Page:Handbook of Ophthalmology (3rd edition).djvu/251

Rh The immediate consequence of the injury is generally a severe traumatic keratitis and conjunctivitis, in which, during the acute stage, the palpebral fissure is kept closed either by the swelling of the lids or by the irritation. During this time adhesions form between the two raw surfaces of the conjunctiva or between the inner surface of the lid and the injured cornea. These adhesions remain, although they become somewhat stretched when motion is restored.

The form and extent of the adhesions vary according to the injury to the conjunctiva. The destruction generally extends back to the fornix, so that the lids adhere to the eyeball throughout a great extent of surface. Often in such cases, when both lids are involved, the palpebral fissure becomes shortened, and the mobility of the lids, as well as of the eyeball, is limited.

In other cases the adhesion of the two conjunctival surfaces extends forward from the fornix to the edge of the lid in an oblique direction; a probe can then be thrust for a greater or less distance under the adhesion till its point reaches the end of the pocket thus formed by the symblepharon.

Finally, it sometimes happens that the adhesions do not extend back quite to the fornix, but bridge it over, so that a probe can be passed under it.

In consequence of these adhesions the movements of both the lids and eyeball are impeded. This gives to the patient a sensation of traction, and where the eye still possesses vision it causes diplopia corresponding to the defect of motion.

The removal of the symblepharon may be indicated either to restore the function of the eye, or, where that cannot be done, to render possible the use of an artificial one.

If the cornea be entirely destroyed by the injury which caused the symblepharon and there be no desire to wear an artificial eye, there is no indication for an operation. If a useful degree of vision still remain, or if in case of extensive corneal opacities it may be re-established, for instance, by an iridectomy, the removal of the symblepharon should be undertaken when the adhesions do not involve more than half the upper or lower lid. More extensive adhesions cannot be relieved, not from any difficulty in dividing them, but because of the impossibility of preventing their reunion. After the division of the adhesions the two wounded