The principles and practice of ophthalmic medicine and surgery

Front matter

YALE MEDICAL LIBRARY

HISTORICAL LIBRARY

Open Knowledge Commons and Yale University, Cushing/Whitney Medical Library

Section I. — Ophthalmoscopy or Exploration of the Eyes, in order to a Diagnosis. PAGE

Objective Exploration of the Eyes, . . .37

Exploration of the eyebrows and orbital margins, . 39

Exploration of the eyelids and their tarsal border, including

the state of the cilia and Meibomian apertures, . . 40

Exploration of the conjunctival surface of the eyelids, and of

the palpebral sinuses, ..... 43

Exploration of the angles of the eye, and of the lacrymal

organs, as regards their general state, . . .44

Examination of the form and appearance of the eyeballs generally, their size and degree of prominence, . . 46 Examination of the direction and movements of the eyeballs, 46 Examination of the front and interior of the eyeball, . 47

Subjective Examination of tiie Eyes, . . .63

Pain ; its seat and character, .... 63

Impairment or loss of common sensibility, . . .63

Intolerance of light or photophobia, ... 64

State of vision, . . . . . .64

Section II. — Application or Remedies to the Eyes or their Neighborhood, and Performance of Minor Operations on them, ... 66

Cold applications, . . . , . .66

Warm applications, ..... 66

Medicated vapors, . . . . . .67

Potential cauterv, . . . . . .74

CONTENTS.

PAGE

Abstraction of blood, ..... 75

Anodyne friction, . . • . . . .78

Counter-irritation, . . . . . . 79

Evulsion of eyelashes, . . . . .79

Foreign bodies in the oculo-palpebral space of the conjunctiva, and their removal, . . . . . 80

Evacuation of the aqueous humor by puncture of the cornea, 83

Chapter II. Ophthalmic Inflammation

Section I. — Inflammation in General, . . 84

Inflammation Proper, ..... 84

Terminations or Events of Inflammation, . . 84

Distinction of Inflammation into Acute and Chronic, 8G

Section II. — Ophthalmic Inflammation in General, 86 Inflammation as it occurs in the different Tissues of

Conjunctivitis, or inflammation of the conjunctiva, . . 87

Sclerotitis, or inflammation of the sclerotica, . . 91 Corneitis, or inflammation of the cornea, . . .92

Iritis, or inflammation of the iris, .... 99

Choroiditis and retinitis, or inflammation of the choroid and retina, . . . . . . .101

Inflammation of the lenses of the eye, . . . 102

Morbid sensations depending on perversion of common sensibility, accompanying inflammation of the different tissues, 103

Morbid sensations depending on perversion of the special sensibility of the retina, ..... 104

Causes of Ophthalmic Inflammation, . . . 108

General — Antiphlogistic treatment, . . . 110 General — Tonic and alterative treatment, . . .112

Local — Antiphlogistic and soothing treatment, . . 112

Local — Irritating applications, .... 113

CONTENTS.

Section III. — TnE Ophthalmia, . . . 114 Order I. — Ophthalmia Externa, . . . .115

Genus I. — Conjunctivitis, . . . . 115

Pustular ophthalmia, . . . .115

Ophthalmia of new-born infants, . . . 127

Gonorrhoeal ophthalmia, . . . . .131

Mild gonorrheal ophthalmia, .... 132

Puro-mucous ophthalmia occurring in female children, in

connection with puro-mucous discharge from the vagina, 132 Erysipelatous ophthalmia, ..... 133

Genus II. — Sclerotitis, ..... 134

Rheumatic ophthalmia, . . . . .134

Scrofulous sclerotitis, ..... 136

Genus III. — Corneitis, ..... 137

Scrofulous corneitis, ..... 143

Acute or erethitic form, . . . . .143

Chronic or torpid form, . . . . .146

Rheumatic corneitis, ..... 146

Genus IV. — Compound External Ophthalmia, . . 147

Scroralo-catarrhal ophthalmia, . . . .147

Catarrho-rheumatic ophthalmia, .... 151

Order II. — Ophthalmia Interna Anterior, . . 153

Genus I. — Aquo-capsulitis, . . . . .156

Aquo-capsulitis, ...... 156

Genus II. — Iritis, . . . . . .158

Scrofulous iritis, ..... 158

Rheumatic ii'itis, . . . . . .159

Syphilitic iritis, . . . . . . 161

Arthritic iritis, . . . . . .163

Genus III. — Crtstallino-Capsulitis Anterior, . 166

Crystallino-capsulitis anterior, . . . .166

XIV

CONTENTS.

