Enucleation of the eye-ball. The eye-lids are fixed asunder, and 

 the conjunctiva is opened near the cornea, and it, together with the 

 capsule of Tenon, is snipped with the scissors close to the cornea. 

 The straight muscles are then caught up by the strabismus hook and 

 severed, and the globe is pulled forwards. The scissors are then 

 passed along the outer, the oblique, wall of the orbit, and the optic 

 nerve is divided. Lastly, the attachments of the oblique muscles 

 and the ciliary vessels and nerves, and some loose connective tissue, 

 are divided. 



Bleeding is checked by firmly bandaging into and over the orbit 

 a wrung-out sponge. The hard walls of the orbit usually render the 

 treatment of haemorrhage by plugging efficient. But, if the disease for 

 which the operation was performed were a tumour of extreme vascu- 

 larity, pressure may absolutely fail to arrest the bleeding. In a case 

 of this sort, in which I saw Mr. Richardson Cross, of Bristol, operate, 

 he had no alternative but to tie the common carotid, and with an 

 excellent result. 



The ophthalmic vein begins in tributaries corresponding to the 

 branches of the ophthalmic artery, and slowly pours its contents 

 through the sphenoidal fissure into the cavernous sinus (p. 40). 

 Pressure upon the vein or upon the cavernous sinus by an inflamma- 

 tory deposit or a growth near the apex of the orbit delays the venous 

 return and causes distension of the tributaries of the vessel, intra- 

 ocular-injection, and a ' choking ' of the optic disc. Thus the condition 

 of the disc in the case of a supposed tumour of the base of the brain may 

 afford valuable information. But, though the pressure upon the vein 

 may be extreme, there may be no excessive injection if the condition 

 have come on slowly, as the facial vein communicates very freely with 

 the ophthalmic and relieves the intra-ocular pressure. 



The nerves of the orbit are the optic ; third ; fourth ; ophthalmic 

 division of fifth ; sixth ; the temporo-malar branch of the second divi- 

 sion of the fifth, and the sympathetic. 



THE EYE-BALL. 



Five-sixths of the vascular and nervous layers of the eye-ball are 

 enclosed within a tough and opaque fibrous capsule, the sclerotic 

 (o-K\r)pos, hard, tough), which is directly continuous in front with the 

 cornea. It is strongest posteriorly, and it is strong again in front after 

 receiving the insertion of the straight muscles ; the intermediate part 

 is that which is most likely to yield to injury. It is covered in front 

 by the conjunctiva, and in the rest of its extent by the flattened epi- 

 thelium which lines the lymph-space in front of the capsule of Tenon. 

 Its inner surface is stained by the lamina fusca (fuscus, swarthy), the 

 delicate tissue which connects it with the choroid, across an inter- 

 mediate lymph -space. 



