First step. The stump is drawn forwards with forceps. A tenotomy knife, inserted well to the outer side of the stump, is then swept freely round and a pocket is formed in the centre of the orbit into which the injection can be made. The tenotomy knife is then withdrawn.
Second step. The sterile melted paraffin (melting-point 115° F.) should be poured into the syringe, which should have been previously kept in a hot-water bath. The paraffin is then allowed to cool slowly until it just becomes opalescent. The injection should be made through the hole made by the tenotomy knife, sufficient paraffin being inserted to obtain the desired result. The operation is usually followed by considerable swelling of the tissues, which will subside in three or four weeks.
OPERATIONS FOR THE RESTORATION OF A CONTRACTED SOCKET
As the result of wearing badly-formed artificial eyes or of subsequent inflammation in the conjunctival sac, the socket not infrequently becomes so contracted that the prosthesis cannot be retained. Enlargement of the sac may be obtained by two methods:—
(a) Skin-grafting (Thiersch’s method).
(b) Transplantation of skin from the surrounding structures (Maxwell’s operation).
SKIN-GRAFTING
Indications. This procedure is especially suitable for cases in which the base of the socket opposite the palpebral aperture has to be enlarged, and it is usually performed prior to Maxwell’s operation for the restoration of the fornices in severe cases.
Instruments. Scalpel, speculum, skin-grafting razor, probes, and a piece of thick style wire.