A treatise on the diseases of the eye / By J. Soelberg Wells... Together with selections from the test-types of Prof. E. Jaeger and Prof. H. Snellen.

  • Wells, J. Soelberg (John Soelberg), -1879
Date:
1883
Catalogue details

Licence: Public Domain Mark

Credit: A treatise on the diseases of the eye / By J. Soelberg Wells... Together with selections from the test-types of Prof. E. Jaeger and Prof. H. Snellen. 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.

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    curing an obstinate and long-established external fistula of the lachrymal gland, by establishing an artificial opening on the conjunctival surface by a small seton, and then closing the external aperture. [Hulke's method also seems to give good results. The two ends of a silk ligature, each armed with a needle, are passed through the external fistulous opening in such a manner that one needle penetrates the conjunctiva of the upper lid above the other. Both ends of the ligature are thus brought out in the conjunctival cul-de-sac, and, being drawn tight, inclose a triangular piece of the upper lid in their grasp, the apex of which is at the fistula, and the base in the conjunctiva. The ends are then cut off, and the fistula soon heals.—B.] Various kinds of tumor are met with in the lachrymal gland, but by far the most frequent are those of a sarcomatous natui'e. Cancer is of very rare occurrence, and is probably always secondary, extending from the neighbor- ing tissues to the gland. Knapp,^ however, reports a case of hypertrophy of the lachrymal gland with carcinoma. [IS^ew growths in the lachrymal gland are rare occurrences. Many different kinds of neoplasms have been described by various authors as met with here, such as simple hypertrophy, adenoma, adenoid, colloid, sarcoma, myxoma, fungus medullaris, encephaloid cancer, scirrhus, etc. Becker's investigations have, however, rendered it probable that these all probably represent different stages of development of the same growth. (See Bericht ueber die Augen- klinik der Wiener Universitat, 1863-65.) A case of mixed enchondroma and hypertropy of the lachrymal gland has been reported by Busch. Schirmer is inclined, with Becker, to classify all the various growths under the common name of adenoid. Chloroma has been described as a greenish, homogeneous, hard mass, always malignant, and causing death by attacking the dura mater. Isolated cases have also been reported of angioma, hydatid cysts, and dermoid growths. (See Graefe und Saemisch's Handb., vii. p. 10.) The symptoms are the same for all these growths, one of the first being ex- ophthalmus, with more or less pain in the orbit and upper lid. A careful examination will always lead to a recognition of the trouble, and the opera- tive removal of the tumor and glands should be done as early as possible, in order, if possible, to prevent permanent damage to the eye and optic nerve. Molliere and Chandelux report a case of intra-acinous colloid epithelioma(?) in a boy, set. 15. Its growth was of unknown duration, and had been ac- companied by orbital pains. There was moderate exophthalraus; the tumor w-as ovoid, its long diameter being transverse, and was not adherent to the skin of the upper lid. It was hard, somewhat painful, lobulated, and ad- herent to the upper and outer wall of the orbit. It was enucleated with facility. It proved to be an epithelioma, developed within the acini of the gland, and had undergone colloid degeneration. Five months after the operation the tumor reappeared, and a second operation was done nine months after the first. This time, the growth had involved more of the orbital tissue. It again recurred, and ten months later had filled the entire orbit, and there were nodules beneath the skin all around the orbital region, and the bones of the face were deeply involved. ( Lyon Med., November 7, 1880.)—B.] Sometimes the secretions of the gland may undergo chalky degeneration and d;icryoliths be formed. [This tendency to concretion is known as lithi- asis, and is exceedingly rare. The concretions should be removed from the conjunctival surface, as they occasion conjunctivitis, episcleritis, and pannus. (See Centralblatt fiir prakt. Augenheilk., December, 1880.)—B.] 1 Kl. Monatsbl., 1865, 378.
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