Order III. — Ophthalmia Interna Posterior,

Scrofulous posterior internal ophthalmia, Arthritic posterior internal ophthalmia,

Order IV. — Panophthalmitis, Genus. — Panophthalmitis, .

Phlegmonous panophthalmitis,

Appendix to the Preceding Section

Scarlatinous and morbillous ophthalmia, .

Variolous ophthalmia, .

Post-febrile ophthalmitis, .

Phlebitic ophthalmitis, .

Traumatic and sympathetic ophthalmia, .

169 171

174 175

177 178 179 180 181

Section IV. — Various Morbid States of the Eye, consequences op the Ophthalmia, . . 182 Vascular cornea and pannus, . . . .186

Cuticular conjunctiva, ...... 187

Onyx and abscess of the cornea, .... 188

Ulcers of the cornea, . . . . . .188

Suffusion, opacities, and specks of the cornea, . . 189

Hernia of the cornea (keratocele), . . . .191

Prolapsus iridis, ...... 192

Partial staphyloma, ..... 192

Total spherical staphyloma, ..... 193

Prominent cornea and dropsy of the aqueous chambers, . 201

Closure of the pupil, . . . . . .202

Iridauxesis, . . . . . . 202

Sclerotic staphyloma, ...... 203

Atrophy of the eyeball, . ..... 205

Shrunk state of the eyeball from evacuation of humors, . 206

Appendix to the Preceding Section, Adaptation of au artificial eye,

200 206

CONTENTS. XV

Section I. — Dropsies, Tumor, Cancer, etc., op the eyeball, 208 Hydrophthalmia, . . . . . . 211

Hremophthalmus, . . . . . .214

Hydatid (cysticercus cellulose) in the anterior chamber, . 215

Non-malignant tumors of the eyeball, .... 218

Scirrhus of the eyeball, ..... 221

Medullary or encephaloid fungus of the eyeball, . . 221

Melanosis of the eyeball, ..... 226

Operation of extirpation of the eyeball, . . . 228

Section II. — Cataract, ..... 230 Genera and Species of Cataract, .... 230

Lenticular Cataract, . . . . .231

Hard or common lenticular cataract of old people, . . 232

Soft or common lenticular cataract of young people, . 237

Capsular Cataract, ...... 238

Anterior capsular cataract, .... 238

Posterior capsular-cataract, ..... 239

Capsulo-Lenticular Cataract, .... 239

Central capsulodenticular cataract, .... 240

General capsulo-lenticular cataract, . . . 240

Siliquose cataract, ...... 241

General observations and questions regarding the operations

for cataract, ...... 241

Extraction of the hard or common lenticular cataract of old

Extraction of capsulo-lenticular cataract, . . 265

Extraction of siliquose cataract, .... 266

CONT E NTS.

Displacement of the Cataract and its Modifications, 2G6

Reclination by sclerotic puncturation, . . . 268

Reclination by corneal puncturation, . . . 272

Division of the cataract by sclerotic puncturation, . 275

Division of the cataract by corneal puncturation, . . 278

Operation for cataract in infants, . . . 280

Secondary cataract, ...... 280

Comparative advantages and disadvantages of extraction,

displacement, and division, - . . . 281 Cataract glasses, . . . . . .282

Section III. — Operations for Artificial Pupil, 283

General conditions necessary, or at least favorable to the success of operations for artificial pupil, . . . 284

