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A METHOD OF OBVIATING RECURRENCE AFTER OPERATION FOR SYMBLEPHARON.
CLINICAL NOTES.
253
inner surfaces of the eyelids any tendency to cicatricial contraction is avoided, which might otherwise lead to subsequent A METHOD OF OBVIATING RECURinversion of eyelashes, &c. RENCE AFTER OPERATION FOR The small detail of operative procedure described above may possibly have been used by other surgeons, but as SYMBLEPHARON. hitherto I have not found mention of it I may perhaps be BY KENNETH SCOTT, F.R.C.S. EDIN. allowed to recommend it on account of its great simplicity, efficiency, and practical painlessness. The cornea is protected by the dressing from extraneous influences, and has THE circumstances under which this special form of treatevery opportunity of healing uninterruptedly, thus avoiding ment was called for occurred in a peculiar case, very similar one of the chief causes of anxiety which the surgeon has to some others which I recently had occasion to describe,l in frequently to encounter in these cases. Cairo. which there were adhesions between the cornea and palpebral conjunotivse due to a specified cause. The patient was an Egyptian peasant, twenty-seven years old, and of strong, healthy constitution. He acknowledged having suffered from inflammation of his left eye some six months previously, and having then employed a white "sheeshm" AND for its cure. White "sheeshm," as I have elsewhere THERAPEUTICAL. stated,2 is a dry powder, usually composed of powdered is and one a and alum, calomel, sugar, flour, amongst variety of others employed by the lower Egyptian peasant class as a A CONGENITAL CYST OF THE NECK OF DOUBTFUL dry collyrium, which is introduced inside the eyelids when NATURE. there is inflammation of the eye ; needless to say the result P. CLENNELL FENWICK, M.B. LOND., M.R.C.S. ENG., BY I is usually more harmful than beneficial. The patient’s left L.R.C.P. LOND. eye when I first saw it presented a slight ptosis, which, ownI closer examination, was found to be caused by the upper I MR. G. E. DEAMER recently delivered a patient of a eyelid and cornea being firmly adherent to each other. The point of junction between the two surfaces was restricted healthy male child and immediately noticed a tumour on the to a spot, about 4 mm. in area, situated on the side of the neck. He asked my opinion of its nature, outer third of the horizontal diameter of the cornea. right and I have thought that a note of the case might find The band of connexion was fleshy, very short, and corresponded in girth to the size of its corneal publication in THE LANCET. The tumour was at birth of the size of a large chestnut, and attachment. The introduction of a tenotomy hook demonstrated that the adhesion was strictly limited to this one was situated between the sterno-mastoid and thyroid bodypoint. During the operation I rendered the band tense limited sharply above by the lower jaw, and showing several with a tenotomy hook and then carefully dissected it off from the cornea with an angular keratome. I also find this swollen veins running over its surface. The anterior border knife convenient to use for a similar purpose when operating of the sterno-mastoid overlapped it. At five weeks old the In the dissection I was careful to tumour was swollen (about the size of a large walnut) and on cases of pterygium. was lying close to the thyroid gland, while between it and Temove a very slight thickness of the anterior corneal the gland a hard, round cord could be defined, apparently so bare clear corneal tissue and also layers, laying to the right lobe of the thyroid and to the back making certain that no opaque debris of cicatricial attached tissue should be left behind. I then everted the of the growth. The swelling was hard and round, and felt like a tense cyst. There was distinct pulsation perceptible upper eyelid and with scissors removed the remainder of the band. I have always found it very difficult to keep any to the eye, and the cyst moved up and down on swallowing. form of dressing or other material in place which When the child cried it increased in size, but returned to has been introduced temporarily with the object of its original dimensions when the infant was quiet. The diagnosis of the growth is obscure. Owing to its close keeping the two opposing conjunctival surfaces apart communication with the thyroid, its entire mobility and its a of healing. There were no thin glass during process shields at hand which might have answered this purpose, rapid variation in size, I was inclined to think’it was an but which have also the disadvantage of, to a certain extent, unobliterated branchial cleft, but I was unable to account the pulsation, which was certainly not transmitted from acting as foreign bodies under the eyelids. In consequence for the underlying vessels. I was compelled to devise some other means for attaining As neither