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S U R G 
■ward, it is as well to be content with eradicating a few every 
day, lest the operation should create too much pain and in¬ 
flammation. The prevention of the hairs from growing 
again in the same position is frequently very difficult; ancl, 
except in young subjects, in whom a frequent repetition of 
this method of extracting the hairs sometimes leads to a 
radical cure, Beer states, that the practice is to be considered 
only as a means of palliation. 
After plucking out the hairs, the most successful plans are 
to smear the whole inner half of the margin of the eyelid, by 
means of a fine hair pencil, with the aq. ammon. pur.; or a 
solution of the argentum nitratum ; or else to remove a piece 
of the skin, containing the roots of the inverted cilia, as pro¬ 
posed by Mr. Saunders. 
The second kind of case, called entropium, is the most 
frequent. In the upper eyelid, the defect is often owing to 
a relaxed state of the levator muscle; and then it may some- 
times be cured by supporting the eyelid for a certain time, 
with the aid of sticking plaister; but if this plan fails, a 
cure may always be accomplished by cutting away, with 
the aid of a pair of forceps and scissars, a fold of the integu¬ 
ments near the edge of the tarsus. Care should be taken to 
do this just in the middle of the inverted part. The wound 
is then to be closed, as well as circumstances will allow, 
with sticking plaister, compresses, and a bandage. In pro¬ 
portion as the contraction of the cicatrix follows, the eyelid 
will be restored to its right position. 
Ptosis is a disease which consists in an inability of pro¬ 
perly raising the upper eyelid. Of this, three varieties 
are noticed: the first depends on a preternatural elonga¬ 
tion of the skin of the upper eye-lid; the second, on a 
weakness or total paralysis of the levator muscle; and the 
third, on a spasmodic contraction of the orbicularis palpe¬ 
brarum. 
“ The first example is the most frequent, and is cured by 
the removal of the redundant integuments of the eyelid. 
“ The second species is principally met with in old per¬ 
sons, in whom the cure is often impracticable. This sort of 
ptosis sometimes seems to be symptomatic of other affections, 
chlorosis, irritation in the stomach and bowels, worms, &c., 
while in other examples it is entirely a local defect. 
“ The chief means of cure are, the external use of the tinc¬ 
ture of cantharides and cold water; the shower bath; the in¬ 
ternal exhibition of bark; the use of camphorated liniments; 
electricity. This ptosis is frequently periodical. 
“ The third species of ptosis arises from a spasmodic affec¬ 
tion of the orbicularis muscle, and is the most uncommon. 
The affection is never continual, but makes its attacks at 
certain or uncertain periods, and its duration varies in dif¬ 
ferent cases. 
“ The spasmodic ptosis usually depends on some sympa¬ 
thetic irritation in the system. The removal of this particular 
irritation, whatever it may be; the internal exhibition of 
antispasmodics; applying a blister to the temple, and bath¬ 
ing the eye with warm milk containing saffron, or with a 
decoction of poppy-heads or cicuta; form the usual method 
of the treatment.” 
Lagophthalmus, or hare-eye, is a complaint, in which 
the eyelids cannot be shut, nor the eye covered. The in- 
conveniencies resulting from the disease are of various kinds. 
The eyes weep constantly, because the interruption of the 
alternate closure and opening of the eyelids hinders the tears 
from passing into the nose : the patient becomes blind in a 
very light situation, in consequence of his not being able to 
diminish the rays of light which fall on the eye; and, on 
the same account, the sight becomes gradually very much 
weakened; the patient cannot sleep in a chamber into which 
any light enters; and the extraneous substances in the atmo¬ 
sphere settling on the eyeball, cannot be washed away by the 
action of the eyelids, so that they occasion irritation, pain, 
and redness. 
The cause of this complaint sometimes depends on a swell¬ 
ing or protrusion of the eyeball out of the orbit. But the 
defect commonly lies in the upper eyelid. Sometimes, 
E R V. 
though very seldom, it originates from a paralytic affection 
of the orbicularis muscle. This case requires the same kind 
of treatment as the second species of ptosis. 
Lagophthalmus most frequently arises from a contraction 
of the skin of the upper eyelid, in consequence of wounds, 
abscesses, burns, &c. This case is to be treated on the same 
principles as the ectropium. 
Until the complaint is permanently cured, the eye should 
be protected by a shade from exposure to a strong light. 
Tumours of the eyelids are of various kinds. The hor¬ 
deolum stye is always situated at the edge of the eyelids. It 
is a very small circumscribed tumour, about the size of a 
barleycorn. An inflamed stye is commonly extremely red 
and painful; and is very similar, in every respect, to a small 
boil, or an inflamed encysted tumour. 
The cure of the inflamed stye demands the external em¬ 
ployment of emollient applications; for, the tumour always 
suppurates, and the more this is promoted, the sooner is the 
patient freed from inconvenience. Even when the stye has 
already suppurated, emollients are the best applications, 
until the hardness has subsided. When the suppuration has 
terminated, a weak solution of the acetate of lead may be 
used to disperse the remaining redness and swelling. 
The indurated stye, as it is called, occasions a good deal 
of inconvenience, by frequently inflaming and becoming 
painful, hindering the motion of the eyelids, and prevent¬ 
ing the free enjoyment of sight. The best mode of curing 
this disease is to touch the little induration with the argentum 
nitratum until it is destroyed. 
Encysted tumours of the eyelids are most frequently 
situated immediately under the skin, but sometimes they lie 
so deeply, that they can be taken out more easily from the 
inside than the outside of the part. They seldom become 
very large, and are more commonly observed on the upper, 
than the lower eyelid. When they have attained a certain 
size, they hinder the elevation of the eyelid, and occasion 
ptosis, they should be cut out. 
Of conjunctivitis.—The irradiation of red vessels over the 
white eye-ball, terminating in a short time in a perfect 
continuous blush, marks conjunctivitis. There is in this 
complaint, at first, a copious, flow of tears, but a great 
dryness, or want of secretion is manifested. A sense of 
grittiness in the eye-ball, and a great deal of pain, much 
aggravated by light, also attend. Much constitutional 
disorder is also present. The inflammation is subdued by 
a full general bleeding, followed by local bleedings, and 
warm fomentations to the part affected, and by purgation 
and low living. 
In general, inflammation of the conjunctiva is a very 
manageable complaint. It passes into chronic inflammation, 
after the acute stage has continued for a certain time, and it 
not unfrequently subsides of itself. A spontaneous cure, 
however, is by no means to be trusted to, because simple 
inflammation of this membrane may lead to inflammation 
of the deeper seated tunics of the globe of the eye. The 
consequences of inflammation of this membrane are very 
similar to those of inflammation in other parts of the body. 
It sometimes terminates in effusion, the serum or blood 
under the conjunctiva rising in a roll above the transparent 
cornea, and forming the appearance called chemosis. It 
sometimes produces the adhesive process, and when it ter¬ 
minates in this manner, the adhesive matter is deposited 
under the conjunctiva, which covers the transparent cornea, 
and is recognized by a hazy appearance at the part. This is 
technically called nebula; when considerable in quantity, 
and very opaque, it is called albugo, or leucoma. The in¬ 
flammation sometimes proceeds to the suppurative process. 
Ulceration is also sometimes produced; this usually occurs 
in the cornea, in consequence, probably of its denudation or 
exposure. Lastly, sloughing and mortification of the cornea, 
is not an uncommon effect of a high degree of inflammation. 
In chronic inflammation the redness is less intense, the pain 
less acute, the intolerance of light less, the chemosis and 
swelling diminished, the effusion of tears less considerable. 
