Ophthalmic surgery : a handbook of surgical operations on the eyeball and its appendages : as practised at the clinic of Hofrat Prof. Fuchs / by Josef Meller ; ed. by William M. Sweet.

Meller, Josef.

Date:: 1912

Credit: Ophthalmic surgery : a handbook of surgical operations on the eyeball and its appendages : as practised at the clinic of Hofrat Prof. Fuchs / by Josef Meller ; ed. by William M. Sweet. Source: Wellcome Collection.

Provider: This material has been provided by the Francis A. Countway Library of Medicine, through the Medical Heritage Library. The original may be consulted at the Francis A. Countway Library of Medicine, Harvard Medical School.

15/308 page 3

$The injection into the -deeper tissues is made with a syringe of i c. c. capacity (Pravaz's preferred, Fig. i), which is filled with a Solution composed of eight to nine parts of i per cent. cocain-solution and one to two parts of adrenalin or suprarenal Solution (i-iooo). One-third of the contents of the syringe is injected beneath the skin, the needle entering slightly below the tarsal ligament. This produces a slight bulging forward of the lachrymal-sac region, but massage causes the immediate disappearance of this swelling. The point of the needle is now inserted above the tarsal ligament and pushed vertically down to the bone. The syringe is then twisted forward 900 so that the needle is turned in the direction of the orbit. Holding it in this position the point is pushed forward closely along the periosteum and the second third of the Solution injected, so that the tissue around the top of the lachrymal sac is infiltrated. With the remainder of the Solution the region immediately about the entrance into the naso-lachrymal duct is anesthetized. The needle is now inserted below the tarsal ligament in a direction vertical to the lachrymal crest, the syringe turned so that the needle lies parallel to the bone, when it is pushed slightly backward. Should the point of the needle enter the lachrymal sac itself, recognized by the escape of fluid from the puncta, it must be pulled out somewhat and turned in a slightly different direction. The stated quantity of adrenalin (t]q- to T\ c.c.) sufhces fully for the production of anemia. In my experience it has never been followed by bad after-results, either local,such as marked secondary hemor- rhage or necrosis of the tissues, or constitutional. Occasionally a pa- tient may complain of sudden distress, such as a Sensation of oppres- sion and palpitation of the heart, but these Symptoms disappear shortly. In elderly patients with advanced arteriosclerosis, not more than TV c.c. of the adrenalin should be injected, and this amount will be sumcient. Dropping the adrenalin into the wound is unsatisfactory. After the sac has been peeled out, and before the probe is inserted into the nose, Cocain should be dropped into the wound. The Cocain will diffuse itself into the duct along the probe, and make' the curetment almost painless. Immediately after completing the injections, the Operation may be commenced. In the majority of cases layer after layer of tissue may be removed without hemorrhage, as in the dissection on the cadaver. I have frequently resected lachrymal sacs in a few minutes without assistance. The incision through the skin may bleed more than$