Mr. Deamer nor I have seen an exactly similar and succeeded the object, my by everting upper eyelid and stitching its ciliary edge in that position to the eye- case we should be glad of any assistance in arriving at a brow. The sutures employed were of very fine silver correct diagnosis, for which purpose, with his permission, I wire, as that material seemed to be the best for the pur- send this note.New Zealand. Christchurch, pose, being recommended by its complete pliability, its if being so readily fastened by twisting, and, necessary, being undone and readjusted ; it was also recommended by the thorough way in which it can be rendered A CASE OF UTERUS BICORNIS. aseptic. The patient’s eye was now treated as a of case extensive corneal abrasion. Atropine was instilled, BY JAMES B. TOMBLESON, M.B., B CH.OXON., and a plain dressing with vaseline and a sprinkling SENIOR OBSTETRICAL HOUSE PHYSICIAN, ST. THOMAS’S HOSPITAL. of dermatol was kept applied to the eye. The healing of the denuded portion of cornea was carefully gauged each I HAVE recently had under my care a case of uterus bicornis, day by the use of fluorescin, and when the process was completed after the lapse of four days the retaining sutures were with gestation in one horn, which I think worth reporting, removed. The patient was being attended in her confinement by an I have similarly applied the principle of this method with obstetric clerk from St. Thomas’s Hospital, who sent for marked success in a case of symblepharon posterius, in me as he thought that the case was a curious one of twins. which class of cases-contrary, I believe, to general usageI always remove flaps of bulbar conjunctiva and attach them On abdominal examination I found a large, almost symby buried sutures to the inner surface of the eyelid, as I find metrical heart-shaped tumour, reaching on each side nearly by experience that the recuperative power of a denudedz, up to the costal margin. There was a deep central sulcus portion of the bulbar conjunctiva is much more speedy and separating the two halves, of which the right was rather satisfactory than that of a corresponding area when situated larger than the left. I decided that probably a foetus lay in on the eyelid ; besides, by attaching the flaps to the bare each half of the tumour, which I had no doubt was the uterus, and as the pains were not very numerous or powerful I left vol. xv., p. 77. 1 Ophthalmic Review, 2 Ibid. the patient, resolving to see her later. Some hours
Clinical Notes:
MEDICAL, SURGICAL, OBSTETRICAL,
z
253
inner surfaces of the eyelids any tendency to cicatricial contraction is avoided, which might otherwise lead to subsequent A METHOD OF OBVIATING RECURinversion of eyelashes, &c. RENCE AFTER OPERATION FOR The small detail of operative procedure described above may possibly have been used by other surgeons, but as SYMBLEPHARON. hitherto I have not found mention of it I may perhaps be BY KENNETH SCOTT, F.R.C.S. EDIN. allowed to recommend it on account of its great simplicity, efficiency, and practical painlessness. The cornea is protected by the dressing from extraneous influences, and has THE circumstances under which this special form of treatevery opportunity of healing uninterruptedly, thus avoiding ment was called for occurred in a peculiar case, very similar one of the chief causes of anxiety which the surgeon has to some others which I recently had occasion to describe,l in frequently to encounter in these cases. Cairo. which there were adhesions between the cornea and palpebral conjunotivse due to a specified cause. The patient was an Egyptian peasant, twenty-seven years old, and of strong, healthy constitution. He acknowledged having suffered from inflammation of his left eye some six months previously, and having then employed a white "sheeshm" AND for its cure. White "sheeshm," as I have elsewhere THERAPEUTICAL. stated,2 is a dry powder, usually composed of powdered is and one a and alum, calomel, sugar, flour, amongst variety of others employed by the lower Egyptian peasant class as a A CONGENITAL CYST OF THE NECK OF DOUBTFUL dry collyrium, which is introduced inside the eyelids when NATURE. there is inflammation of the eye ; needless to say the result P. CLENNELL FENWICK, M.B. LOND., M.R.C.S. ENG., BY I is usually more harmful than beneficial. The patient’s left L.R.C.P. LOND. eye when I first saw it presented a slight ptosis, which, ownI closer examination, was found to be caused by the upper I MR. G. E. DEAMER recently delivered a patient of a eyelid and cornea being firmly adherent to each other. The point of junction between the two surfaces was restricted healthy male child and immediately noticed a tumour on the to a spot, about 4 mm. in area, situated on the side of the neck. He asked my opinion of its nature, outer third of the horizontal diameter of the cornea. right and I have thought that a note of the case might find The band of connexion was