Immediate. Cutting into the globe. This may occur during the division of the optic nerve, and is usually due to imperfect dislocation of the globe. Although of little consequence as a rule, it may be extremely serious, as for instance in the case of an intra-ocular growth, when it is conceivable that a portion of it might be left behind. If this accident should happen, the portion of the sclerotic and choroid left behind should be carefully sought for and removed.
Adhesion of Tenon’s capsule. Eyes that have been the subject of acute inflammation are much more difficult to enucleate, owing to adhesion of the surfaces of Tenon’s capsule. In these cases the globe has practically to be dissected out of that structure.
Remote. Hæmorrhage into the stump may occur, leading to proptosis of the conjunctiva and extravasation into the eyelids and beneath the skin of the face. The use of a firm pressure bandage and the omission of the suture is usually sufficient to prevent this occurring, but the blood-clot may have to be turned out and the bleeding point sought for and ligatured.
Granulations and polypi in the socket are usually the result of leaving some tag of tissue between the margins of the wound, and are therefore more likely to occur when no suture is used to close the wound. They should be removed with forceps and scissors.
Polypoid masses sometimes form in a socket as the result of an imperfect artificial eye causing an œdematous condition of the conjunctiva. They should not be removed, owing to the contraction caused thereby, but the artificial eye should be left out, when they will often disappear.
Contracted socket is usually the result of an imperfectly performed enucleation or loss of large portions of the conjunctiva; for the operations for its relief, see [p. 261].
EVISCERATION
Evisceration is the removal of the intra-ocular contents.
Indications. It is the ideal operation for a suppurating globe; in these cases enucleation is contra-indicated because the lymph-space round the optic nerve is opened up by the division of the latter and the inflammation may spread directly to the meninges.