The immediate danger of the passage of a knife into the anterior chamber
of the eye is the wounding of the lens. To avoid this the point of the
knife should be always kept superficial to the iris if a clear lens be
present in the eye. After operation the chief danger is prolapse of the
iris into the wound. This is best avoided at the time of operation by
carefully replacing the iris with the spatula at the end of the
operation, but unfortunately prolapse not infrequently occurs during the
first few days owing to the reaccumulation of the aqueous in the
anterior chamber and its sudden escape through the imperfectly healed
wound as the result of straining or of some movement on the part of the
patient; the iris may be carried into the wound with the escaping
aqueous, and a fistulous opening or a scar may form subsequently (Fig.
80).
The less manipulation used consistent with the object of the operation
the less likelihood is there of cyclitis following it. All instruments
should be held lightly in the fingers, which should be as far as
possible responsible for the fine manipulation required. The part of the
hand not actually holding the instrument should be steadied on the face
before the instrument is brought in contact with the eye.
When more than one operation has to be performed on the same eye it is
desirable that all ciliary injection after the first operation should
have disappeared before the second is undertaken.
_Dressings._ A pad of sterilized wool, with a few layers of cyanide
gauze moistened with 1-6,000 perchloride of mercury lotion next the
closed eyelid, held in position by a bandage, is all that is necessary.
_Bandaging._ The bandage is started on the forehead over the affected
eye and is carried in a direction away from the eye to be covered. A
complete turn is made to encircle the head and is fixed with a pin. The
bandage is then brought up beneath the ear and over the eye and fixed
with pins on the forehead (Fig. 81). When absolute rest is desired, it
is necessary to bandage both eyes. After intra-ocular operations this is
desirable for the first three days. When pressure is desired, a
figure-of-eight bandage should be used (Fig. 82). A useful bandage
(Moorfield’s bandage) for occlusion of both eyes is made from
stockinette, which fits closely over the eyes and nose and is fastened
with tapes.
Public-domain text, read in full here on John Shaqi.
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