fleshy, very short, and corresponded in girth to the size of its corneal publication in THE LANCET. The tumour was at birth of the size of a large chestnut, and attachment. The introduction of a tenotomy hook demonstrated that the adhesion was strictly limited to this one was situated between the sterno-mastoid and thyroid bodypoint. During the operation I rendered the band tense limited sharply above by the lower jaw, and showing several with a tenotomy hook and then carefully dissected it off from the cornea with an angular keratome. I also find this swollen veins running over its surface. The anterior border knife convenient to use for a similar purpose when operating of the sterno-mastoid overlapped it. At five weeks old the In the dissection I was careful to tumour was swollen (about the size of a large walnut) and on cases of pterygium. was lying close to the thyroid gland, while between it and Temove a very slight thickness of the anterior corneal the gland a hard, round cord could be defined, apparently so bare clear corneal tissue and also layers, laying to the right lobe of the thyroid and to the back making certain that no opaque debris of cicatricial attached tissue should be left behind. I then everted the of the growth. The swelling was hard and round, and felt like a tense cyst. There was distinct pulsation perceptible upper eyelid and with scissors removed the remainder of the band. I have always found it very difficult to keep any to the eye, and the cyst moved up and down on swallowing. form of dressing or other material in place which When the child cried it increased in size, but returned to has been introduced temporarily with the object of its original dimensions when the infant was quiet. The diagnosis of the growth is obscure. Owing to its close keeping the two opposing conjunctival surfaces apart communication with the thyroid, its entire mobility and its a of healing. There were no thin glass during process shields at hand which might have answered this purpose, rapid variation in size, I was inclined to think’it was an but which have also the disadvantage of, to a certain extent, unobliterated branchial cleft, but I was unable to account the pulsation, which was certainly not transmitted from acting as foreign bodies under the eyelids. In consequence for the underlying vessels. I was compelled to devise some other means for attaining As neither Mr. Deamer nor I have seen an exactly similar and succeeded the object, my by everting upper eyelid and stitching its ciliary edge in that position to the eye- case we should be glad of any assistance in arriving at a brow. The sutures employed were of very fine silver correct diagnosis, for which purpose, with his permission, I wire, as that material seemed to be the best for the pur- send this note.New Zealand. Christchurch, pose, being recommended by its complete pliability, its if being so readily fastened by twisting, and, necessary, being undone and readjusted ; it was also recommended by the thorough way in which it can be rendered A CASE OF UTERUS BICORNIS. aseptic. The patient’s eye was now treated as a of case extensive corneal abrasion. Atropine was instilled, BY JAMES B. TOMBLESON, M.B., B CH.OXON., and a plain dressing with vaseline and a sprinkling SENIOR OBSTETRICAL HOUSE PHYSICIAN, ST. THOMAS’S HOSPITAL. of dermatol was kept applied to the eye. The healing of the denuded portion of cornea was carefully gauged each I HAVE recently had under my care a case of uterus bicornis, day by the use of fluorescin, and when the process was completed after the lapse of four days the retaining sutures were with gestation in one horn, which I think worth reporting, removed. The patient was being attended in her confinement by an I have similarly applied the principle of this method with obstetric clerk from St. Thomas’s Hospital, who sent for marked success in a case of symblepharon posterius, in me as he thought that the case was a curious one of twins. which class of cases-contrary, I believe, to general usageI always remove flaps of bulbar conjunctiva and attach them On abdominal examination I found a large, almost symby buried sutures to the inner surface of the eyelid, as I find metrical heart-shaped tumour, reaching on each side nearly by experience that the recuperative power of a denudedz, up to the costal margin. There was a deep central sulcus portion of the bulbar conjunctiva is much more speedy and separating the two halves, of which the right was rather satisfactory than that of a corresponding area when situated larger than the left. I decided that probably a foetus lay in on the eyelid ; besides, by attaching the flaps to the bare each half of the tumour, which I had no doubt was the uterus, and as the pains were not very numerous or powerful I left vol. xv., p. 77. 1 Ophthalmic Review, 2 Ibid. the patient, resolving to see her later. Some hours
Clinical Notes:
MEDICAL, SURGICAL, OBSTETRICAL,
z