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Updated: May 27, 2025
My object in excising the conjunctiva about the sclero-corneal flap, is to delay union of the wound edges, to widen the bridge of loose cicatricial tissue between them, to prevent such a complete growth of the endothelium as would cover the wound and block the exit of fluids, and to insure intra-ocular rest.
They, however, who have had the opportunity of seeing many of these cases, will readily perceive the difference. The conjunctiva is not so red, the pupil is not so dilated, and the dog appears to implore pity and not to menace evil. In this state, if the dog is approached, he will not permit himself to be touched until he he convinced that no harm is intended.
The conjunctiva remained inflamed, the cornea in due course became ulcerous, and the eye was ultimately destroyed by the discharge of its contents. This was the course and final termination of the disease in the case of the hound above referred to, all of which disastrous results might have been prevented by proper management.
It then becomes dull and wasted; a cloudiness steals over the conjunctiva, which changes to a yellow tinge, and then to a dark green, indicative of ulceration deeply seated within the eye. In eight and forty hours from the first clouding of the eye, it becomes one disorganised mass. There is in the rabid dog a strange embarrassment of general sensibility a seemingly total loss of feeling.
The sight of the right eye was entirely lost, and the anterior surface of the globe was so uniformly red that the cornea could hardly be distinguished from the surrounding conjunctiva. There was no perceptible enlargement or protrusion of the eyeball, and it did not appear to have sustained any mechanical injury or loss of tissue.
This hypothesis also might suggest why the subconjunctival injection of sodium citrate in addition to alkalinizing the ocular contents, may be effective in reducing tension, i. e., the amount of fluid injected beneath conjunctiva may overcome the stagnation in the lymph passages, flush out these channels and improve ocular elimination.
At its outer surface the cornea is covered with a very thin layer of the epidermis; this is known as the conjunctiva. It goes from the cornea over the inner surface of the eye-lids, the upper and lower folds which we draw over the eye in closing it. Underneath the upper eye-lid are the lachrymal glands, the product of which, the lachrymal fluid, keeps the outer surface of the eye smooth and clean.
Dermoids are found in the palate and pharynx, and open dermoids of the conjunctiva are classified by Sutton with the moles. According to Senn, Barker collected sixteen dermoid tumors of the tongue. Bryk successfully removed a tumor of this nature the size of a fist. Wellington Gray removed an enormous lingual dermoid from the mouth of a negro. It contained 40 ounces of atheromatous material.
My experience of this modified operation continues to be that it is necessary to clear the neighborhood of the operation wound entirely of conjunctiva. If the down-growth of epithelium into the operative wound is permitted the effects are by no means as pronounced, and the eventual lowering of tension is not as permanent as they otherwise would be.
As the disease progresses, the conjunctiva becomes more vascular, the photophobia intolerable, the cornea itself becomes opaque, and sometimes exhibits a vascular appearance. There is considerable itching of the ball, as evinced by the disposition of the dog to close the eye.
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