Text-book of ophthalmology / by Ernst Fuchs ; authorized translation from the eleventh revised and greatly enlarged German edition with numerous additions by Alexander Duane.

  • Ernst Fuchs
Date:
[1908]
Catalogue details

Licence: In copyright

Credit: Text-book of ophthalmology / by Ernst Fuchs ; authorized translation from the eleventh revised and greatly enlarged German edition with numerous additions by Alexander Duane. Source: Wellcome Collection.

Provider: This material has been provided by UCL Library Services. The original may be consulted at UCL (University College London)

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    a sudden perforation of the cornea, nay, even the extrusion of the lens from the eye. By dropping a solution of cocaine between the slightly parted lids we try to diminish their sensitiveness; and for separating the lids we can, with advantage, use Desmarre's elevator (see Fig. 1), with which we shall less readily inflict an injury than we should do if, by using the fingers, we exerted too great a pressure upon the eyeball. Finally, in many cases it is only by means of general narcosis that we can obtain a sufficiently satisfactory view of the eyes. In spite of all these difficulties we should not be deterred from insisting upon an exact examination of the eyes at the patient's first visit, in order to establish the diagnosis and prognosis and to determine the treatment. [The best way to examine a small child is to put it on its back in the lap of the mother or an assist- ant, who is seated opposite the examiner and who controls the child's arms, legs, and body. The examiner, who is also seated, secures the child's head by gripping it tightly between his knees. The child is thus rendered perfectly im- mobile, and the examiner has both hands free to evert the lids, concentrate light on the eye, make applications, or do anything else that is necessary.—D.] In regard to the eyeball itself, we must first satisfy our- selves whether its situation in the orbit, its position with respect to the other eye, its size, and its mobility are normal or not. The conjunctiva of the lids can be brought into view by everting the latter. With the lower lid, it is sufficient for this purpose simply to draw it down, while the patient is told at the same time to look up. [If in pulling the lid down we make slight pressure against it below with a some- what rolling movement, so as to revolve the lid forward, not only will the lid itself be everted, but the retro tarsal fold will spring up and come into view.—D.] With the upper lid, eversion requires a certain degree of skill, which must be obtained by practice. It is the more important to acquire this facility, since it is just the con- junctiva of the upper lid that generally affords the best evidence for the diagnosis of conjunctival diseases: the thickening of the conjunctiva, the uneven surface, the formation of cicatrices, which are characteristic of trachoma, are here most easily to be perceived. Further, the eversion of the upper lid is very frequently necessary for the removal of foreign bodies. [To evert the upper lid we direct the patient to look down, grasp the lashes between the thumb and finger, and draw the lid down and somewhat away from the eye- brow. When the lid is well on the stretch, we place a pencil or similar object lengthwise in the groove beneath the brow and just above the tarsus. With the fingers that grasp the lashes we turn the lid sharply
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