Diseases and refraction of the eye / by N. C. Macnamara and Gustavus Hartridge.

  • Macnamara, Nottidge Charles, 1832-1918.
Date:
1891
Catalogue details

Licence: Public Domain Mark

Credit: Diseases and refraction of the eye / by N. C. Macnamara and Gustavus Hartridge. Source: Wellcome Collection.

Provider: This material has been provided by University of Bristol Library. The original may be consulted at University of Bristol Library.

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    Eyelids and Lachetmal Apparatus.—The eyelids first call for notice; they may be inflamed or thickened, their movements may be defective, or their position faulty ; sometimes they are the seat of small cysts or tumours. The eyelashes may be stunted or displaced, when turned inwards they may rub against the conjunctiva arid cornea, and so set up irritation, in these cases the lashes are often small and white, and may easily escape detection. Foreign bodies, in the shape of dast, coal, chips of metal, seeds, wing cases of insects, or the insects themselves, fre- quently get between the lids and cause intense discomfort, especially when they become lodged under the upper one; usually the sudden onset of the symptoms leads one to suspect a foreign body; we first inspect the cornea, and then the lower conjunctival sac, by gently pulling down the lid, nothing being found, the upper lid must be inverted ; a steel probe, or some other instrument which will not easily bend, is laid against the skin of the lid along the upper border of the tarsal cartilage, or about half an inch from the free border of the lid; the surgeon with the other hand takes hold of some of the most prominent cilise, and after gently drawing the lid forward, turns it back over the probe ; or a simple method, but one requiring a little knack, is to use the thumb of the left hand on the upper lid as a fulcrum instead of the probe, taking hold of the eyelashes with the right, then a slight movement downwards is made with the left thumb, while at the same time the edge of the lid is everted over it. In cases where there is much photophobia, or the patient is nervous, a drop of a solution of cocaine will facilitate the proceeding; should inspection of the inner surface of the upper lid lead to the discovery of no foreign body, it might be lodged in the cul-de-sac of the retro-tarsal fold above the cartilage; this may be carefully sought for with a director ; many quite large objects have been missed from neglecting to examine this retro-tarsal fold. Supposing the conjunctiva to be congested and that no foreign body is present to account for it, we press our examination a stage further and endeavour to find out if the congestion is limited to this membrane or involves deeper structures; this can easily be decided by placing one linger against the lower lid and making gentle pressure with it near the edge of the cornea, then slide the lid quickly down so as to empty the conjunctival vessels, when the congestion is limited to the conjunctiva, the pres-