Part 63

In foals, puppies, hounds, with narrow fissure, and conjunctivitis, or tarsitis. Permanent bandaging, orbicularis spasm. Symptoms: disappearance of tarsus and lashes by involution. Treatment: in spasm fix by plaster; suture skin; excise elliptical section of skin and suture edges together. Release cicatrices.

Inversion of the eyelid or a portion of it, with consequent trichiasis, conjunctivitis and lachrymation has been met with congenitally in foals (Aubry, Bourdeau, Hamon) and puppies (Cadiot, Almy). Hounds have especially suffered. In the older animals it is largely determined by abnormally narrow fissure, and by old standing disease of the conjunctiva or tarsus, with cicatricial contraction or adhesion. Persistent bandaging turns in the cilia and contributes to entropion. Finally a persistent spasm of the orbicularis muscle may bring it about.

Symptoms. Trichiasis is usually, though not always, present.

In any case the tarsus is turned inward so as to press upon the front of the bulb, or even to disappear completely. Thickening and distortion of the lid is a not infrequent condition.

Treatment. In case of simple spasm clip or shave the hairs from the lid corresponding to the lesion, and close to the tarsus attach a strip of plaster. When firmly adherent draw it sufficiently to efface the entropion and attach it to the skin of the face.

This failing, Gaillard’s sutures may succeed. With a pair of forceps with looped, transversely elongated blades, pinch up skin and muscle sufficient to correct the entropion, and passing a needle twice through this fold with an interval of 3 mm., tie the suture over a small roll of cotton. The stitches may be removed in two days and the cicatrices may permanently obviate the deformity.

The older plastic operation is more trustworthy: The skin of the affected lid is pinched up to such an extent in length and breadth, as to correct the entropion and is then excised with sharp scissors or bistuory so as to leave a long elliptical sore. The edges of this are then carefully sutured together and the resulting union corrects deformity. In case the entropion is caused by an old standing cicatrix, it may be necessary, first, to make a careful incision along the edge of the lid so as to separate the tarsus and conjunctiva from the cilia and Meibomian ducts, and then to proceed with the plastic operation on the skin.

TURNING OUT OF THE EYELID. ECTROPION.

In large dogs, in old age, debility, conjunctival swelling, cicatrized skin of lids, distortions of lids. Symptoms: exposure of palpebral mucosa, weeping eyes, conjunctival hypertrophy (chemosis). Treatment: scarify or excise a fold of mucosa, astringent antiseptics, Snellen’s suture, Diefenbach’s operation, Wharton-Jones operation.

This is much more common than entropion, but much less injurious as the tarsi and lashes do not irritate the conjunctiva. It is especially common in large dogs (hounds, mastiff) and usually affects the inner part of the lower lid. Old age and debility contribute materially to the condition, the lack of tone or paresis being an important factor. It may, however, occur in any animal, from conjunctivitis and swelling of the mucosa, from cicatrices or old standing disease of the skin of the eyelids, or from imperfectly healed wounds leaving distortions of the lower lid. It is most frequent in the lower lid, and the slightest pendulous condition, which detaches the tarsus from the bulb, and exposes a narrow zone of the conjunctiva is considered to be an ectropion.

Symptoms. Beside the exposure of the zone of mucosa, there is the overflow of tears, and in old standing and bad cases a hypertrophy of the exposed conjunctiva, which projects as a fleshy-looking mass, and weighs down the lid, with a continual tendency to aggravation.

Treatment. Where the main factor seems to be the infiltration of the mucosa this may be reduced by scarification, or by the complete excision of a fold of the membrane. Use an antiseptic wash (boric acid) and the retraction of healing tends to brace up the lid against the bulb.

Snellen’s suture is sometimes employed successfully. A silk thread is armed at each end with a needle, and the needles are passed into the conjunctiva just inside the tarsus and brought out through the skin near the margin of the orbit, where they are tied round a small roll of cotton. Several of these may be inserted side by side so as to extend the whole length of the ectropion and they should be drawn tight enough to correct the deformity. If left some days they will usually determine cicatrices which will overcome the deformity.

The most common operation (Dieffenbach’s) is the excision of a triangular portion of skin from just outside the lower lid and having its base or upper side running horizontally outward from the outer canthus. Then pare the margin of the lower lid for a distance equal to the base of the triangle. Then bring together and suture the skin forming the right and left sides of the triangle, and the raw edge of the lid to the skin that formed the base of the triangle. In this way the triangular sore formed by the operation is completely covered and the margin of the lower lid is shortened so as to brace it up against the bulb.

