Extirpation, by means of a small pointed knife, or curved scissors, is
the only means to be relied on for the cure of such warty tumours, and
of encanthis. The growth must be fixed and pulled outwards with a small
hook, and carefully dissected away; the eyelids, and, if necessary,
the ball of the eye, being kept fixed with the fingers, or by means of
a speculum: the fingers are generally sufficient, and more convenient
than any instrument. If from the appearance of the parts, and from
induration surrounding the tumour, malignant action has evidently
taken place or is dreaded, then the incisions must be made wide of the
base of the swelling. For malignant, open, and extensive ulcerations,
nothing can be done farther than to allay the pain, and soothe the
constitutional disturbance. On the whole, encanthis is a rare disease;
however, I have seen, and operated on, several instances of it.
[Illustration]
_Encysted Tumours of the Eyelids._—These occur beneath the conjunctival
lining of either the upper or under lid, but most frequently in the
former. They form rapidly, but seldom attain any very considerable
size; and may be found to contain, along with glairy fluid, a mixture
of pus, or curdy matter. The contents, however, are generally glairy,
rarely atheromatous. The cysts are very thin and adherent, and the
tumour projects externally, forming a dusky red elevation of the
integuments. They cause considerable deformity, watering of the
eye, and stiffness and difficulty in moving the lids. On everting
the eyelid, the contents of the tumour are seen shining through the
distended conjunctiva, and present a bluish appearance. They are seldom
single, and are not remediable but by operation. It is improper to
attempt their extirpation from without, as there is a certainty of
cutting completely through the eyelid, the inner covering of the cyst
being merely attenuated conjunctiva. The lid is to be everted, and
an incision made into the prominent and thin cyst with the point of
a cataract knife; the contents can then be readily scooped out with
the end of a probe. It is impossible to dissect out the tender cyst
entire, and, when this is attempted, the cure can seldom be permanent.
If, after incision and discharge of the contents, nothing farther is
done, the disease will almost certainly return, in consequence of the
remaining cyst reassuming a secreting action. The only effectual and
radical cure is the application of a finely-pointed piece of caustic
potass to the interior of the cyst, after discharge of the contents and
cessation of bleeding. The cyst is thereby completely destroyed. A slip
of soft lint, dipped in oil, is interposed betwixt the lid and eyeball,
for an hour or two, in order to protect that delicate organ from the
caustic. The wound suppurates and heals kindly, and no mark is visible,
the incision having been made from within. I have had no instance of
return of the disease since adopting this practice; and I have operated
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