A practical treatise on the diseases of the eye / by William Mackenzie ; to which is prefixed an anatomical introduction explanatory of a horizontal section of the human eyeball by Thomas Wharton Jones.

Date:: 1840

Credit: A practical treatise on the diseases of the eye / by William Mackenzie ; to which is prefixed an anatomical introduction explanatory of a horizontal section of the human eyeball by Thomas Wharton Jones. Source: Wellcome Collection.

Provider: This material has been provided by the Royal College of Physicians of Edinburgh. The original may be consulted at the Royal College of Physicians of Edinburgh.

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$is transverse, we may content ourselves with including only the in- teguments in the suture; but in perpendicular wounds, the needle ought to pass through the whole thickness of the divided lid. After the stitches arc inserted, and the slips of plaister ap])lidd, the eyelids are to be closed, and covered with a pledget spread with simple cerate. A folded piece of linen is to be laid over the sound eye, and a roller, going round the head, is to press gently upon both eyes, so as at once to keep the dressings in their place, and to restrain the lids from moving. Generally, by the second or third day, union is effected, so that the threads may be cut out; after w'hich, the slips of plaister are to be replaced, as well as the com- presses and roller. A perpendicular wound of the upper eyelid, passing through its whole thickness, so as to divide it into two flaps, somewhat like the two portions of a hare-lip, has received the name of colohoma. If neglected, the edges of such a wound are apt to cicatrize separately. A similar deformity sometimes occurs congenitally.® An operation, analogous to that for the cure of hare-lip, is to be had recourse to under such circumstances. The edges of the colohoma are to be pared, and then accurately brought into contact, and kept so by one or two stitches and slips of court plaister, till reunion is completed. It occasionally happens, that through a w'ound of either eyelid, the eyeball is also injured. This does not alter the mode of pro- ceeding with regard to the lid. So instantaneous is the instinctive shutting of the eye, when approached by any foreign body, the eye- ball rolling upwards and the lid at the same moment descending, that the wound of the lid and that of the ball wdll probably corre- spond, when the eye is closed, so that we must be on our guard, lest symblepharon should take place under such circumstances. Mr Lawrence mentions a case, in which a horizontal wound of the upper lid having been neglected, a sort of button-hole was formed from, the edges not having been kept in apposition ; what was worse, accretion of the conjunctival surface of the palpebra to the globe had taken place, and the lid hung so much over the globe as to render the eye almost useless.^ On the 1st May 1836, I saw a boy at the Glasgow Eye Infirmary, who had been wounded in the ujiper eyelid, six weeks before, with a sharp piece of stone- ware. The lid could not be raised from the eyeball, so as to bring the cornea into view\ There was evidently symblepharon, and probably the eyeball had been penetrated at the time of the wound, as well as the eyelid. Lacerated wounds of the eyebrow and eyelids do not so readily admit of union as incised w’ounds. The swelling, inflammation, and suppuration, which are apt to ensue, often prevent immediate union. Allowed to lieal without particular care, the contraction during the ])rogress of cicatrization, is apt to produce ectropium, against which we ought to guard by treating lacerated wounds of these parts almost exactly as we would do incised w'ounds. Having carefully cleaned them, and removed any foreign substances which may have$