746 SURGERY. 
When the disease, however, advances to the stage in 
which the effusion of lymph begins, every possible means 
must be adopted for resisting this process, and bringing about 
the absorption of the substance already deposited in the pos¬ 
terior chamber, in the pupil, or upon the iris. Of all reme¬ 
dies for this purpose, none merits so much enconium as 
mercury, which must be freely exhibited, in order to affect 
the constitution as soon as possible. The ointment, or the 
pil. hydrarg. with opium, may be employed, and often it is 
right both to exhibit the medicine internally, and have re¬ 
course to frictions In this second stage of iritis, Professor 
Beer gives calomel united with opium, applies to the eye a 
solution containing oxymuriate of mercury, mucilage, and a 
considerable quantity of vinum opii; and when this col ly- 
rium loses its effect, he introduces daily between the eyelids 
a small quantity of a salve, composed of two drachms of 
fresh butter, six grains of red precipitate, and eight grains of 
extract of opium. He observes also, that frictions once a 
day, over the eyebrow with mercurial ointment, containing 
opium, will very much assist in producing an absorption of 
the effused lymph. The tendency of the iris to expand, 
and the pupil to contract, the late Mr. Saunders used to 
oppose by the use of the extract of belladonna, with which 
he sometimes smeared the eyelids and eyebrows. 
Closure of the pupil sometimes occurs in consequence of 
violent inflammation of the internal membranes of the eye, 
especially the iris. In particular instances, the malady 
follows the extraction and depression of the cataract, but 
without any inflammatory affection of the interior of the 
eye appearing to have any share in its origin. After an 
indeterminate time from the operation, the pupil is perceived 
to diminish in diameter daily, without any evident cause, 
and ordinarily closes so much, that it can hardly admit a 
pin’s head. The iris is motionless, assumes a radiated rugous 
appearance, and, when no opacity exists behind it, a little 
black speck is seen in its centre. In this state if the retina 
be sound, the patient may sometimes regain a considerable 
power of vision, by having an artificial pupil formed. 
Cheselden was the first who performed an operation, with 
a view of diminishing the blindness produced by this mala¬ 
dy ; he introduced a couching needle, having a sharp edge 
only on one side, through the sclerotica, about a line and a 
half from the margin of the cornea. After perforating the 
iris, towards the external angle, and then pushing the point 
of the needle transversely through the anterior chamber, as 
far as the edge of the iris next the nose, he turned the edge 
of the instrument backward, and withdrew it, so as to make 
a transverse division of the iris. 
Janin practised this method in two instances, but without 
success, as the edges of the opening after a time united. 
Here, Baron Wenzel practised the excision of a portion 
of the iris. He introduced the point of the cornea knife 
into the anterior chamber, exactly in the same manner as in 
the extraction of the cataract, but when it had arrived nearly 
as far as the centre of the iris, it was plunged into this mem¬ 
brane, and then, by a slight motion of the hand backward, 
it was brought out again, about the distance of three quar¬ 
ters of a line from the part in which it entered. Next, the 
incision being continued as in cases of cataract, the section 
of the iris was completed before that of the cornea, and 
presented a small flap, which was cut off with a pair of scissars. 
Beer opens the cornea, draws out the iris by means of a 
fine hook, and removes a small portion of this membrane. 
Ilypopium is an accumulation of a glutinous yellowish 
fluid, like pus, in the anterior chamber of theaqueous 
humour, and frequently also in the posterior one, in con¬ 
sequence of violent ophthalmy. 
The symptoms exciting apprehension of an hypopium, 
are the very same which occur in the highest stage of vio¬ 
lent acute ophthalmy, viz., prodigious tumefaction of the 
eyelids, redness and swelling of the conjunctiva, as in che- 
mosis; burning heat and pain in the eye ; pains in the 
eyebrow and nape of the neck ; fever; restlessness ; aver¬ 
sion to light, and a contracted state of the pupil. 
