The question of excision of the eye in cases of injury / by R. Affleck Greeves.

  • Greeves, R. Affleck.
Date:
[1913]
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Licence: In copyright

Credit: The question of excision of the eye in cases of injury / by R. Affleck Greeves. 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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    the actual position of the wound. In two recent cases at Moorfields which developed sympathetic ophthalmitis the wound was strictly limited to the cornea, but in each case the iris was prolapsed and could not be freed. In a con- dition of this kind infection of the uveal tract can easily take place, and the delayed healing of the wound gives rise to a long period during which infection may occur; this may account for varying periods of onset. It is noteworthy that although many eyes with retained foreign bodies have been enucleated at Moorfields during the past fifteen years, not one showed the typical appear- ances of sympathetic inflammation, nor did any give rise to sympathetic inflammation in the other eye. Intervals of from a few days to forty years between the entry of the body and the enucleation of the eye are represented, as well as various kinds of foreign body; of these, pieces of iron and steel are the most numerous, and in the case with the longest interval the body was a piece of glass. It would seem that retained foreign bodies are not dangerous per se from a sympathetic point of view, apart from the nature of the wound caused by the body in entering the eye, or by operative measures undertaken for its removal. Leaving sympathetic ophthalmitis out of the question for the moment, the behaviour of an eye into which a foreign body has entered depends partly on whether the body is contaminated with organisms, and partly on the chemical nature of the body itself, as well as on the situa- tion in which it lies. If septic, a panophthalmitis may be set up, rendering early removal of the eye or its contents necessary, or if the organisms are not sufficiently virulent for this, a less severe inflammation may be caused, which may eventually quiet down. Again, if the body is soluble in the intraocular fluids, chemicallv irritating substances resulting from its solution may set up inflammation; iron and steel are less irritating in this way than copper or brass. Particles of metal may become encapsulated the eye quieting down, but siderosis bulbi takes place, and the sight of the eye is inevitably lost through degeneration first of the ganglion cells and nerve fibres, and eventually ot the whole retina. Degeneration of the retina occurs quite early, and detachment is common. Eyes with retained foreign bodies are often subiect to intermittent attacks of pain, so that the eye becomes a nuisance, and sympathetic irritation may be set up in the otlier eye, a condition which renders removal of the exciting eye necessary. So that although thev are probably not dangerous m the sense of causing sympathetic ophthal- mitis it not infrequently happens that it is advisable to rT™ Gye- Wlt-i retained fo™ign bodies for other reasons The lens is said to be more tolerant of foreign stn^L1 T f^' Jfrt8 °f the ^ i whiI° f^eign sub are ZZ tZ^f ?6 neigllbou*ood of the ciliary body trouble 7 ° glVe riSe t0 Persistent inflammatory has^aLTJ,!?11™11 th^.6lfs in which panophthalmitis nas taken place are not liable to give rise to sympathetic