Ophthalmic surgery / by Robert Brudenell Carter and William Adams Frost.

  • Robert Brudenell Carter
Date:
1887
Catalogue details

Licence: Public Domain Mark

Credit: Ophthalmic surgery / by Robert Brudenell Carter and William Adams Frost. Source: Wellcome Collection.

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    Chap.xv.] Acute Localised Periostitis. external wound is closed. If the inner wall of the orbit were carious, an operation of this nature might perhaps he justifiable, but in any other circumstances it would appear to be bad surgery, for it aims at pre- venting the possible formation of a sinus in an acces- sible _ situation by the certain production of suppura- tion in a sinous canal which opens in an inaccessible position by a narrow orifice, and the production of a compound fracture is an essential part of the operation. Periostitis, necrosis, and caries.-Periostitis may be either acute or chronic. The acute cases vary in severity from a localised inflammation which leads to the formation of a subperiosteal abscess, and pos- sibly a limited necrosis, to a diffuse suppurative perios- titis of a large portion of the orbital wall, which runs on rapidly to necrosis, and may set up fatal mischief in the brain or its membranes. Acute localised periostitis commences with deep-seated pain in the orbit radiating along the branches of the first division of the fifth nerve. There may be marked general symptoms, as elevation of temperature and loss of appetite, and the eyelids be- come puffy and the conjunctiva injected, while within the orbit an acutely tender swelling can often be felt by pressing the finger against the orbital wall. The eyeball is fixed, and may be displaced by the swelling. If the pus be evacuated, the general and local symp- toms rapidly subside, unless, as frequently happens, the bone has become necrosed. Such localised periosteal abscesses are, however, by no means free from danger if they are situated on the roof of the orbit. Several instances of this kind have been recorded in which symptoms, looked upon at first as trivial, have suddenly been complicated by the onset of delirium, quickly succeeded by coma and death, and the post-mortem has revealed suppuration between the dura mater and the