During the first stage of violent ophthalmy, while the 
hypopiutn is increasing, the same treatment as is recom¬ 
mended for severe acute inflammation of the eye is the most 
proper. In the second stage of the ophthalmy, when the 
hypopium has become stationary, the surgeon must endea¬ 
vour to quicken tire action of the absorbents in the eye. 
Camphorated emollient poultices may be applied; the 
vapours of the spir. ammon. comp, may be directed against 
the eye, through a tube two or three times a day ; a blister 
may be put on the nape of the neck, and when the irrita¬ 
bility of the organ has diminished, the vitriolic collyrium 
may be used. This may be afterwards strengthened by the 
addition of a few drops of camphorated spirit. Under such 
treatment, hypopium most commonly disappears, in pro¬ 
portion as the chronic ophthalmy is relieved. 
When the secerning extremities of the arteries, and the 
minute mouths of the absorbent vessels of the eye do not 
act in their naturally reciprocal manner, the organ may 
become distended with a morbid redundance of an aqueous 
secretion. This disease constitutes what is termed dropsy 
of the eye, and is at first attended with great weakness, and 
afterwards with total loss of sight. 
In the last stage of the disease, when the dropsical eye 
projects from the orbit, so as not to admit of being covered 
by the eyelids, with the inconveniences already enumerated, 
others associate themselves, arising from the dryness of the 
eye; the contact of extraneous bodies; the friction of the 
eyelashes; the very viscid secretion from the eyelids; the 
ulceration of the lower eyelid, and even of the eye itself. 
Hence, the advanced stage of dropsy of the eye induces vio¬ 
lent ophthalmies, followed by ulceration and a total destruc¬ 
tion of the organ. 
In the incipient period of the disease, it is usual to pre¬ 
scribe mercurials, or cicuta, and make a seton in the nape 
of the neck. Scarpa describes astringent applications as 
hurtful, and recommends the eye to be bathed with a decoc¬ 
tion of mallows. 
When the disease has attained such a pitch, that the eye 
protrudes from the orbit, there is no means of opposing the 
grievous dangers now impending, except making an inci¬ 
sion, in order to evacuate the superabundant fluid in the 
eye. But simply puncturing the eye is no more adequate to 
produce a permanent cure of the dropsical affection, than 
puncturing the tunica vaginalis is sufficient to effect.a radical 
cure of the hydrocele. Besides discharging the redundant 
humours contained in the organ, inflammation aud suppura¬ 
tion must be excited. For this purpose, a portion of the 
centre of the cornea, about as broad as a pea, is to be cut 
out, and so much of the humours is then to be pressed out 
as will permit the eyelids to be brought over the eye. No¬ 
thing but a pledget of dry lint, kept on by a bandage, is to 
be applied before the inflammation has taken place, which 
is usually about the third or fifth day. Then antiphlogistic 
means may be adopted, and emollients employed. 
After operating for the relief of the present affliction, a 
fungus occasionally grows out of the internal part of the 
eye. Such an excrescence was, in one instance, destroyed 
by the external' employment of belladonna. But, in case 
this or other means fail in preventing the reproduction of the 
fungus, it is the duty of the surgeon to recommend the 
entire extirpation of the diseased organ. 
“ Carcinoma of the eye is said to make its appearance in 
three forms. Sometimes the eyeball becomes irregular and 
knobby, and swells to the size of an apple; the sight is 
gradually lost; the blood-vessels in the white of the eye en¬ 
large ; and the whole external and internal structure of the 
organ becomes so altered, that the part resembles a piece of 
flesh, and no vestiges of its original organization remain. 
Sometimes a portion of the cornea is still visible, within 
which a small aperture is also discernible, through which 
can be distinguished the remains of the vitreous humour, 
and of the choroid coat. In some instances, the eyeball is 
ulcerated, and emits a foetid discharge; while, in others, 
there is not the smallest appearance of ulceration, and the 
eyeball resembles a piece of firm flesh. The patient usually 
experiences from the first considerable burning, and at last, 
violent 
