On the treatment of certain injuries of the eye, ocurring in infants and young persons / by Richard Middlemore.

  • Middlemore, Richard, 1804-1891.
Date:
[1840?]
Catalogue details

Licence: Public Domain Mark

Credit: On the treatment of certain injuries of the eye, ocurring in infants and young persons / by Richard Middlemore. Source: Wellcome Collection.

Provider: This material has been provided by UCL Library Services. The original may be consulted at UCL (University College London)

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    points, I entirely differ from preceding writers. First,, in pointini? out thfit, M'hen the lens is rendered opaque in infants and very young persons by the application of accidental violence, it is absolutely necessary to cause its removal by a surgical operation, unless, indeed, it be at the same time displaced, or as- sociated whh other injury necessarily destructive to vision; and secondly, in stating that when this accident occui-s in early life its cure should be attempted, not by the operation of ex- traction, which, for ought I know to the contrary, some persons may be inju- dicious enough to perform, but by that of solution. Operation.—If a child have sustained a,n injury of this description—the cornea not being much injured ; the inflamma- tion produced by the accident not being severe; the lens opaque, but not dis- placed ;—I prepare the eye for operation, by applying belladonna to the eyelids, and bind up the healthy organ. Hav- ing steadied the eye by means of the fingers of an assistant, (T scarcely ever use a speculum) if operating upon the left eye, and by the agency of my own if operating upon the right eye, I intro- duce the needle through the sclerotica, as for the posterior operation of solu- tion,* and, by continued and varying ■nioyeineiits, lacerate the capsule as freely as possible, to an extent equal, at least, to the size of the pupil in its ordinary state of dilatation. Having done this, bearing in mind that the needle is «lightlv curved, I very gently withdraw it, keep the patient in a darkened apart- ment, and employ any antiphlogistic or other measures the after course of the case may render necessary. The daily application of belladonna is requisite, with a view of facilitating and rendering TOore perfect the solution and absorption of the comminuted lens and its cap- sule. Let it be remembered that, as the * I (io not advise the perfornmiice of kerato- nyxiB, because the cornea has, in many of these cases, already sustained injury; the eye is irri- table from the existence of a slight degree of in- flammation ; and, on these nccoutits, the neces- sary manipulalious through the cornea would be more than commonly difficult. The needle em- j)loyed is f mall and round, being slinhtly curved at its point. It is introduced with its point ■downwards (towards the lower part of the cornea), 80 that neither its concave nor its convex surface ds opposed to the iris. As soon as the needle Is perceived within the pu))!!, its point is directed, J)y ft slight rotation of the handle, towards the object of this operation is to prevent the establishment of a secondary form of dis- ease (lough capsularcataracl), which usu- ally occupies in its development several months, it is not imperative to perform it so soon as the opacity of the lens appears ; neither is it advisable to do so until all acute inflammation has been subdued; in this respect differing from- some cases of dislocation of the lens, which may demand the prompt perform- ance of a surgical operation. Sometimes it is necessary to perform a second operation, but this seldom hap- pens if the first operation is practised will), the necessary care, except in those cases- where the lens has become opaque inde- pendently of any local injury, w hich has-, caused the laceration of the capsule. So that a first and single operation for congenital cataract affecting the whole, lenticular substance would not be so likely to be perfectly effective as woultt the same operation performed upon the eye of an infant suffering from traumatic cataract. In fact, in the case of conge- nital cataract, a single operation will not, by any means always, effect the entire removal of the disease, however care- fully and perfectly performed. I shall conclude with the following condensed summary of the more material statements contained in the preceding remarks:— 1. Proposed operation. — Posterior operation of solution, with very free ]aceralio,n of the capsule. 2. State of disease or injury to which the proposed operation is adapted.-— Any injury of the eye, occurring iu infants or persons not more than thirty years old, and producing opacity of the. lens in situ, but not occasioning any extensive wound or injury of the cornea or other part of the globe, necessaril.) destructive to vision. Should the sofi lens, uncovered by its capsule, (which has been extensively torn by the acci- dent,) be thrown from its natural situa- tion, either into thejiupil or the anterior chamber, the operation is not required ; first, because the supposed free laceration of the capsule protects the patient from the occurrence of capsular cataract; and, secondly, because the youthfulness of the patient, and the softness of the lens, render almost certain the disappearance of the cataract without the periormancc of a surgical operation. 3. Time at which an operation should