188 



POPULAR SCIENCE NEWS. 



[Deckmber, 1889. 



[Original in The Popular Science News.] 



INJURIES TO THE EYE FROM LIME AND 



CHEMICALS. 



Not long since, the writer, in a single week, met 

 with (in a New York dispensary) three difterent 

 cases of injuries to the eye caused by lime, wliile 

 numerous other cases of the same nature have been 

 under his observation and treatment. In very many 

 of these cases the tendency to recovery was greatly 

 impeded by the amount of time that elapsed before 

 the patients were placed under proper treatment, 

 while in not a few instances the existing conditions 

 were greatly aggravated by improper treatment, — 

 administered by druggists and other laymen, — and 

 it is with a desire to dispense a better knowledge of 

 how such cases should be treated until the services 

 of a surgeon — or, better, of an ophthalmologist — 

 can be obtained, that this article has been written. 

 Nevertheless, the cases herein cited shall be followed 

 carefully through the entire course of treatment, 

 feeling that they will prove of some value to others 

 more interested in the methods of treatment than 

 the general reader. 



Burns of the eye from lime, fresh mortar, acids, 

 hot fluids, etc., are not rare accidents, and are 

 generally of serious importance, causing severe 

 inflammation, excoriation, and sloughing of both 

 conjunctiva and cornea, while in healing they are 

 quite sure to occasion cicatricial adhesions and con- 

 tractions. Not infrequently the proper substance 

 of the cornea is aflTected so violently as to cause 

 complete opacity, with total loss of vision in the 

 eye aft'ected. (Case No. II.) The desirability of 

 immediate treatment in such cases is at once 

 apparent, and, in fact, it is sometimes this alone 

 which can preserve the sight, while, in all cases, the 

 sooner proper treatment can be obtained, the less 

 serious will be the symptoms, the more speedy the 

 recovery, and the more complete the cure. Thus it 

 seems obvious that the ultimate effects arising from 

 the intrusion of these substances into the eye, 

 depend on the degree of causticity, the quantity, 

 and the length of time that they are allowed to 

 remain in contact with the conjunctiva. Common 

 mortar falling into the eye, if quickly removed, 

 often acts only as a severe stimulant, causing 

 increased redness, swelling, pain, and lachrymation, 

 followed by a conjunctival catarrh. But, even when 

 speedily removed, grave conditions sometimes re- 

 sult, as in a case herein noted. (Case No. III.) 

 Qiiick-lime and slacked-lime, thrown into the eyes, 

 act as powerful caustics, and are apt to produce — 

 especially if not speedily removed — total loss of 

 vision through complete opacity of the cornea, or 

 even suppuration or thickening and protrusion of 

 this part. Hot and caustic fluids — such as boiling 

 water, molten metal, nitric, sulphuric, and other 

 strong acids — act rapidly upon the eye, and occasion 

 inflammation of a highly dangerous character. The 

 diabolical and effective work of the " vitriol thrower ' 

 is familiar to all, and especially so to those of us 

 who are called upon to attend their unfortunate 

 victims. 



The treatment of the conditions which have been 

 thus briefly enumerated will now fitly engage us. 

 Whenever lime — whether it be mixed with sand to 

 form mortar, or combined with certain chemicals in 

 a mixture known as •' white-wash," or in any state 

 whatsoever — be found in the eye, it should be 

 instantly reinoved. The removal of all particles 

 not firmly adherent should be accomplished by 

 means of a small pledget of absorbent cotton, satu- 

 rated with olive oil. If the cotton cannot be readily 

 obtained, a piece of linen or fine muslin may be 

 substituted. The surgeon will wind the cotton on 

 the end of a probe, but if rounded into a thin, flexi- 

 ble wad, it will p- >bRbly be more beneficial in the 



hands of the unskilled, and quite as efiicacious. 

 The eye is to be opened, the lids everted one after 

 the other, so that their inner surfaces may be care- 

 fully examined, and all foreign substances — except 

 those which are firmly adherent — are to be removed 

 from the conjunctiva by the gentle use of the oiled 

 cotton. The lower lid is easily everted by making 

 traction downward upon the skin of the lid with the 

 tip of one of the fingers of the left hand, while the 

 patient rolls his eye well upward. In this manner 

 the conjunctival surface will be exposed, and any 

 substances collected there may be readily removed. 

 The eversion of the upper lid requires more manipu- 

 lation, but is scarcely more difficult of accomplish- 

 ment. Have the patient direct his eyes — not his 

 head — downward; grasp the central eye-lashes 

 between the thumb and first finger of the left hand, 

 and pull the lid a little downward and away from 

 the eye-ball ; then place a small pencil, or probe, or 

 the edge of a stiff card, held in the right hand, 

 against the outer surface of the lid, well back from 

 its edge — beyond the upper limit of the tarsal carti- 

 lage ; then press gently downward upon the surface 

 of the lid with the instrument held in the right 

 hand, and, at the same time, turn the edge of the lid 

 upward by means of the lashes held in the left hand. 

 The instrument is now removed from behind the 

 lid, which is now held in its everted position by the 

 thumb of the left hand, while exatnined and cleaned. 

 Upon releasing the lid, direct the patient to look 

 upward, when it will resume its natural position. 

