System of operative surgery, founded on the basis of anatomy, Vol. 2

Page 51

62 or orncm or This comes. 3. Now holding the membrane up it is to be dissected a ..A_..,.,-.),s,,¢~ ..,-_.-_.-- --:_:.‘EK‘.-r_'4"/"4'"~4':v"' w little from the white part of the eye, and lastly the scissors are to be applied (pointing upward or downward), so as to cut across the middle of the membrane, where it is attached to the albuginea. The eye is to be now washed with tepid water, while the blood flows, and then a light compress of wet linen is to be put on the eye. The surface which has been diseased ac. quires a peculiar yellow colour ; it is some weeks in contracting fully, and forming a cicatrix. The treatment after this is only such as ~would be prescribed to suppress any appear~ ance of returning inflammation. That part. of the cornea from which the pterygion has been cut 011‘, does never entirely recover its transparency. It 435m mom S g t, é. OPACITY OF THE CORNEA: 1. THE cornea becomes opaque in several ways. Inflanr mation may leave. in it a milky opaque spot or spots, from an eiiusion under the outward lamina. There is at the same time a flaccid state of the conjunctiva and tortuous or varicose veins lead to the opaque spot of the cornea. This has been called NEBULA, from its producing only a cloudiness in the vision. 2. If the cornea be opaque in consequence of a preceding very violent attack of ophthalmia, the efl'used matter will be found to be deposited deeper in its substance, and is supposed to be coagulabie lymph ; this is the ALBUGO. 3. Again, there occurs in consequence of inflammation, a t It . 2‘me"9-"... .-.. T?" "Wm-2,. ;:.-,,... Y leaves a firm opaque cleatrix, viz. Lnucoam. The practice in the first instance of Opacity (the NEBULA) is to extirpate the tortuous fasciculus of vessels, whose elonga tion over the cornea caused, or necessarily accompanied the formation of this opacity, and which we may now suppose, feed and support it as it were. The fine cye~scissors and a common housewife needle, stuck with its head in a piece of I rwnrvgp saw'ur'efg-syaalh F.4d; e. _. ""gr postular opacity, which, tweaking, forms an ulcer, which or enemy or THE comma. good, are sufficient apparatus for this end. 63 The head of the patient is supported against the breast of an assistant, and the eyelids held asunder while the eyeball is at the same time pressed so as to steady it. 2. The surgeon passes the needle under the fasciculus of vessels, so as to lift thcm'from the sclerotica near the margin of the cornea. He then places the scissors so under the needle as to cut out a considerable portion of the conjunctiva and the congerics of vessels. The eye is to be fomentcd so as to continue the bleeding from the cut vessels. The opacity 03' the cornea will often disappear the first or second day after the operation. When a young man asks how is this supposeddeposition in the cornea absorbed, I cannot give him a satisfactory answer. The practice in the more permanent opacities of the cornea, Viz. the albugo and lcucoma is very vague, because of the great difficulty of removing them, and the frequent disap» pointment in the attempt to cure them. All that is to be said, seems to resolve into this-if there be a remaining in- flammation or laxity of the vessels of the eye, this is to be re:moved by local and general means ;.--if, on the contrary, all inflammation has subsided, and the speck is stationary, we endeavour to excite such an action in the part by stimulants, as may produce eventually some change in the disposition of the part. APPLICATION OF CAUSTIC TO THE CORNEA. from in the cornea may be a consequence of violent inflammation, or a direct effect of external injury. It has been roundly asserted that the ulcer of the cornea is oftcner the cause of the ophthalmia, which accompanies it, than the ulcer is a consequence of the ophthalmia. This teaches us not to trust to general remedies for the removal of the inflamma tion. The ulcer then is to be touched with the lunar caustic. This of course deadens the very sensible surface of the ulcer, and it being no longer sensible to the acrid stimulus of the tears, the irritation subsides.