These adhesions not only restrict the movements of the lids, preventing their opening and the exposure of the bulb, but they also anchor the bulb itself, and hamper its movements, necessitated for vision. In all cases therefore of wounds, burns, abrasions and ulcers, of the palpebral and bulbar mucosæ it is highly important to take precautions against the formation of such connections. Any forming adhesions must be broken up day by day and the surfaces must be kept apart in the intervals by borated or iodoformed vaseline.
In a small anterior symblepharon the connections may be cut through and subsequent adhesion prevented by the frequent introduction of iodoformed vaseline, and if need be, by the daily separation of the surfaces by a probe. When this fails a plastic operation may be resorted to, the mucosa on the inner side of the lid being incised in a vertical direction a short distance on each side of the sore and the inner edges accurately stitched together. The raw surface left on the bulb thus comes in contact only with the healthy mucous strips on the eyelid, which have been drawn together over the seat of the former sore, and the two new raw surfaces formed on the lid are well to each side of the sore on the bulb, and are in contact with its healthy mucosa only. Thus no two raw surfaces can come in contact, and adhesion is obviated.
When the fornix is implicated mucous membrane from the mouth, vulva, the bronchia of the rabbit, or the skin of the frog must be transplanted after the requisite incision of the cicatrix has been made.
INFLAMMATION OF THE EYELIDS. BLEPHARITIS.
Phlegmon. Causes: traumas, skin disease. Symptoms: swelling, redness, distortion, infiltration, semi-closed lids, scabs, sloughs, abscess. Tenderness. Itching. In eczema papules, vesicles, weeping eye. Treatment: antiseptic astringent lotions, almond oil, vaseline, zinc oxide, salicylic acid, boric acid, starch, xeroform, pyoktannin; for eczema, mercury oxides, silver nitrate.
Conjunctivitis will be treated later, and under the present head there will be considered only the phlegmon of the outer structures.
Causes. This lesion may come from two distinct causes, traumatism and skin disease. The traumatisms in horses and cattle are bruises sustained in rolling, especially during colics, in striking the head against posts, poles, shafts and other solid bodies, in enduring blows with horns or clubs, or frictions by the halter or in putting on a collar. Dogs suffer especially from blows with clubs and kicks from men or animals. All may suffer from wounds of the lids, and from extensions of eczema and other skin diseases.
The symptoms consist in swelling, redness, distortion, and often extensive infiltration of the lid, sometimes eversion with exposure of the reddened conjunctiva, usually abrasion, contusion, puncture or laceration, semi-closed eye, the upper eyelid being comparatively immovable (ptosis), and the formation of scabs, sloughs, or abscess. There may be extreme tenderness, or, more commonly, intense itching. Where eczema exists there may be found minute shot like papules at times surmounted by small vesicles and the skin disease is continuous backward upon the face. When abscess forms, the rounded swelling and manifest fluctuation will betray its presence. Usually the eye waters and the side of the cheek is wet and the hairs matted by a whitish coagulated lymph and mucus.
Treatment. In the early stages without scabs, sloughs, or abscess, antiseptic astringent lotions are in place. Weak solutions of zinc sulphate, boric acid and morphine may be kept applied on a light bandage. Or silver nitrate 1 gram to 1 oz. water may be applied daily with a fine brush.
When scabs and crusts have formed they may be softened by the application of almond oil, and then removed. The surface may then be dusted with a bland antiseptic powder such as: zinc oxide 10 parts, salicylic acid 1 part; or boric acid and starch equal parts; or iodoform; or xeroform. Or unctuous applications may be used; zinc oxide 10, salicylic acid 1, vaseline 10; or iodoform 1, vaseline 5. Or a watery application may be used, such as the silver lotion or that of pyoktannin 1:1000.