Part 61

Treatment. One can trust implicitly to the extraordinary reparatory power of the eyelids, yet so unsightly is any distortion of these parts, that the greatest pains must be taken to obviate loss of substance, or unevenness or puckering in healing. The points to be mainly sought for are the perfect coaptation of the divided edges, and the restraining of the patient from interrupting the healing process and breaking loose the forming adhesions, by rubbing the eye.

Inconsiderable wounds of the skin may be simply stitched together with sterilized catgut. Then the intervals between the stitches may be approximated, dried, and covered with strips of sticking plaster, or with shellac, collodion or gelatine. Frick’s gelatine is made by dissolving fine gelatine in a 1 per cent. solution of corrosive sublimate and adding about 10 per cent. of glycerine, perfecting the admixture by the aid of heat. When wanted for use it may be melted by heat and applied on the skin with a camel’s hair brush. Bird lime may be used as a substitute. Sterilization must be sought by the use of sublimate lotion 1:2000, or boric acid 2:100. Formerly the edges were kept in close opposition by the use of quilled sutures, the stitches passed around the quills being inserted at the usual distances while the quills, applied against the edges of the wound kept them smooth and even and obviated puckering. Or, perhaps better, the twisted suture may be employed, the edges being brought together by pins placed close together and a silk thread carried around each in figure of 8, and spirally from pin to pin along the entire length. If one pin comes out it ought to be promptly replaced and the whole left in place until a firm adhesion is established. The points of the pins are cut off short so that there may be no risk of their pricking.

With any method the horse or ox may be turned in his stall so that his tail may be toward the manger and his face outward, and he may be tied by two halters to the two posts, right and left. His food may be furnished in a sack hung from the ceiling and cut down one side. In this way the animal may be absolutely prevented from rubbing the itching sore against any solid body, and thereby interrupting the healing process. Another method is to apply a hood of stiff material with a metallic guard for the face, having bars extending from above downward and arched outward so that they shall effectually protect the eye in any attempt at rubbing.

DEFICIENCY OF THE EYELIDS. COLOBOMA PALPEBRARUM.

The term coloboma representing merely a hiatus or deficiency is applied to different parts of the eye according as there may be a lack of substance of the part in question:—=Coloboma palpebrarum= (deficiency of the palpebræ or lids), =C. iridis= (perforation of the iris), and =C. choroideæ= (partial absence of the choroid).

=Coloboma palpebrarum= is usually congenital and takes the form of a vertical notch on the upper lid, separating its two lateral parts into independent flaps. According to the breadth and depth of the notch are the extent of the exposure of the bulbar conjunctiva and the liability to irritation and infection by foreign bodies. The same condition of things will occur traumatically and require identical measures of repair. These consist in paring the edges of the notch and bringing them accurately together with catgut, silk or quilled suture, the approximation being rendered more perfect by the application of collodion, shellac or gelatine mixture (see wounds of eyelids). The vascularity and extensibility of the tissues of the lids greatly favor a kindly healing. Rubbing of the eye must be guarded against as advised under wounds of the eyelids.

ORGANIC UNION OF THE EYELIDS. ANKYLOBLEPHARON. NARROWED FISSURE BETWEEN THE LIDS. BLEPHAROPHYMOSIS.

Complete closure of the palpebral fissure has been seen as a congenital infirmity in sheep, dogs and cats, while the partial closure has been found in all classes of animals as the result of chronic conjunctivitis and contraction of the exudation in undergoing organization. Narrowing of the fissure gives the appearance of a small eye, so that a progressive diminution is usually supposed to come from a reduction in size of the bulb, though no actual atrophy of that organ has taken place. In drooping of the upper lid (ptosis) too, the fissure is reduced and the illusion of an atrophy of the eyeball is induced. The closure of the fissure may come from blepharospasm, as the result of irritants in the eye, or even of nervous disorder.

Treatment. In case of complete closure of the palpebral fissure, the skin is picked up with forceps and an incision is made between the two tarsi into the conjunctival sac. Then with probe pointed scissors, or a grooved director and bistuory the incision is carried between the tarsi to the proper position for the internal and external canthi. During healing the lids should be frequently bathed with a boric acid solution, and an ointment of the same with vaseline should be applied to prevent adhesion.

When the trouble consists in a drawing together of the skin at the outer canthus, the result of inflammation, the adhesions are separated by a horizontal incision leading outward from the line of the angle. The edges of the conjunctiva and skin are then sutured together, so as to prevent further adhesion and the part treated as an ordinary wound. This is known as canthoplasty.

Ptosis coming from tumors on the lid, or excess of fat in its substance, or from oculo-motor disease must be treated according to indications. The same remark applies to spasm of the orbicular muscle (blepharospasm), whether clonic or tonic. In domestic animals the removal of the cause (foreign body, eyelash), will usually succeed.

