When _staphyloma_ is small, neither impeding the motions of the
eye, nor preventing its being protected by the lids, no surgical
interference is called for, as the loss or impairment of vision cannot
be remedied, and as no other inconvenience than blindness is produced
by the change of form in the part. But when the diseased cornea
projects from between the eyelids the prominence must be diminished,
on account of the deformity which it occasions, and in consequence
of the eye being deprived of its natural protection of the lids, and
being thereby exposed to constant irritation. In such cases it is
necessary to take away a portion of the cornea, that the eye may be
so diminished in bulk as to retract within the eyelids; the size of
the part removed must be proportioned to the degree of protrusion. A
cornea-knife is passed into the prominence, and carried forwards so as
to transfix the part, in a direction from the external to the inner
canthus; and by the knife being carried on, with its cutting edge
looking downwards, a flap of the cornea is made. This flap is then laid
hold of by means of forceps, and removed either with the knife or with
scissors. The aqueous humour immediately escapes, and in most cases
the crystalline lens and vitreous humour are also discharged. The eye
consequently shrinks, and retracts within the palpebræ. The cut margins
of the cornea soon assume a reddish appearance—they form granulations,
the wound contracts gradually, and ultimately closes; but the eye is
necessarily much shrunk, and totally useless as an organ of vision.
Generally suppuration takes place, causing complete disorganisation of
the parts; and the preceding inflammatory action may be so intense,
and attended with so much constitutional disturbance, as to require
active measures for its moderation. Deformity may be in a great measure
removed by adapting an artificial eye to the shrivelled remains of
the natural one. When it is necessary to remove only a small part of
the cornea, the aqueous humour alone escapes, and during the cure of
the wound the patient not unfrequently enjoys a tolerable degree of
vision; but after the wound has completely closed, vision is again lost
completely.
Public-domain text, read in full here on John Shaqi.
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