by gradual thinning and distension of the weakened fibres of the part from accumulation of aqueous humour or of serum. In some of the latter cases the eyeball acquires a very large size, and is extremely unsightly, on account of the dark leaden-coloured projections of the sclerotic, and the large tortuous veins which ramify over it. When the cornea has been extensively des- troyed by sloughing or ulceration, it very commonly happens that the lens escapes through the breach ; when this does not take place, the lens frequently becomes filled with a deposit of phosphate of lime, and this earthy mass, by pressing against the ciliary processes and iris,, often causes severe neuralgia. In excising a staphyloma, therefore, the opening should be made sufficiently large to allow the lens, if still existing, to escape. In operating, the lids must be held apart with a spring spe- culum or the fingers of an assistant. The surgeon then passes a cataract-knife through the staphyloma, and forms a flap, which he seizes with a forceps, and removes with a second stroke of the knife ; if the lens presents at the opening, it is to be quickly tilted out with a scoop, and then the lids are in- stantly to be closed, and a cold sponge applied firmly over them. This immediate pressure is the most likely means for preventing haemorrhage from the enlarged choroidal vessels, which sometimes give way the moment the fluid contents of the globe have escaped. Moderate pressure should be kept up until the risk of bleeding has gone by, and then water-dressing will be the only application required till the parts are healed. The portion of the globe left after the excision of a staphyloma gradually shrinks to a nodule, and as soon as this has ceased to be tender, an artificial eye may be applied. If, in consequence of the sudden removal of the pressure which the accumulated fluids of the globe had been exerting on the choroidal and retinal vessels, the latter give way, and blood fills and distends the cavity of the sclerotic, extreme pain is the result, and it may even be thought desirable at once to