Incision through the sclerotica, .... 285

Incision through the cornea, .... 287

Artificial Pupil by Excision, .... 289

Lateral excision, ...... 290

Central excision, ...... 293

Separation through the cornea, .... 294

Operations for again rendering the Natural Pupil Available, ....... 297

Restoration to its natural position by abscission, . . 297

Dislocation of the pupil to opposite a clear part of the cornea, 298

Index of the Different Morbid States of the Eye, in which Vision may be Restored by the Operation for Artificial Pupil, and of the Plan of Operating, or

Modification of it adapted to each Particular State, 300

Section IV. — Congenital Defects of the Iris and Pupil, 301

Congenital absence of the iris, .... 301

Congenital fissure of the iris, .... 302

Congenital imperforation of the iris, .... 304

CO NT F.N TS.

• (J II AFTER IV.

PAGE

Section I. — Abnormal States of the Optical Refractions AND ADJUSTMENTS OF THE EYE, . 304 Myosis axd Mydriasis, ...... 304

Conditions on which the movements of the pupil depend, . 304 Myosis, . . . . . . . .307

Myopy, or Shortsightedness, and Presbyopy, or Farsightedness, ....... 308

Refraction by convergent lenses and the adjustment of the eye

to different distances, ..... 309

Shortsightedness, . . . . . .310

Cylindrical eye, . . . . . .317

Unequally refractive state of the two eyes, . . 517

Loss of power of adjustment, ..... 318

Chromatic vision, ...... 318

Diplopy and polyopy with one eye, .... 318

Asthenopy or weaksightedness, . . . . 319

Section II. — Vision of Objects in and on the Eye, . 322 Vision of Objects in the Eyes, .... 322

Common musca? volitantes, ..... 322

Spectrum of the vascular ramifications and network of the

Circulatory spectrum, ..... 326

Vision of Objects on the Eyes, .... 327

Muco-lacrymal muscae, ..... 327

Chapter V. Amaurotic Affections

Section I. — Introduction. — Abnormal Excitement of

Visual Sensations, . . . . .327

Sensations of light and color, independent of external light, 2*

CONTENTS.

PAGE excited by internal influences operating on the optic nervous

Reciprocal action of the different parts of the retina on each

other's sensation, ...... 329

Spectra consequent to impressions on the retina and complementary colors, ...... 330

Section II. — Impairment and Loss of Sensibility of the Optic Nervous Apparatus, or Amaurosis in its various Degrees, . . . . .331

Defective perception of colors, .... 332

Temporary hemiopy, ...... 332

Night-blindness, ...... 333

Day-blindness, ....... 335

Fixed muscas, ...... 335

Amaurosis considered empirically, .... 336

Amaurosis considered pathologically, .... 340

Amaurosis considered therapeutically, . . . 343

Section III. — Glaucoma and Cat's Eye, . . 345 Simple glaucoma, ...... 346

Simple glaucoma with cataract, .... 346

Chronic glaucoma with amaurosis, .... 347

Chronic glaucoma with amaurosis and cataract, . . 347

Acute glaucoma with amaurosis, .... 347

Section I. — Loss of Correspondence of the Sensations and Movements of the Two Eyes, . 348 Correspondence between the sensations of the two eyes, . 348

Natural double vision with two eyes, . . . 353

Correspondence in the movements of the two eyeballs, . 353

Loss of Correspondence in the Sensations of the Two

Diplopy or double vision with two eyes, . . . 356

366 360

CONTENTS. XIX

PAGE LOSS OF CORRESPONDENCE IN THE DIRECTION OF THE TWO EYES, 358

Strabismus, or squinting, and luscitas, or immovable distortion

of the eyeballs, ..... .,358

Strabismus convergent, ..... 359

Strabismus divergens, ...... 365

Strabismus sursumvergens and strabismus deorsumvergens, 365 Paralysis of the muscles supplied by the nerve of the third