WIDENED PALPEBRAL FISSURE.

After wounds of the outer canthus the union of the edges may remain imperfect so that the fissure is enlarged and the eye unduly exposed. The case is still worse if the wound has deviated from the horizontal and has involved the orbicular muscle, the divided ends of which continue to draw the edges apart, and cause a constant overflow of tears (epiphora). Enlargement of the bulb or its protrusion by reason of a swelling beneath it may give rise to the same appearance (exophthalmos).

Treatment. Pare the edges of the upper and lower lids at the outer canthus and bring them together by sutures.

LAGOPHTHALMOS. INABILITY TO CLOSE EYELIDS.

This is called hare-eye (lagos, hare) from the fact that the hare habitually keeps the eyelids open. It is mostly due to spasm of the levatores palpebræ, or to undue size of the orbicular opening. It may, however, accompany ectropion, exophthalmos, and enlargement or swelling of the eyeball from any cause. Bayer has seen cases in diseases of the trifacial nerve, in neoplasms in the orbit and in buphthalmus.

Cases of the kind are especially liable to irritation, inflammation and ulceration due to foreign bodies falling on the exposed bulb.

The treatment is largely that of the attendant condition ectropion, tumor, etc., which may be consulted.

ADHESION OF THE EYELID TO THE BULB. SYMBLEPHARON.

Causes: Conjunctivitis, burns, operation and other wounds. In front of or behind the reflection of the mucosa from eye to lid. Prevention. Treatment: section of adhesion, and vaseline, etc., Two edges of healthy mucosa sutured together over the sore. When fornix is implicated mucosa is transplanted.

This is liable to occur to a greater or less extent, in all animals, in connection with violent conjunctivitis, burns and operation and other wounds. It has been divided into anterior and posterior symblepharon, the former being an union in front of the normal reflection of the conjunctiva from the lid upon the bulb (fornix), and the latter involving the fornix in the substance of the adhesion. The anterior form by anchoring the lid to the eyeball is much more likely to induce blindness, but it has the compensation that the union may be broken up and the parts healed without subsequent reunion. In the posterior form the eye can be better exposed and vision retained, its repair is much more difficult demanding transplantation of skin or mucous membrane on to the sore, and even then the granulation tissue being continuous from bulb to eyelid may so contract in healing as to leave matters no better than before.

These adhesions not only restrict the movements of the lids, preventing their opening and the exposure of the bulb, but they also anchor the bulb itself, and hamper its movements, necessitated for vision. In all cases therefore of wounds, burns, abrasions and ulcers, of the palpebral and bulbar mucosæ it is highly important to take precautions against the formation of such connections. Any forming adhesions must be broken up day by day and the surfaces must be kept apart in the intervals by borated or iodoformed vaseline.

In a small anterior symblepharon the connections may be cut through and subsequent adhesion prevented by the frequent introduction of iodoformed vaseline, and if need be, by the daily separation of the surfaces by a probe. When this fails a plastic operation may be resorted to, the mucosa on the inner side of the lid being incised in a vertical direction a short distance on each side of the sore and the inner edges accurately stitched together. The raw surface left on the bulb thus comes in contact only with the healthy mucous strips on the eyelid, which have been drawn together over the seat of the former sore, and the two new raw surfaces formed on the lid are well to each side of the sore on the bulb, and are in contact with its healthy mucosa only. Thus no two raw surfaces can come in contact, and adhesion is obviated.

When the fornix is implicated mucous membrane from the mouth, vulva, the bronchia of the rabbit, or the skin of the frog must be transplanted after the requisite incision of the cicatrix has been made.

INFLAMMATION OF THE EYELIDS. BLEPHARITIS.

Phlegmon. Causes: traumas, skin disease. Symptoms: swelling, redness, distortion, infiltration, semi-closed lids, scabs, sloughs, abscess. Tenderness. Itching. In eczema papules, vesicles, weeping eye. Treatment: antiseptic astringent lotions, almond oil, vaseline, zinc oxide, salicylic acid, boric acid, starch, xeroform, pyoktannin; for eczema, mercury oxides, silver nitrate.

Conjunctivitis will be treated later, and under the present head there will be considered only the phlegmon of the outer structures.

Causes. This lesion may come from two distinct causes, traumatism and skin disease. The traumatisms in horses and cattle are bruises sustained in rolling, especially during colics, in striking the head against posts, poles, shafts and other solid bodies, in enduring blows with horns or clubs, or frictions by the halter or in putting on a collar. Dogs suffer especially from blows with clubs and kicks from men or animals. All may suffer from wounds of the lids, and from extensions of eczema and other skin diseases.