The practical details of cataract extraction / by H. Herbert.

  • Herbert, H.
Date:
1903
Catalogue details

Licence: In copyright

Credit: The practical details of cataract extraction / by H. Herbert. Source: Wellcome Collection.

    44/142 (page 28)
    especially with a sunken eyeball and with the speculum raised, that Meibomian secretion might float up to the wound, possibly with organisms also from the fornices, supposing there were any not imprisoned in the mucus produced by the perchloride. Hence some care is taken to prevent accumulation of the solu- tion, by tilting the patient’s head to one side at times. The speculum is then inserted, and the outer eyelashes of the upper lid, beyond the blade of the speculum, are cut off with scissors unless the eyes be so prominent that the blade of the knife is not likely to touch the lashes while making the incision. And the eye is at once moistened with a stream of fluid from the irrigator. The patient must then look down towards one of his hands held up. The eyelashes should touch nothing that has to enter the wound, as it is impossible to sterilize either them or the lid- margins ; however, it is unnecessary to cut away any but the outermost lashes. Even the stumps left are likely to touch the blade of the knife if care be not taken while the incision is being made. The muscular sense is sufficient to indicate to a blind patient the position of his hand. The sunken eyeballs of very thin people need to be fully rotated downwards, but when the eyes are prominent this is not essential. The blades of the speculum, forced down on the eyeball by spasm of the lids, are the means of producing some large vitreous losses after the section has been made. But the responsibility is shared by (i) insufficient preliminary schooling of the patient, (2) unreadiness of the assistant in elevating the speculum on completion of the section, and (3) imperfect action of the cocaine. Many patients feel a little pain when the iris is rubbed or seized, whereas other eyes are rendered completely anaesthetic. The accident, with due care, is not sufficiently frequent to necessitate any alteration in design of the instrument at the cost of its convenience, still less its rejec- tion in favour of elevation of the upper lid by retractor or by the finger. But it must be realized that, however well elevated the speculum may be by the assistant, it affords insufficient