Paralysis of the muscles supplied by the nerve of the fourth

Paralysis of the muscles supplied by the nerve of the sixth

Oscillation and nystagmus of the eyeballs, . . . 370

Chapter VII. Diseases Of The Eyelids

Section I. — Inflammations and Ulcerations of the

Phlegmonous inflammation of the eyelids, . . . 372

Erysipelatous inflammation of the eyelids, . . . 372

Variolous inflammation of the eyelids, . . . 373

Carbuncle and malignant pustule of the eyelids, . . 373

Ophthalmia tarsi, ...... 374

Catarrhal ophthalmia tarsi, . . . . .374

Scrofulous ophthalmia tarsi, .... 376

Hordeolum, or stye, . . . . . .378

Inflammation and abscess of the Meibomian glands, . 379 Syphilitic affections of the eyelids, .... 370

Section II. — Abnormal Position of the Eyelids, Misdirection of the Eyelashes, Irregularity and Loss of Movements of the Eyelids, etc., . 381

EcTKOPIVM OR EVERSION OF THE EYELIDS, . . 381

Ectropium from excoriation and contraction of the skin of the eyelid, together with a thickened and sarcomatous state of the conjunctiva, ...... 381

Ectropium from contraction of the skin in consequence of cicatrices, &c, ...... 385

Ectropium from caries of the orbit, .... 392

Extropium or Inversion of the Eyelids, . . 303

Entropium from relaxation of the integuments of the eyelid, and spasmodic contraction of the orbicularis palpebrarum muscle. ....... 394

CONTENTS.

Entropium from a contracted and deformed state of the tarsal

Trichiasis and distichiasis, ..... 398

Lagophthalmos, . . . . . .401

Lagophthalmos from paralysis of the orbicularis palpebrarum, 401 Lagophthalmos from organic contraction or adhesions of the

Congenital lagophthalmos, ..... 403

Ptosis or falling down of the upper eyelid, . . 403

Ptosis from paralysis of the nerve of the third pair, . . 403

Ptosis from injury of levator palpebrae muscle, . • 403 Ptosis from extension and relaxation of the skin, or of the

whole substance of the eyelid, .... 404

Congenital ptosis, ...... 404

Section III. — Morbid Connections op the Eyelids, 405

. Ankyloblepharon, ...... 405

Symblepharon, ...... 407

Section IV. — Tumors, Cancer, etc., of the Eyelids

and Eyebrows, ..... 408

Phlyctenular on the borders of the eyelids, from obstruction of

the Meibomian apertures and retention of the secretion, 408

Meibomian calculus, ...... 408

Enlargement and induration of the Meibomian glands, . 408

Abnormal occurrence of a sebaceous gland in the palpebral conjunctiva of the upper eyelid, .... 408

Vesicles or phlyctenular on the cutaneous surface of the eyelid near its margin, ..... 408

Warts on the eyelids, . . . . . .409

Horny-like excrescences connected with the skin of the eyelids. ....... 409

Thickwalled encysted tumors, . . . . 410

Chalazion, or tarsal tumor, . . . . .410

Encysted tumor, . . . . . . Ill

Hydatids in the cellular substance of the eyelids, . .411

Nasvus maternus and aneurism by anastomosis of the region of the eyelids, . . . . . 41 1

Scirrhoid callosity of the eyelids, .... 412

Cancer of the eyelids, . . . . .412

Phtheiriasis of the eyebrows and eyelashes, . . . 413 tlONTKNTS XXI

Section I. — Diseases of the Conjunctiva, . . 414 Pinguecula, ...... 416

Tricnosis bulbi, ...... 416

Abnormal development, or hypertrophy of the conjunctiva cornea?, . . . . . . .417

Fungous excrescence of the conjunctiva cornea?, . .417

Various kinds of tumors of the conjunctiva, . . . 417

Hydatids in the cellular tissue under the sclerotic conjunctiva, 417 Filaria medinensis, or Guinea worm, . . . 419

