An American text-book of diseases of the eye, ear, nose and throat / edited by G.E. De Schweinitz and B. Alex. Randall.

Date:
1899
Catalogue details

Licence: Public Domain Mark

Credit: An American text-book of diseases of the eye, ear, nose and throat / edited by G.E. De Schweinitz and B. Alex. Randall. 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.

    607/1336 (page 583)
    with deleterious consequences. Its presence is recognized if the lens presents in the wound, but does not advance. No forcible pressure should be used, but the section should be enlarged by a strong pair of strabismus-scissors (those of Stevens answer well). If the knife on its passage through the anterior chamber engages in the iris, or if the counter-puncture is not at the right place, the knife should be drawn back and its direction corrected. If the iris falls over the knife when the knife, after the counter-puncture, is moved upward, in many cases the iris can be re-dressed by turning the edge of the knife slightly forward; but if this fails to push the iris back, it is best to continue and to complete the section. The exsection of a small piece of iris does not much interfere with a good recovery. Disturbances of the Healing Process.—Profuse intraocular hemorrhage during or after the operation is followed by the ruin of the eye, do what we may. Prolapse of iris is treated in the manner already described (page 576). Iritis is treated as usual—-leeches, atropin, anodynes, etc. Oyclitis loith capsulitis, which mostly manifests itself in the second week by pain, marked, deep-seated circumcorneal injection, with a round, clear pupil and good sight, is commonly tedious and requires patient treatment for from three to six weeks. Then the sclera gets white, the vitreous clears up, the capsule is more or less opaque, but the vision is commonly not greatly damaged, and can be improved by a subsequent discission. Irido-cyclitis, especially after combined extraction, is moi*e deleterious. It lasts weeks, and sometimes months, damages sight greatly, leads to closure of the pupil, and dense pseudo-membranes behind the iris. We should not tire in treating such cases, for not infrequently, even if sight is reduced to perception of light, a cystectomy will restore useful vision. Irido-cyclitis ruins, in rare cases, the other eye by sympathetic ophthal- mia. Suppuration may occur in the cornea, the iris, and the vitreous. In almost all cases it destroys the eye by extension to the deeper tunics—-panophthal- mitis. In some cases a corneal suppuration is limited to the lips of the wound and the adjacent parts. The result is partial preservation of the cornea, indrawn scar, and closure of the pupil. If the eyeball is not soft and the light-perception good, an iridectomy may restore a moderate degree of vision. Whether a beginning suppuration of the flap will be limited or progress to total destruction of the cornea seems to depend more on the nature of the individual case than on the medication employed. The author has not found that galvano-cautery or any other means has a controlling, or even favorable, influence on the morbid process. Of the many modes of treatment recommended and praised, the best seems to be to open the wound and estab- lish drainage of the anterior chamber by reopening the wound with a spatula once every day or oftener. Eyes with ring abscess and panophthalmitis are beyond rescue. Our endeavor should be to relieve the atrocious pain and establish a safe and non-irritable stump suitable for wearing an artificial eye. This is best accomplished by poulticing and incisions giving free vent to the pus. The result of cataract extraction is restoration of useful sight in about 95 per cent, of the uncomplicated cases, perception of light in 3 per cent., total blindness in 2 per cent.