08 The Philippine Journal of Science 1920 
Another very important phase of the question which the phy- 
sician must decide, and which requires the exercise of careful 
judgment, is whether or not he shall advise removal of the 
eye, knowing as we do what a great sacrifice such a step would 
mean to a patient. There are cases where the patient can 
recognize objects quite well and with only slight pain in the 
affected eye; but, with the affection extending to the ciliary 
region, and with great danger of sympathetic ophthalmia, in 
such instances would the patient submit to removal of his eye 
as advised by his physician? 
When we are therapeutically powerless, we resort to surgical 
means and advise operation. Saemisch incision, corneal para- 
centesis, enucleation, and evisceration are the main operative 
measures generally followed. 
Evisceration and enucleation have been performed with about 
the same frequency in our cases. In our practice, we have pre- 
ferred to perform enucleation in the less-infected cases, and 
evisceration in the most septic. In our experience, the time 
of postoperative treatment in enucleation was considerably less 
than in evisceration, the former taking an average duration of 
from one to two weeks to make a good recovery, while the latter 
required about three to six weeks. 
As to the proper time when enucleation should be performed 
in cases of panophthalmitis, it is interesting to note the expe- 
rience of Professor Hook, (3) of Zurich, who reports 118 enuclea- 
tions for panophthalmitis of different origins and in various 
stages, without registering a single case which showed an 
unfavorable course. (2) 
There is very little danger of intracranial extension of the 
infection, and no complicating cases of meningitis, even in the 
severest types of panophthalmitis in which enucleation was per- 
formed, have been reported. (3) 
Both enucleation and evisceration have their individual ad- 
vantages and disadvantages, their advocates and foes ; and, 
while enucleation is performed more frequently than any other 
method of operation, yet the wisest surgeon is he who would 
utilize the operation best adapted under existing circumstances 
to his cases. 
Many surgeons feel that evisceration is probably safer than 
enucleation in panophthalmitis. There was one instance re- 
ported by De Schweinitz of an interesting case of panophthal- 
mitis, which, after a careful evisceration, developed severe pain 
in the operated eye, that became so unbearable as to require enu- 
