« AnteriorContinua »
relief was obtained by again evacuating the contents of the staphyloma.
It is very probable, that in this case all the violent symptoms were produced from an effusion of blood within the eyeball, in consequence of the injury.
$10. Of the Effects of evacuating the Aqueous Humour in Prolapsus of the Iris.
Even after the cornea has given way, and the aqueous humour has been evacuated, in severe cases of ophthalmia, the relief which that discharge produces does not remain permanent, for the portion of the iris which is prolapsed, so completely fills up the wound, that no more aqueous humour can escape, should its quantity become superabundant. Under such circumstances, an artificial discharge not only alleviates the inflammatory symptoms, but, if the protrusion of the iris has been recent, the depletion of the anterior chamber will permit the iris to fall back into its natural situation. In a case of this kind, where Mr. Ware performed the operation, immediately after the evacuation of the aqueous humour, the iris resumed its natural position. Should the iris still continue to be pressed forward, even after a puncture has been made on the cornea, recourse might then be advantageously had to the ingenious proposal of the late Mr. Gibson of Manchester. When the iris was prolapsed, either through a wound or ulcer of the cornea, Mr. G. found that the displacement arose from the portion of the aqueous humour lodged behind the iris, constantly pressing that membrane forwards at the point where there was least resistance. In such cases he made a puncture in the prolapsed portion of iris; and when the fluid collected behind it was discharged, it immediately regained its natural situation; unless in those cases, where, from the duration of the disease, the situation of the iris had become unalterable, from adhesions having formed between it and that portion of the cornea with which it was in contact.
§ 11. Of the Effects of evacuating the Aqueous Humour, in Injuries of the Eyeball.
Injuries of the eyeball are very often followed by severe and tedious attacks of inflammation, more particularly when from punctured wounds, and wounds penetrating into any of the cavities.
Besides a powerful antiphlogistic treatment, much benefit will often be derived by discharging the aqueous humour, especially in those cases where, along with pain and redness of the eye, there is a sense of fulness and dull pain about the brow, or some other part of the head;-symptoms of ophthalmia, which, it has already been remarked, the evacuation of the aqueous humour is particularly well calculated to remove. In all cases, too, where there is a tendency to the formation of matter after injuries of the eye, the discharge of the aque ous humour becomes a powerful auxiliary to the other means usually employed.
At the union of the cornea and sclerotica of the eye of a middle aged woman, towards the upper and nasal part, there was a prominent bluish-coloured tumour, covered with a network of red vessels, and the iris was drawn towards that part, so that the pupil was of an oblong form. There were a good number of red vessels over the sclerotic coat, and a dimness of the whole anterior chamber.
She complained of much pain in the eyeball, but particularly in the brow and temples. Her sight was impaired, and the pulse frequent and full. About eight days before, she had received a wound of the eye, either from the spur or beak of a cock. All the symptoms were alleviated by the discharge of the aqueous humour, particularly the pain in the head, which was instantly removed; and the redness of the conjunctiva was much diminished. A slight heaviness about the eyebrow re
mained for a day or two, but went off by the use of brisk purgatives.
CASE XI. While a strong healthy man was employed hammering melted iron, a piece of it fell into the eye, and was found lying between the eyeball and under eyelid. It occasioned most excruciating pain, and although it was removed in a few minutes, violent inflammation succeeded, and I saw him four days after the accident. The whole conjunctiva was then very much inflamed, and it was so much swelled, that the cornea appeared as if depressed. There was a white slough towards the inferior part of the sclerotic coat, and on the corresponding portion of the internal palpebral membrane; but the cornea was not injured, nor its transparency diminished. He complained of great pain in the ball of the eye, extending over the forehead, and through the whole side of the head. He could not raise the upper eyelid without the assistance of his finger. Light gave considerable uneasiness, and his vision was so much destroyed, that he could only distinguish between light and darkness.
Treatment. Under these circumstances I discharged the aqueous humour by making a small opening through the transparent cornea. The operation occasioned a smarting pain, which lasted a few seconds; when it went off, he said he could open the eyelid much easier; and was surprised to find that he could even distinguish the furniture of the room and books in a library. Slight scarifications were afterwards made on the under eyelid, which bled freely; and he was advised to foment the temples and adjacent parts; and as his pulse was frequent and full, he was bled at the arm, and ordered a brisk purge. During the remaining part of the day, the pain of the eyeball was much alleviated, and that of the head was completely removed, except that an uneasy sensation still remained in the brow. On the following day there was no vestige of the wound of the cornea; the pain and swelling of the conjunctiva were
nearly gone, but the redness continued. His vision was quite distinct, but the eye was irritable. In three days, by the application of an opiate, the inflammation was completely removed, his vision perfectly restored, and he returned home complaining merely of a little tenderness. Since which he has remained well.
A case of inflammation of the eye, occasioned by a burn exactly similar to the case just related, though the symptoms were not so severe, was completely relieved by the evacuation of the aqueous humour, which suddenly mitigated the pain, and removed all the inflammatory symptoms.
12. Of the Changes produced in Opacities of the Cornea from the Discharge of the Aqueous Humour.
It has already been observed that a diminution might take place in the transparency of the cornea, from an alteration in the quantity of the contents of the eyeball, and it has also been noticed, that in the dead eye the cornea assumes a milky colour when pressure is applied upon the eyeball, or when the veins are injected with clear water.
That some opacities of the cornea are produced from an increase in the quantity of the contents of the eyeball, and not from the deposition of an albuminous fluid in the texture of the cornea, as takes place in common speck, seems to be proved from the immediate effects which have resulted, in some in. stances, from the discharge of the aqueous humour. In these cases the opacity of the cornea seemed entirely to arise from over-distension; for the instant the aqueous humour was discharged, the cornea regained its natural transparency, as imitated in the experiments on the dead eye. In other cases it was evident, that the opacity of the cornea depended on two distinct causes; the one, as in the former cases, arising from overdistension, whilst the other proceeded from that change in the structure of the cornea which produces common speck. Cases of the first class are distinguished by a cloudines or
turbid state of the whole anterior chamber; whereas in common speck the obscurity is more defined, being limited to a certain portion of the cornea.
These two different kinds of opacity were strikingly illustrated, in some instances, where both took place in one eye at the same time, there being a general dimness throughout the whole anterior chamber, besides some defined spots in particular parts of the cornea. In these cases, the instant the aque ous humour was discharged, all the general obscurity disap peared, and nothing remained but the more opake spots, which became more distinctly circumscribed.
From what has been already said, little difficulty will arise in selecting those cases of opacity of the cornea, which the evacuation of the aqueous humour is calculated to remedy. From the cases, the particulars of which are detailed, the beneficial effects of the operation are sufficiently obvious, and would lead us to expect very important results from future experience.
In a girl, twelve years of age, the whole of the white of the right eyeball had become of a bright red colour, from a number of blood-vessels, whose trunks could all be separately distinguished running in straight lines towards the cornea, and some of their small branches passed over its edge, and were distributed into its substance. There was a circularshaped speck, of a considerable size, near the centre of the cornea; and throughout the rest of the cornea, particularly around the speck, there was a good deal of muddiness. The upper eyelid was slightly swelled, with some varicose veins on its external surface; whilst the vessels of the internal membrane were increased in number and in size. She had a good deal of pain in the eyeball, but it was particularly severe in the side of the head and temple above the affected eye. Though the vision was destroyed, yet she complained when the eye