Foreign bodies lodged in the conjunctival sac, unless embedded in the conjunctiva, are usually found by the surgeon under the upper lid, the sulcus subtarsalis being a favourite situation. They are easily removed with a spud or needle, after the instillation of a drop of 4% cocaine solution. Subsequently the eye should be bandaged for a few hours until the effect of the cocaine has passed off, as in wiping the eye the patient may wipe off the epithelium of the cornea whilst it is insensitive from the cocaine.
In order to evert the upper lid the patient is made to look strongly down, the eyelashes are seized between the thumb and forefinger of the left hand, the skin of the upper lid is pushed down above the tarsal cartilage with the thumb of the right hand, and the lid is everted by pulling it upwards against the point of the thumb.
OPERATION FOR PTERYGIUM
Indications. Pterygium should be removed when advancing across the cornea, especially when the pupillary area is becoming involved. The operation of ablation is the one now generally in use.
Instruments. Speculum, straight iris forceps, small sharp-pointed scissors.
Operation. Under adrenalin and cocaine the neck of the pterygium is seized with the forceps and the body and neck are carefully dissected from the conjunctiva. The body and neck should be very carefully separated right up to the corneal margin by means of forceps and scissors. The head is then stripped off the cornea with a sharp pull. The wound in the conjunctiva should be subsequently closed with fine sutures, otherwise the disease will certainly recur. In stripping the head from the cornea some of the epithelium may be torn off with it. This usually regenerates without impairing the vision.
EXPRESSION
This is an operation for the removal of follicular formations in the conjunctiva, and is used more especially in trachoma.
Instruments. Graddy’s forceps (Fig. 129), fixation forceps.