_Contracted socket_ is usually the result of an imperfectly performed enucleation or loss of large portions of the conjunctiva; for the operations for its relief, see p. 261. EVISCERATION Evisceration is the removal of the intra-ocular contents. =Indications.= It is the ideal operation for a suppurating globe; in these cases enucleation is contra-indicated because the lymph-space round the optic nerve is opened up by the division of the latter and the inflammation may spread directly to the meninges. =Instruments.= Speculum, fixation forceps, Beer’s knife, scissors, scoop and stitches. =Operation.= A general anæsthetic is necessary. _First step._ The eye is transfixed about 4 mm. behind the corneo-sclerotic junction with a Beer’s knife, which is made to cut out upwards (Fig. 135). The flap of corneal and scleral tissue is then seized with forceps and the cornea removed entirely by completing the incision in the sclerotic round it with scissors (Fig. 136). _Second step._ The contents of the globe are then eviscerated by means of a spoon, and the cavity flushed out with 1 in 4,000 perchloride of mercury lotion. Great care should be taken to remove all portions of the uveal tract; this is best ensured by visual inspection after the hæmorrhage has ceased. The interior of the sclerotic should appear perfectly white. [Illustration: FIG. 135. MULES’S OPERATION. _First step._ Excision of the cornea.] [Illustration: FIG. 136. MULES’S OPERATION. The completion of the excision of the cornea with scissors.] _Third step._ Although not absolutely necessary, and inadvisable in the case of a septic globe, a single suture may be passed through the centre of the wound in the conjunctiva and sclerotic. =Complications.= As the operation is not infrequently performed for panophthalmitis, much swelling of the lids and discharge from the socket may take place after the operation; these symptoms usually subside in the course of a few weeks without further trouble. The interval which must elapse before an artificial eye can be worn is considerably longer than after enucleation. MULES’S OPERATION Mules’s operation is the insertion of a celluloid globe into the sclerotic after evisceration, followed by closure of the scleral wound over it. In both this and Frost’s operation a better stump is formed, so that more movement may be obtained in the artificial eye which is subsequently worn over the inserted globe. =Indications.= (i) The operation is especially suitable for anterior staphyloma following ophthalmia neonatorum. In young children the presence of the ball in the orbit assists the development of that structure. (ii) It is also suitable for large, recently made, fairly aseptic wounds in the globe. =Operation.= The _first two steps_ are the same as for evisceration.