SURGERY. 
violent darting pains in the organ extending over one side of 
the head. This is the most frequent description of cancer 
of the eye. 
Sometimes excrescences form upon the anterior surface 
of the eye, especially upon the transparent cornea, and fre¬ 
quently "admit of being radically cured by the knife, caustic, 
or ligature. But, occasionally, they repeatedly grow again 
after the employment of these means, becoming broader, 
more malignant, and even cancerous, and at length, chang¬ 
ing into a spongy fungus, which is very painful, covers 
the whole anterior surface of the eye, and renders extirpa¬ 
tion indispensable. This is the second species of cancer of 
the eye. 
On several occasions, ulcers form on the front of the eye¬ 
ball, which, though generally curable by proper means, 
sometimes are exceedingly inveterate, entirely destroying the 
eyesight, and becoming so malignant as to obtain the appel¬ 
lation of cancer. This is the third form of the disease." 
According to Scarpa, we have no pathognomonic symp¬ 
toms, excepting one, indicative of the exact period when 
the sarcoma of the eye changes from a benign fungus to 
carcinoma. The exquisite sensibility, darting pains, rapi¬ 
dity of growth, colour, and ichorous discharge, are by no 
means a sufficient criterion, and, says Scarpa, the only 
symptom, if not entirely pathognomonic, at all events less 
uncertain than any other, is the almost cartilaginous hard¬ 
ness of the malignant ulcerated fungus, which induration is 
not met with in the benign fungus, and never fails to pre¬ 
cede the formation of cancer. 
Cancer and fungus heematodes of the eye, however, are 
the two diseases, for which the extirpation of the eye is com¬ 
monly required. 
In the performance of the operation, there are two im¬ 
portant circumstances to which attention ought to be paid. 
The first is, to remove every particle of the disease, and 
leave none of the affected parts behind. The second is, to 
avoid piercing or injuring the orbit, behind which the dura 
mater is immediately situated. 
In order to be able to separate the eyelids far enough from 
each other, for the easy removal of an eye that is much en¬ 
larged, it is sometimes recommended, in the first instance, 
to make an incision through them at their external commis¬ 
sure. The patient should lie down on a table of convenient 
height, with his face exposed to a good light. 
The best instrument for the operation is a common scalpel. 
When the diseased part is very large, a knife, somewhat 
curved, has been occasionally used for dividing the parts 
deeply situated in the orbit. Scarpa uses a knife for the di- 
vision of the conjunctiva and superficial connections, and 
completes the rest of the incisions with a pair of curved 
scissars. The patient being placed in a horizontal posture, 
and the upper eye-lid raised by an assistant, and the lower 
one depressed by the surgeon himself, the conjunctiva, con¬ 
necting the eye'with the two eye-lids, is first to be divided. 
As when the eye-ball is enlarged, it mostly falls towards 
the cheek, so that an incision between the diseased part and 
the lower eye-lid cannot easily be made, Richter recom¬ 
mends first, separating the globe from the upper eye-lid, 
then dividing the superior and lateral attachments of the eye; 
and, lastly, its connections with the lower eye-lid. This 
mode of operating is said to be the more easy, because the 
globe of the eye can always be more readily inclined down¬ 
wards, so as to make room above, than pushed upwards for 
the purpose of making room below. 
Scarpa, after dividing the external commissure of the eye¬ 
lids, if the tumour be very large, perforates the conjunctiva 
at ffie external angle, and from thence, keeping the knife 
close to the upper plane of the orbit, as far as the caruncula 
lachrymalis inclusively, cuts through the elevator muscle of 
the upper eye-lid, the tendon of the greater oblique muscle, 
and the superciliary nerve. The diseased eye-ball being 
then raised, and the lower eye-lid depressed, the incision is 
next continued along the inferior segment of the orbit, from 
the external towards the internal angle; by doing which, 
the knife will penetrate between the orbit and lesser oblique 
747 
muscle, and not pass between the eye-ball and this muscle, 
as would happen in cutting in the opposite direction. The 
eye freed from these attachments, and from that formed by 
the nasal branch of the ophthalmic nerve, will fall on the 
external side of the orbit, and give the surgeon room on the 
internal side as far as the bottom of the orbit, where he is to 
divide, with one stroke of the scissars, the origin of the 
muscles of the eye and the optic nerve. He is then gently 
to bring his finger round to the external side of the orbit, 
and push its contents a little towards himself, while, with a 
second stroke of the scissars, he divides all the parts which 
enter the orbit through the sphseno-orbital fissure. 
Until the optic nerve has been divided, the operator must 
avoid drawing the eye-ball too forcibly forwards. 
As soon as the eye has been completely detached, all the 
inside of the orbit should be very carefully examined, and 
whatever indurated parts are found should now be diligently 
removed. In particular, the surgeon should introduce his 
finger along the inner side of the orbit, where he will feel 
the greater oblique muscle, which he must dissect away by 
means of a tenaculum and the scissars. 
All writers agree concerning the propriety of cutting away 
one or both the eye-lids, whenever they are affected with 
cancerous disease; but in all other instances they should be 
spared. 
The first appearances of a fungus hasmatodes of the eye, 
according to Mr. Wardrop, are in the posterior chamber. 
The pupil becomes dilated, of a dark amber, or greenish 
hue, instead of its natural deep black colour, and iris im¬ 
moveable. Mr. Ware states, however, that the first symp¬ 
tom is a white shining substance in the posterior part of the 
eye, visible through the pupil in some particular positions of 
the head; but not in all; an appearance compared to that 
of burnished iron. As the disease advances, this deviation 
from the natural appearance of the pupil is discovered to be 
produced by a solid substance, which is formed at the bottom 
of the eye, and gradually approaches the cornea. At length 
the excrescence occupies the whole interior of the eye be¬ 
hind the iris, and appears through the pupil to be of an 
amber or brown colour. 
When the disease advances still further, the form of the 
eyeball begins to alter, acquiring an irregular knobby ap¬ 
pearance ; and at the same time, the sclerotic coat loses its 
natural pearly white colour, and becomes of a dark blue, or 
livid colour. The tumour, by its continued growth, finally 
occupies the whole anterior chamber; and in some cases 
a quantity of purulent matter collects between the diseased 
mass and the cornea. 
At last, the cornea ulcerates, and a fungous tumour shoots 
out, or else the excrescence makes its way through the 
sclerotic coat, and is then covered with the conjunctiva. 
The protruded fungus is generally rapid in its growth, 
often attains a large size, is of a dark red, or purple colour, 
has an irregular surface, and is frequently covered with 
coagulated blood. It bleeds profusely from the slightest 
causes, and when it is large, its most prominent parts are 
apt to slough. 
In some cases, the optic nerve becomes thicker, firmer, 
and harder, than common, assumes a brownish ash-colour, 
and loses its natural tubular appearance. Sometimes, it is 
converted into a tumour, of the figure and size of an olive, 
the disorganized substance of which exactly resembles that 
of the fungus, which fills the orbit, and projects beyond the 
eyelids. In other instances, the nerve, besides being altered 
in its structure, is split into one or more pieces, the morbid 
growth filling up the intervening spaces, and surrounding 
the different portions of the nerve. The divided parts of the 
nerve are entirely deprived of their proper structure and 
colour. 
Among many other particulars, Mr. Wardrop mentions, 
that when the optic nerve is diseased, the alteration in its 
structure generally extends as far up as its junction with the 
opposite nerve. In many cases, it extends further, the thala¬ 
mus being converted into an irregular, soft pulpy mass, more 
or less blended with blood. Sometimes, the dura matter 
and 
