TREATMENT.-We should endeavor to prevent this result by the use of those remedies given under scleritis, but if it seems to progress in spite of our remedies, an iridectomy must be made.
If the staphyloma has existed for some time, it may be abscised according to one of the various methods advised under staphyloma of the cornea; if it be extensive, and sight is lost, enucleation is to be preferred.
Sclerotico-Choroiditis Anterior and Posterior.-As these diseases involve the choroid as well as the sclera their description will be found under the choroid.
Injuries of the Sclera.-In penetrating wounds there is diminished tension, and, if extensive, there is usually a prolapse of the iris, ciliary body or vitreous. Wounds accompanied by a prolapse of the iris are especially dangerous from their liability to cause an irido-cyclitis and even sympathetic ophthalmia of the other eye. Wounds further back, causing escape of the vitreous, if slight, may heal without any serious consequences; but, if extensive, may result in inflammatory changes in the choroid, detachment of the retina, or a panophthalmitis with subsequent atrophy of the globe. Rupture of the sclera from a severe blow usually takes place parallel with the cornea and from two to five mm. posterior to it. There is usually a dislocation of the lens, which may be through the rupture and found underneath the conjunctiva, or, if the conjunctiva is also ruptured, it may be expelled wholly from the eye.
TREATMENT.-The treatment of wounds of the sclerotic varies according to their extent and situation. If any protrusion of the contents of the globe has occurred, it should be cut off and the edges of the wound approximated as closely as possible by the aid of a bandage, or the introduction of a fine suture. The patient should be kept quiet in bed and ice-compresses, with or without applications of Arnica or Calendula solutions, employed as may be most applicable from the nature of the injury, whether contused or incised. Aconite should be given internally.
If the wound, however, is extensive, especially if in the ciliary region, even though the vision is not wholly lost, enucleation is far the safer method of proceeding in order that all danger of sympathetic trouble in the other (healthy) eye may be taken away. In all cases in which a large portion of the globe has escaped and sight is irretrievably lost enucleation is necessary.
If there is a foreign body in the sclerotic it should be removed, but if it has penetrated the sclerotic and is within the eye, it is usually necessary to enucleate, although its extraction may be attempted if there has not been too much injury to the ciliary body. The magnet has, of late, been highly recommended for the removal of steel or iron from the interior of the eyeball.
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.