WOKM IN THE EYE. 347 



he sliould wait until he finds the worm in a convenient position 

 to make its exit; for, if it be hidden away behind the iris, 

 the operation most probably will be in vain. If the parasite 

 is not between the iris and cornea, he should wait until it comes 

 in sight before oommencing. He should then make the incision 

 by a strong, firm pressure. The direction of the puncture should 

 be more or less parallel to the iris, so as to avoid wounding that 

 structure; and close to where the cornea joins the white of the 

 eye, and on the outer or inner upper margin, as may be most 

 convenient. To facilitate the escape of the aqueous humour, the 

 knife should be allowed to remain in the eye, as long as the fluid 

 continues to flow, and very slight pressure may be made with 

 the finger on the cornea, if necessary. When the wound is 

 thus made obliquely to the surface of the cornea, its edge will 

 unite more readily than if the puncture was made at right angles 

 — to say nothing about the danger to the iris. Our object in 

 making the opening high up, is to have the subsequent scar 

 covered by the upper eyelid, so that it will be neither visible 

 under ordinary circumstances, nor liable to interfere with the 

 rays of light Avhich may enter the pupil. Besides, the higher it 

 is, the less will be the danger of too great an escape of fluid. 

 A " transfixion forceps," which has two fine points for insertion 

 into the surface of the eye, will be useful here for steadying the 

 eye, if cocaine is not used. If the iris is touched by the knife 

 in operating, it will bleed, and will probably fill the chamber with 

 blood; but this complication will pass off in a few days. In 

 the majority of cases, the worm seems anxious to quit the eye ; 

 for it will generally make its escape if the aperture is big enough, 

 even if it has not been drawn through by the first rush of fluid. 

 When the parasite remains in the eye after the operation, 

 the escape of the fluid will often cause its death. If the puncture 

 be unsuccessful, we may repeat it after a fortnight, by which 

 time the anterior chamber of the eye will again become filled 

 with fluid. 



If the iris has been wounded, and on that account protrudes 

 through the opening in the coTuea, we should, as advised by Mr. R. 

 Spooner Hart, wait a little time until the inflammation has sub- 

 sided, and then, while the eye is under the influence of cocaine, 

 snip off the protruding portion with a pair of curved scissors. 



The subsequent treatment of the wound made by the operation 

 consists in protecting it from injury and irritation, and furthering 

 its cure. With this object, w^e may, as recommended by Hart, put 

 the patient on the pillar reins for about a week, keep the eyelids 

 smeared with extract of belladonna (made up with a little glycerine, 

 for instance), and shade his eyes from light. If necessary, the eye 



