DISEASES OF THE EYE. 279 



DISEASES OF THE EYELIDS. 



CONGENITAL DISORDERS. 



Some faulty conditions of the eyelids are congenital, as division 

 of an eyelid in two, after the manner of harelip, abnormally small 

 opening between the lids, often connected with imperfect develop- 

 ment of the eye, and closure of the lids by adhesion. The first is 

 to be remedied by paring the edges of the division and then bring- 

 ing them together, as in torn lids. The last two, if remediable at all, 

 require separation by the Iniife, and subsequent treatment with a 

 cooling astringent eyewash. 



NERVOUS DISORDERS. 



Spasm or eteltos may be owing to constitutional susceptibility, or 

 to the presence of local irritants (insects, chemical irritants, sand, 

 etc.) in the eye, to wounds or inflammation of the mucous membrane, 

 or to disease of the brain. When due to local irritation it may be 

 temporarily overcome by instilling a few drops of a 4 per cent solu- 

 tion of cocaine into the eye, when the true cause may be ascertained 

 and removed. The nervous or constitutional disease must be treated 

 according to its nature. 



Drooping eyelids, or ptosis. — ^This is usually present in the upper 

 lid, or is at least little noticed in the lower. It is sometimes but a 

 symptom of paralysis of one-half of the face, in which case the ear, 

 lips, and nostrils on the same side will be found soft, drooping, and 

 inactive, and even the half of the tongue may partake of the palsy. 

 If the same condition exists on both sides, there is difficult, snuffling 

 breathing, from the air drawing in the flaps of the nostrils in inspira- 

 tion, and all feed is taken in by the teeth, as the lips are useless. In 

 both there is a free discharge of saliva from the mouth during mas- 

 tication. This paralysis is a frequent result of injury, by a poke, to 

 the seventh nerve, as it passes over the back of the lower jaw. In 

 some cases the paralysis is confined to the lid, the injury having been 

 sustained by the muscles which raise it, or by the supraorbital nerve, 

 which emerges from the bone just above the eye. Such injury to the 

 nerve may have resulted from fracture of the orbital process of the 

 frontal bone above the eyebalL 



The condition may, however, be due to spasm of the sphincter 

 muscle, which closes the lids, or to inflammation of the upper lid, 

 usually a result of blows on the orbit. In the latter case it may run 

 a slow course with chronic thickening of the lid. 



The paralysis due to the poke may be often remedied, first, by the 

 removal of any remaining inflammation by a wet sponge worn be- 

 neath the ear and kept in place by a bandage ; secondly, when all in- 

 flammation has passed, by a blister on the same region, or by rubbing 



