The Head and Neck 53 



axis is deviated from the point of fixation. It is a very rare con- 

 dition but ha^ been seen by Hobday in which case it was congenital, 

 there being a convergent squint in both eyes. It may also result 

 from paralysis of the ocular muscles, their unequal contraction, or 

 from neoplasms of the orbit. 



Treatment. Under general anesthesia the abnormally con- 

 tracting or contracted muscle is divided in a manner similar to that 

 in enucleation with some slight modification of technic. The con- 

 junctiva at the canthus on the affected side only is incised, the 

 probe-pointed hook passed inward and under the muscle, and made 

 to raise the latter which is then severed. Subsequent treatment is 

 directed to maintaining the wound free of infection by antiseptic 

 irrigation. In Hobday's case the condition of one eye only was 

 improved by the operation. 



EXOPHTHAUVIIA. 



Reference has already been made to prominent bulging of the 

 eyes seen in Hydrophthalmia and Intraocular Hemorrhage. But 

 these must be differentiated from the protrusion of Exophthalmic 

 Goiter. 



Symptoms and Diagnosis. In the latter disease the protrusion 

 is so great that the eyelids cannot close, and the exposure to which 

 the eye is subject results in drying of the corneal epithelium 

 and ulceration. The accompanying and characteristic symptoms, 

 viz., enlargement of the thyroid and palpitation of the heart, 

 serve to distinguish it from other eye lesions. 



Treatment. This is described under The Thyroid Gland. 



NEOPLASMS. 



Growths of the eye are uncommon, but both innocent and ma- 

 lignant types have been observed. Of the former, Pinguecula is a 

 term applied to a small nodule which sometimes appears in the con- 

 junctiva, and Pterygium to a peculiar hypertrophy of conjunctival 

 connective tissue. Granuloma of the cornea sometimes results from 

 a wound of that membrane. Reference has already been made to 

 congenital sequestration dermoid. Sarcoma and Carcinoma repre- 

 sent the malignant types. 



Symptoms and Diagnosis. Pinguecula occurs near the margin 



