_The direction of an incision_ into the globe should be as oblique as is
consistent with the object of the operation, so as to allow larger
healing surfaces to come into apposition. With this object in view it is
desirable that a conjunctival flap should be formed to all wounds
wherever possible (Fig. 78). Further, owing to the extreme vascularity
of the conjunctiva, as has been shown elsewhere,[3] wounds in it become
firmly united after 48 hours. As a rule sutures are best avoided and are
seldom required.
[3] Mayou, _Hunterian Lectures_, 1905.
_Position of the incisions._ Corneal incisions are to be avoided, if
possible, for the following reasons: firstly, the cornea being free from
blood-vessels heals comparatively slowly; secondly, the wound is liable
to become fistulous owing to the rapidity with which the epithelium
grows down the side of the wound. On the other hand, incisions situated
from 3 to 6 millimetres behind the limbus are liable to injure the
ciliary body, and, in addition to irido-cyclitis being set up by the
trauma, the iris or ciliary body will prolapse into the wound and
prevent the union of its edges, with the result that sepsis may spread
into the globe along the prolapsed portion of the uveal tract and set up
an irido-cyclitis which may not only ruin the eye affected but may also
cause a sympathetic irido-cyclitis in the other eye (Fig. 79).
[Illustration: FIG. 79. SYMPATHETIC OPHTHALMIA. The exciting eye of a
case following cataract extraction. The section shows the incarceration
of the iris in the wound.]
[Illustration: FIG. 80. CYSTOID SCAR AFTER GLAUCOMA IRIDECT]
_The site of election of an incision_ into the anterior part of the
globe is therefore about 1 millimetre behind the limbus; that is to say,
as near the cornea as is consistent with obtaining a good conjunctival
flap to cover the wound in the globe (Fig. 78). When possible it is
advisable to make all incisions in an upward direction for the following
reasons: They are more easily performed; any deformities, such as an
iridectomy, are hidden by the upper lid; more perfect rest is obtained,
as the wound is not exposed in the palpebral aperture, the eye being
turned upwards when the lids are closed.
[Illustration: FIG. 81. AN EYE BANDAGE. The first turn, A, encircles the
head and is fixed with a pin. This portion of the bandage can be put on
before the operation and obviates movement of the head. The turn B is
then brought up below the ear and fixed with pins.]
[Illustration: FIG. 82. A PRESSURE BANDAGE. The first turn of a
1-1/2-inch bandage encircles the head. It is then carried beneath the
ear and over the head in a figure-of-eight. The final turn goes round
the head and is fixed by a pin at the point of crossing of the previous
turns.]
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