In case of cicatricial ectropion the Wharton-Jones operation is to be adopted. A V-shaped incision is made in the skin of the lower lid commencing just beneath the tarsus and carried down so that the two lines of incision meet well down beneath the cicatrix. The triangular flap of skin thus made, is detached by a bistuory from the cicatricial tissue beneath, and allowed to shrink upward toward the tarsus. Finally the two edges are sewed together from the angle upward, as far as may be necessary to allow the proper application of the tarsus against the bulb, and the remainder of these edges are sutured to those of the triangular flap.

TUMORS OF THE EYELIDS.

=Warts.= The most common tumors of the eyelids in horses, cattle, and dogs are warts. These are most simply disposed of by seizing them with rat-tooth forceps and clipping them off with sharp scissors curved on the flat. Any bleeding may be checked by a pencil of silver nitrate.

=Sarcoma=, =melanoma=, and =epithelioma= are common in solipeds, especially in the gray and white. They usually form a cauliflower-like mass red and angry and bleed easily. They may occupy any part of the lid, the skin, the dark tarsal margin, the connective tissue or the mucosa, and not unfrequently they involve the eyeball, and the surrounding tissues, even the bones of the orbit.

Treatment. These may be excised like warts taking care to remove every vestige of disease. In these cases I have usually found it necessary to remove the entire bulb.

FRACTURE OF THE ORBIT.

Nature and Causes. The usual seat of fracture is the orbital process of the frontal bone, yet any portion of the orbital margin may suffer, and even the inner wall or floor of the orbit may be broken by a penetrating instrument. Horses and polled cattle and sheep are especially exposed to the injury, while in horned stock the region is in a measure protected. Carnivora, which have no bony orbital process, are less liable but may still sustain fractures of the remaining parts. Horses and polled ruminants suffer mainly from beating the head on the ground or other solid body in the paroxysms of colic and enteritis, or in nervous affections; horned stock suffer from concussions in fighting and direct blows by the horns. All animals suffer from blows with clubs, kicks and other mechanical injuries.

Symptoms. With (and less frequently without) a skin wound, there may be indication of depression, or mobility of the detached segment, or its sharp edge may be felt, through the skin, or by the sterilized finger introduced into the orbit. In case of a penetrating or stab wound, which cannot be followed by the finger, it may be followed by an aseptic probe and any fracture recognized. The conjunctival sac must be first thoroughly washed out with an antiseptic lotion, as the introduction of any septic germs into the osseous wound, is likely to cause a dangerous infection or abscess.

Treatment. Simple, slight fractures with blunt instruments are treated by rest and cooling, disinfectant lotions. If foreign bodies or detached particles of bone are found in the wound they should be extracted. Shot that are difficult to find, may be left, as they are often aseptic and tend to become encapsuled. Should they cause abscess they will usually be found in the pus sac and may then be removed. Displaced bones may often be replaced by the finger in the orbit. Sometimes they can be best reached by trephining the frontal or maxillary sinus and introducing a lever through the cavity (Hendrickx). If the sinus has been involved it must be opened in any case. Cadiot advises bandages impregnated with black pitch to fix the bones in certain cases. Antiseptic washes (sublimate 1 ∶ 5000) and antiseptic cotton packing are demanded for all wounds.

BRUISES AND WOUNDS OF THE ORBIT.

These may come from the same causes as fractures and though less violent may occasion inflammation which involves the eye or even the brain with fatal results. Thus in horses it has been a cause of infective inflammation, with a fatal extension (Robellet); in cattle a similar inflammation has extended to the cerebral meninges and caused death (Leblanc), and in dogs an advance to the eyeball threatens its destruction (Möller). Short of this necrosis is not uncommon (Rey).

Treatment. This does not differ materially from that demanded by penetrating wounds with fracture. A perfect cleansing and antisepsis of the wound is the first demand. A solution of boric acid (4 per cent.) or of mercuric chloride (1 ∶ 5000) liberally applied, and maintained thereafter on soft pledgets of surgical cotton, will often have the best results. All foreign bodies must be carefully removed, lacerated flaps and shreds may require suturing, dead portions excision, and finally abscesses or excessive exudate may require the lance, but cooling, antiseptic lotions and an elevated position of the head, are among the most prominent resorts.

RETRO-BULBAR ABSCESS.

Schindelka has observed this in the horse, in connection with petechial fever. If connected with meningeal abscess it will be necessarily fatal. In favorable cases evacuate the pus as soon as detected and dress with pledgets of cotton saturated with a mercuric chloride solution (1:2000) or other antiseptic.