 The examination of a child's eye is often very diffi- 

 cult, and the surgeon usually finds it necessary to 

 hold the child's head firmly between his knees, 

 while the body is supported in the lap of an attend- 

 ant. The necessity of thoroughly cleansing the eye 

 can scarcely be overestimated. The writer has 

 seen a severe conjunctivitis, attended with swelling, 

 catarrh, and pain, caused by the presence of a small 

 hair in the eye,- — the conditions improving at once 

 upon the removal of the little offender and the 

 employment of a mild astringent wash, — and if so 

 small a body can provoke so great an irritation, how 

 much more damage can be effected by the presence 

 in the eye of such significant substances as we are 

 now considering! Very ofien, patches and particles 

 remain too firmly adherent to be removed with cot- 

 ton or rag, but these must also be removed, as they 

 will eat their way into the tissue and become incor- 

 porated with it. To this end, olive oil should be 

 dropped into the eye, to loosen, as much as possible, 

 the imbedded particles and allay irritation, and the 

 forceps, the spud, or the curette should be em- 

 ployed. In the inner canthus and the cul-de-sac, 

 substances will be found which must be dug out 

 carefully and thoroughly. When all visible particles 

 of the lime have been removed, — and not until then, 

 — the eye should be copiously washed with water, 

 which will wash away any remaining particles and 

 relieve congestion. If the burn is of any consider- 

 able extent, there is quite sure to be adhesion of the 

 lid to the globe (called symblepharon) as the 

 process of repair goes on. The difficulties of these 

 adhesions, and the necessity for surgical interference, 

 are always in proportion to their extent. In some 

 cases, the tendency to symblepharon can be lessened 

 by making occasional traction upon the lids, and 

 thus breaking up the incipient adhesions, but these 

 .idhesions and contractions are quite sure to form, 

 regardless of the many methods suggested for their 

 prevention, and they can be dealt with at a future 

 time. The prognosis is often very favorable, and 

 the operations of Teale and Arlt are performed 

 with good results, though their consideration can- 

 not now detain us. 



The therapeutical treatment of these cases is 

 scarcely of less importance than the surgical. The 



inner surface of the lids should be kept well smeared 

 with boric acid ointment (boric acid 31- to vaseline 

 § i.), and if the pain is intense, it should be relieved 

 by the occasional use of a few drops of a 4 per cent, 

 solution of hydrochlorate of cocaine. The use of 

 atropine to dilate the pupil is always proper, and 

 especially so when the cornea is involved. Ice-cold 

 cloths are to be applied over the eye, to control the 

 conjunctivitis and allay pain, and, after the active 

 symptoms have subsided, the subsequent catarrh 

 and weakness can be benefitted by the use of mild 

 astringent lotions, such as a saturated (4 per cent.) 

 solution of boric acid. The eye should not be band- 

 aged, as such a procedure increases the irritation 

 by retaining the irritating muco-purulent discharge 

 from the conjunctiva: on the contrary, the eye 

 should be carefully cleansed, by means of a pledget 

 of absorbent cotton and the free use of water or 

 boric acid solution, as often as the occasion may 

 require. Particles of potash (common caustic) and 

 nitrate of silver (lunar caustic), and other like sub- 

 stances which exert a corroding and disintegrating 

 action upon the tissues, must be immediately ex- 

 tracted from the eye, with the forceps, or anv other 

 instrument which is at hand. Water must not be 

 employed until all has been removed, as even the 

 mixture of the tears with such substances increases 

 their destructive effects. Burns of the eye caused by 

 melted metal are usually less severe than those 

 occasioned by caustics, since the metal readily 

 solidifies, and afterwards possesses no continuously 

 destructive chemical action. Nitric, sulphuric, 

 acetic, and other acids can do great mischief, the 

 ulcers caused by these and all like substances being 

 damaging to sight in the ratio in which the cornea 

 is involved. If the acid has just entered the eye, it 

 should be at once neutralized by the use of a solu- 

 tion of soda (3i. to §iv.), or a mixture consisting 

 of one part of lime-water to three of water. The 

 eye should then be bathed freely for considerable 

 periods of time with cold water, and the pain, con- 

 junctivitis, and keratitis which occur should be 

 treated by means of cold applications, astringent 

 lotions, etc., as already explained. Very trouble- 

 some symblepharon may result. Vinegar, spirituous 

 liquors, and other stimulating fluids not infrequently 

 occasion severe inflammations. Ammonia in the 

 eye usually causes much pain, but seldom produces 

 more than a superficial ulcer. Red pepper produces 

 intense burning, but does not cauterize. In these 

 cases, the prompt and free use of cold water is the 

 proper treatment. The following cases, chosen 

 from a large number, cannot fail to interest. 



Case No. I. — Early in the morning of August 

 20th, L. B., aged 64, a painter by trade, got some 

 builder's lime into his left eye. He at once called 

 at a drug store, where the eye was bathed with cold 

 water, which proved to be one of the worst things 

 that could have been done under the circumstances. 

 When I saw him, at about 2.30 P. M. the same day, 

 the conditions presented were as follows : There 

 was oedema of both lids and extensive conjunctivitis, 

 with combustion of the lower lid. A large adherent 

 patch of lime was found in the cul-de-sac, where it 

 had probably settled upon being received into the 

 eye, and had been slacked and made adherent by 

 the tears and the injudicious application of water. 

 The treatment consisted in softening the lime as 

 much as possible with olive oil, and scraping it 

 away with a curette. Boric acid ointment was 

 prescribed, to be applied every half hour. Atropine 

 was employed, and cold applications were made to 

 control the conjunctivitis. The possibilities of 

 symblepharon were great. The treatment was con- 

 tinued about two weeks, when the cure was quite 

 complete. The patient has a small symblepharon 



