CORNEAL ULCERATION. 
55 
apply a ten per cent, solution of cocaine locally and wait until 
the patient is semi-stupid, then put on the table and secure. 
A 1/1,000 corrosive sublimate cotton compress should be put 
over the eye and immediate surrounding integument a few hours 
before operation. 
After thorough disinfection of the conjunctival sac and cau¬ 
terization of ulcer or ulcers, the conjunctiva just below and a 
little to the left of the lower margin of the cornea is grasped with 
the fixation forceps, to hold the eyeball in position; the paracen¬ 
tesis trocar is passed perpendicularly through the cornea near the 
limbus at the lower margin, unless the situation of the ulcer re¬ 
quires another site. As soon as its point reaches the anterior 
chamber the handle is depressed and the trocar or knife is pushed 
in horizontally, avoiding wounding the iris or lens, until the in¬ 
cision is fully 3 to 6 mm. long. The instrument should be with¬ 
drawn slowly and pressure should be applied upon cornea, so as 
to evacuate the contents of the aqueous chamber gradually. 
Frequently, when the infection seems very virulent, the cqr- 
neal incision will ha-ve to be opened daily until the ulcer heals. 
We have in a few cases irrigated the aqueous chamber with a 
normal saline solution and others with 1/5,000 corrosive subli¬ 
mate or germicidal disc solution. This isn’t necessary, only in 
the virulent cases. 
Iodoform can now be dusted in the eye and a protective dress¬ 
ing applied. Atropine, sometimes eserine, must be used as indi¬ 
cated by position of iris and location of ulcer. Atropine relieves 
the irritation. After the operation we usually instill a solution 
of atropine and apply a cotton compress soaked in a 1/1,000 cor¬ 
rosive sublimate solution. 
The subsequent treatment consists of the installation of anti¬ 
septic astringent lotion—atropine or eserine, as indicated—and 
a protective dressing or compress until the eye has completely 
healed. After the healing process is well established, ointment 
of the yellow oxide of mercury is used to hasten cicatrization 
and to clear up the cornea. 
Division or incision of the ulcer is obsolete. 
