The aseptic treatment of wounds in ophthalmic surgery / by Angus McGillivray.

  • MacGillivray, Angus.
Date:
1898
Catalogue details

Licence: Public Domain Mark

Credit: The aseptic treatment of wounds in ophthalmic surgery / by Angus McGillivray. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

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    operation. We, however,prefer the patient to be in hospital for at least a couple of days before being operated on, so that be may become accustomed to his new surroundings. On the morning of the operation, and about an hour and a half before the surgeon’s arrival, the eyelashes are cut short, and the face and eye are treated as on the day of admission. Sterilised cocaine drops 5 per cent, are in- stilled into the eye for twenty minutes before operating’ to ensure complete anaesthesia of the deeper parts, corneal desiccation being prevented by keeping the eyelids closed. The surgeon wears a white operating jacket, closely fitting at the neck, with sleeves rolled halfway up the forearm. His hands are very carefully washed in water, and disin- fected with a carbol-sublimate solution, which is removed before operating by washing the hands in sterilised water. The margins of the eyelids, especially the openings of the Meibomian ducts, are gently rubbed with a sterilised mop and saline solution. This mechanical cleansing can be carried out without irritating the eye if the margins of the eyelids, after being approximated, be pressed to- gether until they become slightly everted. After this the patient is directed to keep opening and closing his eyelids while a stream of saline solution at the tem- perature of about 90° F. is made to play over the eyeball. The upper lid is then everted, and the conjunctival surface of the tarsus carefully cleansed by pouring the solution from a little height. The cleansing of this part of the conjunctiva is very important, seeing that the tarsus is to lie in actual contact with the wound, and in reality form the innermost and therefore the most important part of the dressing. The lower cul-de-sac is in turn exposed and douched, and the lachrymal sac emptied by making firm pressure over it with the finger. Flushing the lac- rymal sac and tear duct on the evening before operation was practised by us for some time, but was abandoned about eighteen months ago, because it produced more or less redness and irritation of the conjunctiva at the inner cauthus. The upper cul-de-sac receives attention next.