Ophthalmic notes / by C. R. Agnew.

  • Agnew, Cornelius Rea, 1830-1888.
Date:
1874
Catalogue details

Licence: Public Domain Mark

Credit: Ophthalmic notes / by C. R. Agnew. Source: Wellcome Collection.

Provider: This material has been provided by UCL Library Services. The original may be consulted at UCL (University College London)

    4/30 (page 4)
    examined the case by means of oblique illumination and the ophthalmoscope, and agreed with me as to its nature, and that the very minute black speck in the bottom of the sinus was not a pigmentary product in the inflamed cornea. It was evident that enucleation was inevitable unless the foreign body could be removed. It occm-red to me, as I could not re- move the foreign body alone, that I might remove, by means of the trephine, the disc of corneal tissue which included it, and thus remove the cause of the kerato-iritis and of the sympathetic trouble in the fellow eye. We placed the patient under ether, held the eye under fixation forceps, and without difficulty re- moved a disc of corneal tissue, the exact centre of which was the opening of the sinus holding the foreign body. Although we applied the trephine perpendicularly to the corneal surface, we did not cut through into the anterior chamber so as to com- plete the circle at once, but so as to leave a small segment of the deep surface of the disc to be cut by the scissors. Kemoving the disc and examining the sinus in its centre, no foreign body could be found, as the black speck had disappeared. This speck had not dropped through the sinus into the anterior chamber, as there was no opening in that direction ; it could not be found floating on the surface of the eyeball, or in the infe- rior conjunctival cul-de-sac, and it is not probable that it got into the anterior chamber through the wound made by the trephine, as the kerato-iritis soon subsided and the eye regained a healthy state, and all sympathetic trouble in the fellow eye disappeared. The question remains, what became of the ex- reme ly minute black speck which was seen in the cornea before the operation, and could not be found in the disc of corneal tissue removed. In using the corneal trephine it is observed that the disc of tissue which it cuts out is more or less crumpled by the rotatory motion, and reasoning upon this fact, we were led to believe that the foreign body was worked out from the depth of the sinus, and washed away unseen by the free escape of aqueous humor and tears. No prolapse of iris followed the trephining, and under simple dressing, with a light bandage, the eye soon recovered without synechia anterior. The symptoms of kerato-iritis rapidly vanished, the cornea be- came much clearer except where the scar was left by the trephine.