Sepsis after intra-ocular operations manifests itself in one of two forms: either by suppuration, which usually ends in a rapid and complete destruction of the eye (panophthalmitis), or more rarely in less virulent cases by recurrent attacks of hypopyon associated with acute irido-cyclitis; or by a plastic irido-cyclitis, which may lead to slow disorganization of the eye, with always the possibility of destruction of the other eye by sympathetic cyclitis (sympathetic ophthalmia). Although these conditions are comparatively rare, owing to the improvement in modern aseptic and antiseptic methods, every surgeon of experience will meet with these disastrous complications; indeed it has been suggested that immunization with staphylococcus vaccine should be carried out before major intra-ocular operations, since infection is generally due to this organism. [Illustration: FIG. 76. LANG’S EYE SPECULUM. Designed to hold the lashes away from the field of operation.] _The methods of purifying the eye before operation._ On the second night previous to the operation the eye should be bandaged and examined the following morning for conjunctival discharge. If any be present, an examination for organisms should be made, and the operation postponed until the conjunctival condition has improved. In the event of the case being extremely urgent, the conjunctiva should be swabbed over with nitrate of silver (10 gr. to the oz.) immediately before the operation; some surgeons prefer 1-2,000 perchloride of mercury. If lachrymal obstruction be present, the sac should be thoroughly washed out with boric lotion and protargol (10%) injected. The canaliculi may be temporarily occluded subsequently (see p. 294). If the lashes be very long they should be cut short. Epilation is performed by some Continental surgeons, but is not practised in this country. Various forms of specula are made to keep the lashes out of the field of operation; of these, a modification of Lang’s is perhaps the best (Fig. 76). On the morning of the operation the lids should be thoroughly cleansed with soap and water, followed by 1-2,000 solution of perchloride of mercury, special attention being paid to the lid margins and lashes. The conjunctival sac should be washed out with boric lotion and a pad of cyanide gauze applied over the closed lid. GENERAL CONSIDERATIONS AS TO MAKING AND HEALING OF WOUNDS IN THE GLOBE It has already been pointed out that the great danger in intra-ocular operations is sepsis. It is the aim and object of every ophthalmic surgeon to make such wounds into the globe as will become rapidly shut off from the conjunctival sac. Delay in the healing tends to the formation of a fistulous opening into the globe. This aperture in the continuity of the globe may lead either directly on to the surface or beneath the conjunctiva, subsequent inflammation in which may spread to the interior of the eye. [Illustration: FIG. 77. UNDINE FOR WASHING OUT THE CONJUNCTIVAL SAC.]