Section II. — Diseases op the Semilunar Fold and Lacrymal Caruncle, . . . . .419

Inflammation of the semilunar fold and lacrymal caruncle, 419

Catarrhal inflammation of the semilunar fold and lacrymal

Inflammation and abscess of the lacrymal caruncle, . 420

Chronic enlargement of the lacrymal caruncle and semilunar

Polypous and fungous excrescences of the lacrymal caruncle

and semilunar fold, ..... 421

Cancer of the lacrymal caruncle, .... 421

Chapter IX. Diseases Of The Lacrymal Organs

Section I. — Diseases of the Secreting Lacrymal

Disordered state of the lacrymal secretion, . . . 422

Suppression of the lacrymal secretion, . . . 422

Epiphora or watery eye, ..... 423

Inflammation of the lacrymal gland, . . . 423

Fistula of the lacrymal gland, or true lacrymal fistula, . 424 Extirpation of tumors in the neighborhood of the lacrymal

gland, or of the diseased gland itself, . . . 424

CONTENTS.

Section IT. — Diseases of the Derivative Lacrymal

Inflammatory swelling, abscess, or sinuous ulcer in the region

over the lacrymal sac, ..... 426

Catarrhal inflammation of the derivative lacrymal passages, . 427

Acute inflammation of the derivative lacrymal passages, . 428

Chronic inflammation of the derivative lacrymal passages, . 429

Atony or relaxation of the lacrymal sac, . . . 431 Mucocele, . . . . . . .432

Exostosis of the inner and posterior wall of the lacrymal fossa, 433

Fistula of the lacrymal sac, .... 433

Atony or relaxation of the papilla?, with a dilated state of the

Shrunk papillae and contracted state of the puncta, . 433 Obliteration or obstruction of the lacrymal puncta and canali-

Exploration of the nasal duct, to determine whether it is obstructed or obliterated, ..... 436

Obstruction of the nasal duct, and the different operative methods adopted with a view to remove it, and to restore a

passage to the tears, . . . . . 441

Obliteration of the nasal duct, .... 445

Lacrymal calculi, ...... 445

Chapter X. Diseases Of The Orbit

Section I. — Inflammations, etc., of the Orbit, . 446

Inflammation of the orbital cellular tissue, . . 446

Inflammation of the periorbita and bones of the orbit, . 449

Section II. — Orbital Growths and Tumors, . 449

Infiltration of the orbital cellular tissue, . . . 450

Sarcomatous tumors in the orbit, .... 451

Encysted tumors in the orbit, . . . . .451

Operation of extirpating sarcomatous and encysted orbital

Hydatidgenous cysts in the orbit, . . . .452

Medullary tumor in the orbit, .... 452

CONTENTS.

PAGE

Melanotic tumor in the orbit, . • • • 453

Aneurism by anastomosis in the orbit, • . • 453

True aneurism in the orbit, ..... 4j3

Chapter XI. Injuries Of The Eye

Section I. — Injuries of the Conjunctiva and Eyeball, .......

Injuries of the Conjunctiva from Intrusion of Foreign

Bodies into the Oculo-Palpebral Space, . . 453

Mechanical injuries, ...... 454

Chemical injuries, ...... 454

Injuries of the Eyeball and its Proper Tunics, . . 456

Concussion of the eyeball, ..... 456 Contused wounds of the eyeball, . . . .457

Injuries of the cornea, ..... 457

Inflammation from abrasion of the cornea, . . . 460

Foreign bodies in the aqueous chambers, . . . 461

Injuries of the iris and pupil, ..... 463

Injuries of the crystalline body, .... 463

Wounds of the sclerotic and posterior segment of the eyeball, 467

Dislocation of the eyeball, ..... 468 Evulsion of the eyeball, . . . . .468

Section II. — Injuries op the Eyebrow and Eyelids, . 468

Contusion with ecchymosis, ..... 468

Incised, lacerated, and contused wounds of the eyebrows and

Poisoned wounds, ...... 469

Burns and scalds, ...... 470

Section III. — Injuries of the Lacrymal Organs, . 470 Injuries of the lacrymal gland and ducts, . . . 470

Injuries of the derivative lacrymal organs, . . .471

XXIV CONTENTS.

PAGE