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When resection is impracticable, a subcapsular enucleation is performed, followed by the insertion of radium. #Pulsating Hæmatoma# or #Aneurysm of Bone#. A limited number of these are innocent cavernous tumours dating from a congenital angioma. The majority would appear to be the result of changes in a sarcoma, endothelioma, or myeloma.
Its bill penetrated his eyeball and completely ruined his sight. There are several instances on record in which game fowls have destroyed the eyes of their owners. In one case a game cock almost completed the enucleation of the eye of his handler by striking him with his gaff while preparing in a cock-pit. Moorehead explains a rare accident to an eye as follows: "Mr.
Snell reports a case in which a piece of steel was imbedded and encapsulated in the ciliary process twenty-nine years without producing sympathetic irritation of its fellow, but causing such pain as to warrant enucleation of this eye.
Cloudiness of the lens set in in 4 per cent of the cases, while posterior synechiae developed in the great majority of them. In 2.3 per cent the eye was attacked by iridocyclitis and in 3.4 per cent enucleation was found to be necessary. Six eyes became atrophic but were not, for various reasons, removed. One and three-tenths per cent of the eyes operated on were lost from late infection.
Von Langenbeck of Berlin mentions an instance of fracture of the superior maxilla, in which the eyeball was so much displaced as to lodge in the antrum of Highmore. Von Becker of Heidelberg reports the history of a case in which a blow from the horn of a cow dislocated the eye so far back in the orbit as to present the appearance of enucleation.
It must end some day." I shook my head, and I smiled down upon her a smile that was very full of confidence. "That day will never dawn, unless the Lord Giovanni's impatience transcends all bounds." She looked at me, a puzzled glance in her eyes, a bewildered expression knitting her fine brows. "I do not take your meaning, my friend," she complained. "Then mark the enucleation.
Now that surgery forms so large a part of our therapeutic proceedings, they may not reach middle life without being submitted to one or more surgical operations. With good management both on the physical side and on the moral or psychological side they can be made into strong and useful members of society. Enucleation may then be indicated as the first step in treatment.
But it may become suddenly worse, or go on to complete blindness with pain, demanding enucleation, after some temporary perturbation, as the performance of a glaucoma operation. It is pre-eminently the kind of a case you would prefer would go to some one else. Each of these types illustrate a distinct cause or group of causes.
There is on record the history of an insane medical student in Dublin who extirpated both eyes and threw them on the grass. He was in a state of acute mania, and the explanation offered was that as a "grinder" before examination he had been diligently studying the surgery of the eye, and particularly that relating to enucleation.
In the case of central tumours the shell of bone is removed over an area sufficient to allow of the enucleation of the tumour, or the affected portion of bone is resected. Should there be evidence of malignancy, such as increased rate of growth, a tube of radium should be inserted, and in advanced cases with destruction of tissue, amputation may be called for.
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