The principles and practice of ophthalmic medicine and surgery / By T. Wharton Jones.

  • Jones, Thomas Wharton, 1808-1891.
Date:
1863
Catalogue details

Licence: Public Domain Mark

Credit: The principles and practice of ophthalmic medicine and surgery / By T. Wharton Jones. Source: Wellcome Collection.

Provider: This material has been provided by the Harvey Cushing/John Hay Whitney Medical Library at Yale University, through the Medical Heritage Library. The original may be consulted at the Harvey Cushing/John Hay Whitney Medical Library at Yale University.

    49/508 (page 35)
    eyelids are almost necessarily more or less implicated; and it is to be remarked, that in the case of blows, contusions, and wounds of the eyebrow and margin of the orbit, there may have occurred injury of tin' fifth pair, concussion of the retina, or even of the brain, and, as a consequence, amaurosis. In the exploration, attention is directed to the state of the skin all around the margin of the orbit, and of the hairs of the eyebrow. The skin may be the seat of an eruption, or of cicatrices. The hairs may have fallen off, or they may be the seat of phtheiriasis. [It will be recollected that in old persons they are often seen to disappear, which is in harmony with the necessity of having a bright light, experienced by those whose eyes have become far-sighted. When, however, they fall prematurely, the sight is sometimes seriously affected.—Ed.] Tu- mors will not unfrequently come under notice in the eyebrows, or connected with the margin of the orbit. The injuries met with are burns, from which the eyelids in general suffer most; contusions and wounds with ecchymosis. The affections found more particularly seated in the margin of the orbit, besides fracture, &c, which may complicate the injuries just referred to, are inflammation and abscess, involving the periosteum and bone. Abscess manifests itself by a dark-red swelling, which at last bursts and discharges a thin or curdy matter. The carious or necrosed bone is felt bare and rough, on the introduction of a probe through the opening, now become fistulous. Lastly, the margin of the orbit may be thickened from periostosis, or hyperostosis, or be the seat of an exostosis, or of an osteosarcomatous tumor. Exploration of the eyelids, and their tarsal border, including the state of the cilia and Meibomian apertures. The points to be noticed, in regard to the eyelids, are: first, their position, their connections, and their movements; then their organic condition generally, and that of their tarsal border in particular; the direction of the eyelashes, the state of the Meibomian apertures, and of the Meibomian discharge, as indicated by the presence or absence of incrustation of the eyelashes. The morbid changes in position, which the eyelids may be found to present, are, eversion or ectropium, inversion or entropium, retraction and shortening or lagopldhalmus. The morbid connections are, adhesion to each other's edges, or anchyloblepharon, which may be either mediate or immediate, total or partial, congenital or accidental; and adhesion of the inner surface of one or both e}7elids to the globe, or symblepharon, which may likewise be mediate or immediate, total or partial. In proceeding to indicate the morbid changes to which the move- ments of the eyelids are subject, it may be useful to premise that it is chiefly by the movements of the upper eyelid that the open or closed state of the eye is produced. The upper eyelid is both vertically and horizontal^ larger than the lower, and in the closed state during sleep covers much more of the front of the eyeball; but in voluntary or forced closure of the eye, the lower eyelid is drawn up, being at the