SECT. XV.—ON ADHESION OF THE EYELIDS.
The upper eyelid undergoes adhesion sometimes to the lower tarsus, sometimes to the tunica adnata, and sometimes to the cornea itself. This disease obstructs the motions of the eye. Wherefore, applying an ear-specillum to the broad margin of the eyelid, or stretching it with a hook-like instrument, we free the adhesion with the scalpel used in the operation for pterygia, taking care that the cornea be not wounded, lest we give rise to procidentia. After the incision, having bathed the eye, we separate the eyelids with tents, lest adhesion again take place, and applying wool, soaked in an egg, after the third day we have recourse to attenuant and healing collyria.
Commentary. See Aëtius (vii, 66); Celsus (vii, 7); Albucasis (Chirurg. ii, 15); Avenzoar (i, 8, 5); Avicenna (iii, 3, 8, 10); Haly Abbas (Pract. ix, 22); Alsaharavius (Pract. iv, 5); Rhases (Cont. ii); Jesu Hali (ii, 7.)
The description given by Aëtius is exactly the same as our author’s.
Celsus correctly remarks that the disease is the consequence of neglected ulcers. He describes the operation in the following terms:—“Igitur aversum specillum inserendum deducendæque eo palpebræ sunt: deinde exigua penicilla interponenda, donec exulceratio ejus loci finiatur.” He mentions that Heraclides of Tarentum directed the eyelid to be dissected from the white of the eye when there is adhesion between them; but recommends us to do it cautiously with an averted specillum (dos de la spathule, Fabr. d’Aquapen.), taking care to wound the eyelid rather than the ball of the eye. Suitable ointments are afterwards to be applied. Yet he says that he never saw a case thus cured; and states, that Meges likewise thought the disease incurable.
In order to understand the above description of Celsus it may be useful to give from Fabricius some account of the ancient specillum. “Il nous suffit scauvoir que specillum (qui est le mot Latin de Celse) est un instrument long et rond, de cuivre, d’argent, ou de plomb, duquel on sonde les fistules, ayant un de ses bouts plus large, et l’autre plus étroit, en vulgaire Italien stilo.” (Œuv. Chir. ii.) It was, therefore, a sort of sound.
Avenzoar directs us to make the separation by means of a golden rod or probe, and then to apply the white of an egg broken with oil of roses and oil of almonds. When the eyelid adheres to the white of the eye he advises us in like manner to make the separation gently with a golden spatula, and then to apply the oil of roses and of almonds. But the latter case, he says, is difficult to cure.
Of the other Arabians, Albucasis and Haly Abbas evidently copy the description of the operation given by Paulus; and Rhases and Avicenna supply no additional information. Jesu Hali’s description is accurate, but similar to that of Celsus.