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Credit: Ophthalmic surgery / by J. F. Streatfield. Source: Wellcome Collection.
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![CHAPTEE LVI. OPHTHALMIC SURGERY. [This Chapter has been written and contributed by J. F. STREATFEILD, F.R.C.S., Surgeon to the Royal London Ophthalmic Hospital, Moorfields, and Ophthalmic Surgeon to University College Hospital. ] Operations on the eye are in many ways peculiar. They specially demand an accurate knowledge of the anatomy of the parts concerned, of their relative connection and position. In eye-023erations, any small error in estimating the relationships of the delicate parts constituting the organ of vision is much more likely to be injurious than in operations on other parts of the body. Again, as the eyeball is enclosed in dense firm membranes, capable of little or no extension, inflammation is fraught with very much danger to the future integrity of the parts. An external opening made into the globe in all probability soon heals ; but the parts within, if there be inflammation, are perhaps in so much the greater danger ; and, as the circumference of the globe is limited, the inflammation is so much the more and more continually aggravated. The re-absorption of inflammatory effusion, and the return to the healthy state, are hindered by the unaccommodating nature of the sclerotic and cornea. The optic nerve will give way, after some time has elapsed, in any case of intraocular pressure, with, of course, serious injury to vision (see Glaucoma, p. 358). The sclerotic or cornea may allow extension ; and a corneal or sclerotic staphyloma, when these structures have been weakened and dete- riorated, is formed, but very slowly, and the bulging is a permanent deformity almost always very seriously interfering with good vision. Inflamma- tion of the eye, as of other parts—such as the testis—which are enclosed in inextensible fibrous coverings, is attended with pain in proportion to the un- jdelding nature of the envelope ; but the functions of the eye are more readily destroyed, and we cannot in the same way relieve tension by straj)ping or by simple incision, nor can we so well apply cold externally. If one eye be destroyed by intenial inflammation, especially of a traumatic nature, whether accidental or surgical, the other will not improbably follow it and also become blind by a peculiar sympathetic inflammation, to which the eye, among duplicate organs, is specially liable. In some cases this is almost certain ; so that the Surgeon has then further a clear duty to perform. In- flammatory effusion or suppuration within other organs, is followed generally by much less destructive results as regards the integrity of the whole; in them, abscess probably soon finds a harmless outlet. A few ophthalmic opera- tions, especially on the parts around the eye, resemble operations in similar cases in ordinary surgery, and are done according to general rules given in other chapters (see Chapter LVIIL). It used to be always remarked of the diseases of the eye that, even of many of the internal changes, iritic, cataractous, &c., it was no small advantage that we could see their progress, and that their study was instructive inasmuch as it was the more certain. With the ophthalmoscope our advantages are tenfold increased, and we may see morbid processes existing even in the choroid or sclerotic coats, in the retina and optic nerve. Amaurosis is an almost obsolete term, or is, as before, at any rate restricted to those (now com-](https://iiif.wellcomecollection.org/image/b21636953_0006.jp2/full/800%2C/0/default.jpg)
