WIDENED PALPEBRAL FISSURE.
After wounds of the outer canthus the union of the edges may remain imperfect so that the fissure is enlarged and the eye unduly exposed. The case is still worse if the wound has deviated from the horizontal and has involved the orbicular muscle, the divided ends of which continue to draw the edges apart, and cause a constant overflow of tears (epiphora). Enlargement of the bulb or its protrusion by reason of a swelling beneath it may give rise to the same appearance (exophthalmos).
Treatment. Pare the edges of the upper and lower lids at the outer canthus and bring them together by sutures.
LAGOPHTHALMOS. INABILITY TO CLOSE EYELIDS.
This is called hare-eye (lagos, hare) from the fact that the hare habitually keeps the eyelids open. It is mostly due to spasm of the levatores palpebræ, or to undue size of the orbicular opening. It may, however, accompany ectropion, exophthalmos, and enlargement or swelling of the eyeball from any cause. Bayer has seen cases in diseases of the trifacial nerve, in neoplasms in the orbit and in buphthalmus.
Cases of the kind are especially liable to irritation, inflammation and ulceration due to foreign bodies falling on the exposed bulb.
The treatment is largely that of the attendant condition ectropion, tumor, etc., which may be consulted.
ADHESION OF THE EYELID TO THE BULB. SYMBLEPHARON.
Causes: Conjunctivitis, burns, operation and other wounds. In front of or behind the reflection of the mucosa from eye to lid. Prevention. Treatment: section of adhesion, and vaseline, etc., Two edges of healthy mucosa sutured together over the sore. When fornix is implicated mucosa is transplanted.
This is liable to occur to a greater or less extent, in all animals, in connection with violent conjunctivitis, burns and operation and other wounds. It has been divided into anterior and posterior symblepharon, the former being an union in front of the normal reflection of the conjunctiva from the lid upon the bulb (fornix), and the latter involving the fornix in the substance of the adhesion. The anterior form by anchoring the lid to the eyeball is much more likely to induce blindness, but it has the compensation that the union may be broken up and the parts healed without subsequent reunion. In the posterior form the eye can be better exposed and vision retained, its repair is much more difficult demanding transplantation of skin or mucous membrane on to the sore, and even then the granulation tissue being continuous from bulb to eyelid may so contract in healing as to leave matters no better than before.