LUXATIO BULBI. DISLOCATION OF THE GLOBE OF THE EYE.
Definition. Dog, anatomical factors. Symptoms: protrusion of bulb through palpebral orifice, orbicular spasm, vessel, muscle, nerve stretching or tearing. Sphacelus. Panophthalmia. Fracture of orbit. Treatment: early reduction, antisepsis, astringents, scarify sclera, cold, astringents, puncture aqueous with hypodermic needle, enlarge palpebral opening, suture and compress, remove foreign bodies and injurious fragments of tissues, enucleation.
Definition. Displacement of the globe of the eye out of the orbit and through the eyelids.
Causes. Among domestic animals the condition is most frequently seen in the dog, which is predisposed by reason of the normal prominence of its eye, the width of the aperture between the lids and the absence of the orbital process of the frontal bone. Blows upon the region and the insertion of pointed bodies, (teeth, horns, etc.), which can act as levers using the margin of the orbit as a fulcrum are especially liable to cause the lesion. Dog fights are the most common occasions. Other animals may also suffer but not at all frequently.
Symptoms and lesions. In the simplest form the bulb is displaced forward out of the orbit and through the palpebræ which latter contract spasmodically behind it and effectually prevent a spontaneous reduction. The optic nerve, muscles, and vessels are unduly stretched and the circulation in the bulb is seriously impaired, so that even in the least complicated cases any undue delay in reducing the dislocation will lead to serious and destructive changes in the eye. Sphacelus of the globe is not uncommon under such conditions.
In the more complicated cases, the conjunctiva, palpebræ, nictitans, muscles, nerves, etc., maybe more or less lacerated and the globe itself may be seriously damaged either by internal lesion or by an external trauma. In all these cases there is most imminent danger of general infective inflammation of the eye, of panophthalmia, and even of secondary general infection of the system. Fracture of the bones of the orbit may also be looked for.
Treatment. When dislocation is uncomplicated and recent, say of a few hours standing only, it may be reduced and a favorable issue secured. The bulb should be first washed with water which has been sterilized by boiling or rendered antiseptic with sublimate (1 ∶ 5000), and can usually be pressed back by steady uniform pressure. The insertion under one lid of a small spatula bent at the end or the one limb of a lid speculum may assist in difficult cases. When replaced the parts may be again washed with antiseptic solution and covered by a bandage wet with an astringent collyria.
When the condition has been neglected for a day or more the bulb is congested and swollen so that its return is rendered much more difficult, and its subsequent retention may require much care and ingenuity. The reduction of the turgid globe may be assisted by opening the veins and arteries on the sclera, by astringent applications, by massage, and in obstinate cases by evacuation of a portion of the aqueous humor, by the aid of a fine aseptic needle. Finally the palpebral opening may be enlarged by incising the outer canthus with a probe pointed bistuory. When the eye has been replaced in its socket this must be closed by suture. For the retention of the eye in such cases a bandage may suffice, or this failing, the lids may be held together by strips of adhesive plaster, or by collodion. In very difficult cases Lafosse and Trasbot recommend sutures through the skin 1½ to 2 inches from the palpebral borders and the whole covered with a bandage impregnated with an antiseptic and astringent collyrium.
It is not requisite to keep the bandage in position for over four or five days as the swelling of the eyelids and other adjacent structures effectually prevents any tendency to repetition of the luxation, and the eye may be treated like an ordinary traumatic lesion.
At the outset, and later if need be, any foreign body in the orbit should be removed and any detached pieces of bone which cannot be retained firmly in position, and which are liable to prevent healing or to determine infection of the wound.
In the worst cases and in those that have been neglected until gangrene or panophthalmitis threatens, the removal of the eyeball may be the only resort. The animal may be anæsthetized by chloroform or ether, or locally by cocaine. The conjunctiva covering the sclera is then pinched up with forceps and cut through with scissors, this is continued all around the globe. Then the recti muscles, the superior and inferior oblique muscles, the retractor and finally the optic nerve are cut through with a pair of scissors curved on the flat. The divided ends of the muscles are now sutured together around the nerve which has been cut shorter, and the cavity irrigated by a cold antiseptic solution. Bleeding vessels may be twisted through with forceps if the flow is not readily checked by cold irrigation. Or a pledget of cotton dipped in tincture of muriate of iron may be loosely inserted (firm pressure would be unnecessarily painful). As a subsequent dressing, standard sulphurous acid solution, glycerine and water in equal proportions, or other antiseptic dressings may be applied.