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
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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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    particles of dust, etc.) soon produces conjunctivitis and superficial keratitis, ending, perhaps, in pannus and xerophthalmia. The affection of the orbicularis is due to paralysis of the facial nerve. The orbicularis may be alone affected, or the paralysis may extend to several, or all the branches of the facial nerve. It is only very rarely met together with hemiplegia. The causes of the disease may be peripheral or central. Amongst the former, exposure to cold air, damp, etc., is the most frequent. It may also be caused by direct pressure (as from a tumor) upon any part of the nerve, or by injuries which implicate the latter. Amongst the cere- bral causes need only be mentioned the presence of tumors, syphilitic exuda- tions, hemorrhagic or purulent effusions, etc., and different lesions situated at the base of the brain. [Diseases of the ear, the lymphatic glands and parotid gland, may all produce lesions of the facial nerve. According to Eulenburg, facial paralysis originating from lesion of the pons involves the orbicularis; while if it proceed from the cerebral peduncles, or from the central ganglia, or from progressive paralysis of cranial nerves, or from affections of the spinal cord, the orbicularis is likely to escape. (See A Treatise on Diseases of the Eye, by Henry D. Noyes, 1881.)—B.] If the disease is due to paralysis, the treatment laid down in the article upon The Paralytic Affections of the Muscles of the Eye should be pursued. In order to guard the eyeball against the effect of external irritants, we may pare to a slight extent two corresponding points of the tarsal margins of the upper and lower lid, and then unite them by two or three stitches; the eye- ball being thus protected until the orbicularis has regained its power. 11.—BLEPHAROSPASM. This affection varies much in intensity. In the slighter forms, there may only exist a moderate degree of temporary twitching and contraction of the lids, which soon passes off again. If the affection is more severe, the spasm of the orbicularis may be so great, that the eyelids are firmly pressed to- gether, and that it is quite in)possible for the patient or the surgeon to open them even to a slight degree. The endeavor forcibly to open the eye is in- tensely painful, and may even almost throw the patient into epileptiform convulsions. At the outset, the disease is generally but moderate, but if the cause persists, or efficient treatment is not adopted, it gradually increases In severity, and the spasm, which was before perhaps only periodical, becomes permanent, so that the patient cannot open his eye at all. Then the other eye may become affected in a similar manner, and the muscles of the face, neck, and even of the extremities, may undergo spasmodic contractions.^ Blepharospasm is often met with in the course of inflammatory affections of the cornea and conjunctiva, or if a foreign body has become lodged within the folds of the latter. In such cases, it is evidently due to a reflex neurosis dependent upon irritation of some of the branches of the fifth nerve. This disease likewise occurs in severe cases of hypenesthesia of the retina. It is also observed in connection with neuralgia of the supra-orbital nerve, or of other branches of the fifth ; the exact seat of these afi'ections being perhaps unsuspected until a certain spot is found where firm pressure will at once arrest the spasm. It must be mentioned, however, that in some instances even direct pressure upon the facial nerve at its exit through the stylo-mas- toid foramen will stop the blepharospasm (Romberg).
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