754: OPERATIONS UPON THE EYE AND EAR. 



E. — Amputation or Extirpation of the Eye. 



This operation is only indicated in cases of degeneration of 

 the globe, and after special traumatic lesions of the organ. It is 

 comparatively a simjDle one, and not as dangerous nor as painful 

 as it is generally supposed to be. It can easily be performed 

 with a simple or a blunt bistoury. Hertwig recommends a sage- 

 knife, and we have often performed it with only a pair of curved 

 scissors. 



With the lids well separated, the eye, or what may remain of 

 it, is secured with a pointed tenaculum, or a pair of forceps, and 

 the conjunctiva divided in all its circumference with the knife. 

 Then passing the bistoury into the orbital cavity, close to its 

 walls, and cutting from the inside, and thence to the inferior part, 

 the entire mass is detached, with the exception only of being held 

 by the cord of the optic nerve. 



This last attachment is then severed with the scissors. The 

 hemorrhage which always accompanies the operation is readily 

 subdued by pressure. Simple cleanliness is all that is required in 

 the subsequent treatment. 



Doctor E. Eolland describes his modus operandi for the enu- 

 cleation of the eye as follows: The operation requires a specu- 

 lum oculi, a hook such as is used in the operation for strabismus, 

 curved blunt scissors, forcej)s to fix the eye, and a pair of scissors 

 curved on their flat for the section of the optic nerve. 



The lids being held apart with the speculum the operator 

 grasps a fold of the conjunctiva, on the outside of the eye, and 

 shts it near the border of the cornea. Then, with the scissors, 

 the conjunctiva is eutu'ely divided round its margin, near the 

 corneal border. The sub-con junctival cellular tissue being after- 

 ward divided with the scissors, the muscles are brought out with 

 the strabismus hook and divided, beginning with the external 

 rectus. The speculum is then removed, and by pressing firmly on 

 both Hds, the globe of the eye is pushed out of the orbital cavity. 

 The curved scissors are passed behind the globe, and the optic 

 nerve amputated at its i)oint of entrance into the globe. 



The operation ended, the orbital cavity is washed out with cold 

 sterilized water, and is then filled with pulverized and sifted bor- 

 acic acid. This dressing is removed daily for five or six days, and 

 the eye protected as in Fig. 549. 



