The advantage of this operation over the other substitutes for simple enucleation is that it can be used after any enucleation. The chief disadvantages are that the globe is sometimes extruded unless the wound be carefully closed by sutures, and occasionally it may become dislocated from Tenon’s capsule beneath the conjunctiva, thus preventing an artificial eye from being worn, and requiring removal. These disadvantages are largely done away with if the method of suture described above be used.
OPERATIONS UPON THE SOCKET AFTER THE REMOVAL OF THE EYE
PARAFFIN INJECTION
Indications. Occasionally after an eye has been removed the movements in the socket are not communicated sufficiently to the artificial eye which is placed over it, so that the glass eye has a fixed, staring appearance. As a rule, this can be remedied by the use of a Snellen’s improved eye, which has a rounded posterior surface and fits well on to the stump. If this be not satisfactory, the injection of paraffin into the stump will often improve the movements considerably. The injection should be made by what is known as the ‘cold method’.
The ‘cold method’ of paraffin injection is by far the most satisfactory, for the following reasons:—
(a) The temperature need not be so high, and no damage is therefore done to the tissues.
(b) It is more easily regulated (see Vol. I, p. 682).
(c) Embolism is less likely to occur.
Instruments. Fixation forceps, tenotomy knife, speculum, a large paraffin syringe, and a short needle having a big bore.
Operation. This may be performed under adrenalin and cocaine.