j20 DISIiASES or Till-: EYE 



{X) TIr- |)aii(.'nt miisi have ^^n>d perception of liglil ; that is to say, 



he must appreciate the covering of the eye. 

 (4) His peripheral vision should be good. 



The jxjsition of- a lighted candle when placed in varying 

 |)ositions in a darU r(M)m should be appreciated by the patient 

 when looking straight forward. 

 H.Nlraciion can be carried out with or without iridectomy as 

 follows : — 



(i) The Corneal Section. 



Cocaine with a few drops of adrenalin are necessary, rarely 

 general ana'Sthesia. Tlu' patient looks downwards, fixation 

 forceps are applied, the (Iraefe knife enters the cornea, with 

 the cutting edge upwards, a knife's breadth above the hori- 

 zontal meridian, and the corneal flap completed. The knife 

 must not be twisted, the aqueous humour must not escape, 

 and the iris must not be cut. 



(2) The Iridectomy. 



The conjunctival ilap is turned forwards on to the cornea, 

 curved iris forceps are inserted and grasp the upper margin 

 of the pujDil, which is gently drawn out and a small portion 

 removed with scissors. 



(3) Opening of the Capsule. 



The cystotome is inlrtxiuced flatwise into the anterior chamber, 

 its point turned towards the capsule, which is gently cut. 

 The incision may be T-shaped, A-shaped, or +-shaped. 



(4) Delivery of the Cataract. 



Gentle pressure is exercised upon the lower part of the cornea 

 towards the centre of the globe w ith the back of the spoon ; 

 the section opens and the lens presents. 



(5) The ]]'ound Toilet. 



Stroke the cornea upwards to remove any cortical remnants and 

 blood-clots. The edges of the section must be clear. 



The lids must not touch the wound. The coloboma is flattened 

 out with a spatula; adjust the flap, insert a drop of atropine 

 and close the lids. 



(6) The Dressings, ^'c. 



Cover with gauze, both eyes, and add cotton wool soaked in 

 antiseptic and fix with a binocular bandage. 



The patient must remain upon his back, quiet, anodynes are 

 best given, straining is to be avoided, the wound examined 

 and atropine instilled daily, the iris excised if prolapsed; 

 liberate the unoperated eye on the fifth day when the patient 

 may sit uj). In two weeks smoked glasses are worn. 



