The principles and practice of ophthalmic medicine and surgery / By T. Wharton Jones.

  • Thomas Wharton Jones
Date:
1863
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Licence: Public Domain Mark

Credit: The principles and practice of ophthalmic medicine and surgery / By T. Wharton Jones. 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.

    452/508 (page 438)
    — 438 PENETRATING WOUNDS OF THE ORBIT. Section IV.—Injuries of the Orbit. Blows, &c, on the edge of the orbit. Such injuries are, as above stated, the cause sometimes of perior- bitis, running into suppuration and disease of the bone; sometimes of orbital tumors; sometimes of concussion of the eyeball. Penetrating wounds of the orbit. Injury of the orbit from penetrating wounds is necessarily attended with external wound of the eyelids, &c, but this, it is to be remarked, may be very small. The consequences of such injuries of the orbit may be:— 1. Swelling of the eyelids, protrusion of the conjunctiva, and ex- ophthalmus, from effusion of blood into the orbit. 2. Inflammation of the orbital cellular tissue, especially if any portion of the wounded body has been left lodged in the orbit. 3. Injuries of the muscles and nerves of the orbit, sometimes dislo- cation of the eyeball (p. 433). As the instrument inflicting a penetrating wound of the orbit may, by piercing the orbital plate of the frontal bone, wound the brain, accidents of this kind must always be regarded with great anxiety, and carefully watched and treated. The importance of keeping in mind the possibility of a foreign body having penetrated and become lodged in the orbit, has been above (p. 76) insisted on. [We have reported a very instructive and remarkable case in point: A young man had received a blow from an umbrella handle at the inferior and internal part of the orbit of the left eye. When he came to his senses, he saw the umbrella handle, intact; at least such a one was shown to him. For the space of three years he was in the hands of Desmarres, and the first surgeons of Paris, without any foreign body being found. His e}^e remained thrust outwards; there was slight exorbitis of the ball; the move- ment of the eye was imperfect, and vision was almost gone. After making a few incisions below the inner angle of the eye, a cylindrical, slightly-conical umbrella-handle was removed by Mr. Nelaton, two-fifths of an inch in diameter, at the thickest part, and one and four-fifth inches in length.— Clinical Lectures on Surgery, by M. Nelaton, p. 408.—Ed.] If a foreign body has penetrated into, and lodged in the orbit, it must be extracted as soon as possible. By its extraction the risk of inflammation will be diminished, and if the eyeball is at the same time dislocated, restoration of it to its proper position, in the manner above indicated (p. 433), will be possible. If, however, from the situation of the body, removal does not admit of being readily effected, attempts should not be persisted in, and especially if inflammation has already come on, it will be safer to wait. Eest, and the antiphlogistic regimen, more or less strict, must not only be enjoined, but the case must be closely watched for some time, in order that inflammation may at its onset be duly met.