The Head and Neck 55 



the conjunctival sac being previously disinfected with any of the 

 antiseptic solutions indicated in Keratitis. The lids are widely 

 separated either with the finger and thumb or a stop-speculum, and 

 the needle inserted flatwise and manipulated so as to separate the 

 lips of the opening and allow the aqueous humor to escape. It 

 should be withdrawn cautiously to guard against prolapse of the 

 iris as may take place with a too sudden gush. 



ENUCLEATION OF THE EYEBALL. 



For this operation certain instruments are indispensable to its 

 proper performance, to wit: a stop-speculum, fixation forceps, a 

 probe-pointed hook, and a pair of scissors curved on the flat. The 

 stop-speculum is first introduced to hold the lids apart. Next, the 

 cornea being seized with fixation-forceps (the latter being employed 

 to steady the ball), the conjunctiva and adjacent fascia are divided 

 in a circle close to the margin of the cornea by snipping at them with 

 scissors. The hook is then passed successively under the tendon 

 of each ocular muscle and made to raise the latter prominently to 

 view, when they are divided close to their ocular attachment. To 

 sever the only remaining attachment, viz., the optic nerve, the blades 

 of the scissors are passed between the divided conjunctiva and the 

 eyeball until the optic nerve is reached, when they are expanded 

 and made to cut the nerve squarely off. The hemorrhage is insignfi- 

 cant and can be controlled by pressure or packing. No after-treat- 

 ment is necessary, nor should any kind of bandage be applied. An 

 artificial eye may be worn, selected to match the sound one, and 

 it should first be introduced about a week or ten days after the 

 operation, but only worn "for a few hours at a time at the outset. 



DISCISSION OF THE LENS. 



For this operation only two instruments are essential, viz., 

 discission needle and fixation forceps. In bilateral cataracts only 

 one eye should be operated upon at a time. The pupil being previously 

 dilated with atropine, the conjunctiva is grasped with the forceps to 

 steady the globe, and the needle is passed through the cornea at a 

 point in its lower and outer quadrant corresponding to the margin 

 of the dilated pupil. It is then directed upward to the upper margin 

 of the pupil, made to enter the capsule and drawn boldly through 

 the latter. A second crucial incision is made in like manner and 



