256 DISEASES OF THE HOBSB. 



The first is to be remedied by paring the edges of the division and 

 then bringing them together, as in torn lids. The last two, if reme- 

 diable at all, require separation by the knife, and subsequent treat- 

 ment with a cooling astringent eyewash. 



Nervous disorders. — Spasm of eyelids may be owing to consti- 

 tutional 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 solution of cocaine into the eye, when the true 

 cause may be ascertained and removed. The nervous or constitu- 

 tional 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 food is taken in by the teeth, as the lips are useless. In 

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

 cation. 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; second, when all in- 

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

 it daily with a mixture in equal proportions of olive oil and strong 

 aqua ammonia. Improvement is usually slow, and it may be months 

 before complete recovery ensues. 



In paralysis from blows above the eyes the same treatment may be 

 applied to that part. 



Thickening of the lid may be treated by painting with tincture of 

 iodine, and that failing, by cutting out an elliptical strip of the skin 

 from the middle of the upper lid and stitching the edges together. 



