WOUNDS OF THE EYELIDS.
Traumas: bites, lacerations, blows, penetrating wounds, gunshot, scratches, kicks. Upper lid or commissure. Reparatory power of eyelid. Danger of distortion. Treatment: sutures, plaster, shellac, collodion, gelatine, Frick’s gelatine, birdlime, sterilisation: Quilled and twisted suture. Position in stall. Metallic guard for eye.
Causes. Traumatic injuries of the eyelids are especially common in the horse mainly because of his exposure in connection with the services required of him. In a team he is liable to be bitten by one of his fellows, or the lid may be caught on nails, in turning, or on hooks upon harness, chains or wagons. It is sometimes injured by a blow from a club or whiplash, or by knocking the head against solid objects that he failed to see on account of the blinds. Again the injury will come from running against prongs of bushes or trees, or of stump fences. Occasionally a blow with the horn of an ox or cow is the cause, but this is much more frequent with the bovine races. Then again gunshot wounds are found in all animals. In sheep the eyelids sometimes suffer from bites of dogs, while in dogs and cats, the teeth and claws are the main causes of injury. These smaller animals also suffer from brutal blows and kicks.
Nature. Wounds of the eyelids almost invariably affect the upper lid, because of its extra size and prominence. Sometimes one commissure or the lower lid is the injured part.
Clean incised wounds are rare, while lacerations with or without contusions are the common experience. The laceration often extends through the free margin of the lid, and then to one side, mostly the outer, in a direction more or less parallel to the tarsus. The result is that the detached flap drops downward exposing a greater or less portion of the bulb covered with blood. The conjunctiva, the cornea, the sclerotic or iris may be implicated in the lesion in different cases, so that such wounds are of the most varied degree of gravity. If, however, the lesion is confined to the lid, and in the absence of absolute detachment of the flap, or severe contusion, a good repair may be confidently hoped for. The vascularity and reparatory powers of the eyelid are unusually great, and the looseness of the skin, connective tissue, mucosa, and even the muscles is such that they do not draw injuriously upon the edges of the wound to disturb the process of cicatrization. If the two opposing ends of the divided tarsal cartilage are kept in accurate opposition, the elasticity of his structure serves to preserve the even contour of the palpebral margin, and the adhesion or granulation process between the edges of the wound, soon becomes firm enough to prevent further displacement. Even when one-half of the eyelid is torn loose, remaining attached only by a narrow portion, reunion without any unsightly distortion is not to be despaired of. In case of a mere vertical laceration on the other hand, the case is very simple and hopeful. Even when a portion of a lid has been completely torn off and lost, the loose textures of the remaining part, often appear to stretch in the process of healing so that a fairly serviceable, though by no means an æsthetic covering for the eye may remain. This may serve for a common work horse, but the unsightliness would necessarily debar him from use in a carriage or as a saddle horse. The imperfect protection too, exposes the eye to rainstorms, hail and snow, as well as to dust, and greatly predisposes to conjunctivitis.
Treatment. One can trust implicitly to the extraordinary reparatory power of the eyelids, yet so unsightly is any distortion of these parts, that the greatest pains must be taken to obviate loss of substance, or unevenness or puckering in healing. The points to be mainly sought for are the perfect coaptation of the divided edges, and the restraining of the patient from interrupting the healing process and breaking loose the forming adhesions, by rubbing the eye.
Inconsiderable wounds of the skin may be simply stitched together with sterilized catgut. Then the intervals between the stitches may be approximated, dried, and covered with strips of sticking plaster, or with shellac, collodion or gelatine. Frick’s gelatine is made by dissolving fine gelatine in a 1 per cent. solution of corrosive sublimate and adding about 10 per cent. of glycerine, perfecting the admixture by the aid of heat. When wanted for use it may be melted by heat and applied on the skin with a camel’s hair brush. Bird lime may be used as a substitute. Sterilization must be sought by the use of sublimate lotion 1:2000, or boric acid 2:100. Formerly the edges were kept in close opposition by the use of quilled sutures, the stitches passed around the quills being inserted at the usual distances while the quills, applied against the edges of the wound kept them smooth and even and obviated puckering. Or, perhaps better, the twisted suture may be employed, the edges being brought together by pins placed close together and a silk thread carried around each in figure of 8, and spirally from pin to pin along the entire length. If one pin comes out it ought to be promptly replaced and the whole left in place until a firm adhesion is established. The points of the pins are cut off short so that there may be no risk of their pricking.
With any method the horse or ox may be turned in his stall so that his tail may be toward the manger and his face outward, and he may be tied by two halters to the two posts, right and left. His food may be furnished in a sack hung from the ceiling and cut down one side. In this way the animal may be absolutely prevented from rubbing the itching sore against any solid body, and thereby interrupting the healing process. Another method is to apply a hood of stiff material with a metallic guard for the face, having bars extending from above downward and arched outward so that they shall effectually protect the eye in any attempt at rubbing.