Lipoma is another rare, congenital and benign tumor which is most frequently found to the outer side, either above or below the external rectus muscle. They appear as flat, yellow swellings, and are apparently extensions of the fatty tissue of the orbit. They do not disfigure much or interfere with the movements of the eye and should not be touched.
Vascular Tumors.- These are very rare, but we do meet them occasionally as a small triangular-shaped elevation of the conjunctiva which causes deformity by their bright red appearance. They are most frequently found associated with vascular dilatations of the face or nose. They should be carefully removed by electrolysis.
Angioma spring from the caruncle or cul-de-sacs, and are seldom large enough to require removal; but when they do, may be removed by suture or electrolysis.
Fleshy Excresences are usually from wounds or operations and should be removed.
Cysts are round, circumscribed, rose-colored tumors. They are semi-transparent and may take on a yellowish hue, sometimes grow to the size of a bean and contain a thick fluid. They are usually congenital, but may follow a blow on the eye, and should be either incised or removed entire.
Erectile Tumors are usually an extension from a similar tumor of the lid. They should be destroyed by excision, galvanocautery or electrolysis.
Pigment Spots are quite frequent and harmless. May be excised for cosmetic effect.
Fibroma and Osteoma have been found.
Epithelioma, while not common, are sometimes found on the ocular conjunctiva and at first may be mistaken for phlyctenules, but their persistence and the age of the patient will be apt to cause suspicion. When well advanced, they appear usually at the corneal margin as a puffy, reddish lobulated mass and are sometimes ulcerated. Their course varies-they may invade the cornea slowly or rapidly, but will do so sooner or later. They should be removed, and, if they return, the eye must be enucleated.
Sarcoma and Melano Sarcoma.- The former are generally pedunculated and may cover the cornea without penetrating it. The latter are generally close to the corneal border and are rarely found on the tarsus or in the cul-de-sacs. If they seem to be rapidly progressing, there should be a careful examination made for general infection, and, if convinced that general infection is not imminent, the eye may be enucleated. There is always great danger of the growth returning after an operation, or of metastasis.
Carcinoma are extremely rare; but, when found, should be removed.
Lupus generally spreads to the conjunctiva from other structures and rarely occurs in the conjunctiva primarily. They are usually found on the lid in the form of fungous granulations, a soft doughy mass broken by cicatrices. They should be scraped away thoroughly with a curette and cauterized with nitrate of silver, 1 to 10.
Entozoon or Cysticercus may occur under the conjunctiva.
Syphilitic Ulcerations are usually found on the palpebral conjunctiva and cul-de-sacs. They have the usual hard base and indurated edges and give the syphilitic history.
Gummata have also been seen under the conjunctiva. The treatment should be both general and local.
Professor of Ophthalmology in the College of the New York Ophthalmic Hospital; Surgeon to the New York Ophthalmic Hospital. Visiting Oculist to the Laura Franklin Free Hospital for Children; Ex-President American Homoeopathic Ophthalmological, Otological and Laryngological Society. First Vice-President American Institute of Homoeopathy : President Homoeopathic Medical Society of the State of New York ; Editor Homoeopathic Eye. Ear and Throat Journal : Associate Editor. Department of Ophthalmology, North American Journal of Homoeopathy, etc.