114 



SURGERY. 



Entropion^ which is a permanent inversion of the eyelid, often 

 results from tarsal ophthalmia, and it can only be remedied by an 

 operation, such as dissecting off the edges of the eyelids with the 

 lashes and their bulbs ; or by removing a transverse fold of the skin 

 beyond the eyelid. 



Ectropion is an eversion of the eyelid, caused often by a thicken- 

 ing of the conjunctiva from long inflammation. This is to be cured 

 by bringing the conjunctiva to a healthy condition, by the applica- 

 tion of nitrate of silver or sulphate of copper. Should these remedies 

 fail, a portion of the conjunctiva is to be excised. 



Ptosis is a falling of the upper eyelid, from a palsy of the third 

 nerve. It is often connected with congestion of the head, and may 

 be a precursor of apoplexy, and should be treated by bleeding, 

 purgatives, mercury, and blisters. If persistent, it may be obviated 

 by removing a fold of the skin from the upper eyelid. 



DISEASES OF THE LACHRYMAL APPARATUS. 



Xerophthalmia is a- dryness of the eye, arising either from a 

 want of secretion of the conjunctiva, or, as some suppose, from a 

 deficiency of tears. It is to be remedied by frequently bathing the 

 eye with mucilage. 



Epiphora is a superabundance of tears, so that they run over the 

 cheeks : it should be distinguished from stillicidium lachrymarurn, 

 which is an overflow in consequence of an obstruction of the chan- 

 nels that convey them to the nose. It arises frequently from scro- 

 fulous inflammation ; or from the action of chemical or mechanical 

 agents, cold winds, acrid vapours, &c. The treatment will, of 

 course, vary with the cause. 



Obstruction of the lachrymal duct, is known by the overflow of the 

 tears, the dryness of the nostril, distension of the sac, and formation of 



a small tumour. It often leads 

 to inflammation and abscess. In 

 other instances it results in thicken- 

 ing of the tubes and duct, which 

 may be much benefited by the use 

 of probes. 



Fistula lachrymalis is an aper- 

 ture at the inner corner of the eye, 

 the result of a bursting of an abscess 

 caused by obstruction. The inflam- 

 mation of the sac is to be treated by 

 leeches and cold applications. If 

 suppuration cannot be obviated, the 

 tumour is to be opened as soon as 

 it has become soft and fluctuating. 

 The opening should be make paral- 

 lel to the margin of the orbit, and 

 below the tendon of the orbicularis. 



Fig. 45. 



