Injuries of the eye, orbit, and eyelids : their immediate and remote effects

Front matter

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Preface

In the work which I now offer to the profession I have endeavoured to group together all the most important points relating to injuries of the eye, orbit, and eye-lids. My aim has been to produce a book of reference in which will be found not only a description of the injury and its primary treatment, but also the best methods of dealing with those changes and deformities which, however remote, may be more or less consequent on the accident.

I have illustrated, as far as I have been able, each form of injury with characteristic cases, feeling that the truthful record of what has been, makes a more lasting impression on the mind than the mere detail of what may be. In my report of the cases I have had frequent occasion to refer to Jaeger's Test-types as a means for ascertaining the acuteness of the patient's vision. I have therefore for the convenience of reference added at the end of the book a set of test-types, printed so as to correspond with Jaeger's, but with the addition of No. 15, as it appeared to me that the leap from the letters marked 14 to those

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numbered 16 was too great, and that an intermediate link was wanting.

At the close of the last chapter I have printed an abstract from the Surgical Eeport of the Royal London Ophthalmic Hospital for the past year, 1866. It forms a good index of the different diseases of the eye, and it gives also a fair approximation of the relative frequency of each.

In alluding to the tension of the eye in the different cases, I have adopted the symbols first suggested by Mr. Bowman for recording accurately its varying degrees of increase and diminution. I quote the account given by him, as reported in the British Medical Journal, October 11, 1862: —

" T represents tension (' t ' being commonly used for 4 tangent,' the capital T is to be preferred) ; Tn, tension normal. The interrogative, P, marks a doubt, which in such matters we must often be content with. The numerals following the letter T on the same line indicate the degree of increased tension; or, if the T be preceded by — , of diminished tension, as further explained below. Thus :

" T 3. Third degree, or extreme tension. The fingers cannot dimple the eye by firm pressure.

"T2. Second degree, or considerable tension. The finger can slightly impress the coats.

"T 1. First degree. Slight but positive increase of tension.

"Tl? Doubtful if tension increased.

" Tn. Tension normal.

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" — T 1 ? Doubtful if tension be less than natural. "-T1. First degree of reduced tension. Slight but positive reduction of tension.

"-T21 Successive degrees of reduced tension, short of " — T 3 J such considerable softness of the eye as allows the finger to sink in the coats. It is less easy to define these by words."

Parts of some of the chapters have already appeared as short papers in the medical periodicals^ but from the rapid progress of ophthalmic surgery I have had occasion either to re-write them or to add much new material.

To my colleagues both at the Ophthalmic and the Middlesex Hospitals I return my warmest thanks for the use they have allowed me to make of their cases, and for the information which they have at all times readily afforded me.

I am also greatly obliged to my friend Dr. Workman for the assistance he has kindly rendered me in revising the proof sheets as they have passed through the press.

The drawings of the different instruments are by Mr. Dearie, and those of the eye by Mr. Stecher.

12 Harley Street, Cavendish Square, W. March, 18G7.

Chapter I. Superficial Injuries Of The Eye

Introduction — Foreign Bodies on the Eye, or on the Inner Surface of the Lids — Symptoms of a Foreign Body on the Eye or on the Conjunctiva of the Lids — How to examine an Eye which is suspected to be suffering from the Presence of a Foreign Body on its Surface— How to remove a Foreign Body if lodged in the Cornea either superficially or deeply — Blows on the Eye without any Lesion of Structure — Concussion of the Eye — Subconjunctival Haemorrhage — Lacerations of the Conjunctiva — Traumatic Ophthalmitis — Its Symptoms, Treatment, and Results ..... pagk 1

Chapter II. Injuries To The Eye From Burns, Scalds, And Chemical Agents

General Effects of Escharotics on the Eye — The Effects produced by, and the Treatment for Injuries to the Eye from Qiiick Lime, Mortar, Lime-Plashr, and other Combinations of Lime — Scalds and Burns of the Eye — Treatment of Fungoid Granulations after a Burn— The Effects caused by, and Treatment of, Injuries from strong Sulphuric and Nitric Acids, Vinegar and Diluto Acetic Acid, and strong Alkalis ........ 28

CHAPTER HI.

PENETRATING WOUNDS OF THE EYE, AND OTHER INJURIES OF THE CORNEA AND IRIS.

Penetrating Wounds of the Cornea and Sclerotic — Repair of Wounds of the Cornea — Treatment of Wounds of the Cornea — Diffuse Suppurative Corneiiis — Abrasions of the Cornea — Fistula of the Cornea — Leucoma and Nebula <>t' I be Cornea — Operations for Artificial Pupil — Opacity of the Cornea from Lead Deposit — Staphyloma of the Cornea, partial and complete — Abscission

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of the Staphyloma — Ciliary Staphyloma — Operation of Iridectomy — Prolapse of the Iris, Treatment of — Coredialysis — Laceration of the Iris without Rupture of the External Coats of the Eye page 57

Chapter IV. Teatj31atic Cataract

Traumatic Cataract with Rupture of the External Coats of the Eye — Traumatic Glaucoma following a Wound of the Lens : Cases of — Traumatic Cataract without Rupture of the External Coats of the Eye : Cases of — Treatment of Traumatic Cataract : Eirst, if the Cataract is uncomplicated with Prolapse of the Iris ; Second, if it is complicated with Prolapse of the Iris ; Third, if complicated with Injury to Iris and Protrusion of Lenticular Matter through the Wound — Operations for the Removal of a Traumatic Cataract : Rules for Guidance in the selection of the Operation — Linear Extraction of Cataract — Suction Operation for Cataract — Cases of Traumatic Cataract suitable for Linear Extraction or Suction — The Traction Operation — Cases suited for the Traction Operation — Von Graefe's Linear Extraction Operation for Cataract — -Liebreich's Eye-bandage . . . . . . . . .126

Chapter V. Capsular Opacities And Dislocations Op The Lens

Capsular Opacities following the Loss of the Lens — Simple Opacity of the Lens Capsule — Defect of Sight after an Extraction of the Lens from a Wrinkling of the Capsule — Opacity of the Capsule, with Particles of Lens Matter between its Layers — Opacity of the Capsule blended with Inflammatory Exudations — Degenerative Changes of the Lens Capsule — Treatment of Capsular Opacities — Needle Operations for Opaque Capsule — Removal of Opaque Capside with Canular Eorceps — Dislocations of the Lens : Eirst, into the Anterior Chamber, Treatment of; Second, into the Vitreous, Prognosis and Treatment of; Third, beneath Conjunctiva, Prognosis and Treatment of— Partial Dislocations of the Lens ........ 17*5

Chapter VI. Foreign Bodies Within The Eye

The Lodgement of a Foreign Body within the Eye — How to examine an Eye suspected to have a Eoreign Body within it — The Dangers of a Foreign Body within the Eye — The Severity of the Symptoms influenced by the Size of the Foreign Body and the Part of the Eye in which it is embedded — Exceptional Cases in which a Foreign Body within the Eye excites little or no irritation — Treatment of Foreign Bodies within the Eye : When lodged between the Iris and Lens ; on the Iris ; in the Lens ; or in the Vitreous : Cases illustrative of — Foreign Bodies suspected to be within the Eye, but not actually seen : Cases of 213

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Chapter VII. Traumatic Intraocular Hemorrhage And Rupture Op The Globe

Traumatic Intraocular Haemorrhage : Definition of — Division into Anterior and Posterior Intraocular Haemorrhage — Haemorrhage into the Anterior Chamber: Causes, Prognosis, and Treatment of : Cases of — Deep or Posterior Intraocular Haemorrhage : First, between Choroid and Retina, Cases of; Second, between Choroid and Sclerotic, Cases of ; Third, Haemorrhage into the Vitreous, Cases of — Prognosis and Treatment of Deep or Posterior Intraocular Haemorrhage — Rupture of the Globe, Causes of — Usual Seat of the Rupture, Prognosis and Treatment of — Cases of Ruptured Globe — Operation for Excision of the Globe — Directions for wearing an Artificial Eye . page 236

Chapter VIII. Gunshot Injuries Op The Ete

The Effects produced by the Explosion of Gunpowder near the Eye — Squib Accidents — Lodgement of Grains of Powder on the Cornea and within the Eye — Treatment of Gunpowder Injuries— Accidents from cheap Percussion Caps — Injuries from Small Shot — First, Spent Shot — Second, Glancing Shots — Third, Penetrating Shots — Gunshot Injuries of the Eye in Military Practice — First, from Shot and Shell — Second, from the Explosion of Magazines— Injuries from Gravel and Dust thrown up by the Explosion of Shells and Magazines — Treatment of Gunshot Injuries .... 282

Chapter IX. Sympathetic Ophthalmia

The Primary Cause of Sympathetic Ophthalmia — Two Forms of the Disease — Sympathetic Irritation and Sympathetic Ophthalmia — Symptoms of — Its Nature, and the way in which it invades the different Tissues of the Eye — Tension of the Eye — Sympathetic Ophthalmia not excited by a Suppurative Inflammation of the Injured Eye — Influence of Age on the Disease — The Period at which it may come on after an Injury — The Causes of Sympathetic Ophthalmia — First, from Wounds of the Eye — Second, from the Lodgement of Foreign Bodies within the Globe — Third, from the Irritation excited by Degenerative Changes taking place in Eyes already lost — Treatment of Sympathetic Ophthalmia — General Conclusions ..... 304

Chapter X. Injuries Op The Orbit

The Lodgemenl of Foreign Bodies in the Orbit — First, the immediate Effects they may produce— Second, the secondary Effects which may result from then

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— Treatment of Foreign Bodies in the Orbit — Penetrating Wounds of the Orbit — Fracture of the Bones of the Orbit — Abscess of the Orbit, Acute and Chronic: Causes of, Symptoms, and Treatment .... page 341