BLEPHAROSPASM is an involuntary con traction of the orbicularis palpebrarum, and may be either the result of irritation of the ophthalmic division of the fifth nerve by reflex action, as in disease of the cornea, etc., or it may be an essential spasm, occurring in eyes that are per fectly normal. A slight twitching in a few fibres of the muscle is not unusual in ametropia and may be made to disappear by the adjustment of the proper glasses.
Cases of blindness after phlyctenular spasm have occurred not infrequently. Laber suggested that they might be either reflex or the result of a forgetful ness of the use of the eyes. Hysteria does not appear to have been present in any case. Ordinarily, the children re cover, learning to see exactly as does the newborn infant. The theory that they have forgotten the use of their eyes is, personally, not wholly accepted, it being believed that they avoid visual percep tion because previous to the palpebral spasm such visual perceptions \vere pain ful or at least unpleasant. Amaurosis following phlyctenular spasm is a disease that does not find a place in any of the classifications used to-day. It appears to be a purely functional condition, or at least an anatomical one, not recog nizable as such. It should be regarded as a retrogression to an earlier stage of intellectual development. Baas (Munch. med. Woch., Jan. 24, '99).
Treatment should aim at the cause. In severe cases hypodermic injections of morphine into the lids may be necessary, or even subcutaneous division of the nerve.
In cases of obstinate blepharospasm stretching fibres of orbicularis muscle resorted to preferably under an anes thetic, by placing a strong, short specu lum between the lids. instrument is firmly set, and allowed to remain in posi tion for about five minutes. If neces sary, the procedure can be repeated sev eral times at intervals of a few days. Allport (Amer. Jour. of Ophthal., Jan., '91).
Ptosis is a drooping of the upper lid over the eyeball, with inability to raise the same. When not congenital, or the result of thickening of the lid from flammation, it is due to paralysis of that branch of the third nerve which supplies the levator palpebr superior. Ptosis is frequently associated with palsies of other muscles supplied by the third nerve, and when it is an isolated symp tom suggests central disease.
TREATMENT.—If of recent origin, al teratives, such as mercury and potassium iodides, should be administered in high doses; if of long standing recourse must be had to operative procedure. That of Panas is preferred. This operation has for its object the securing of a connec tion between the lid and the frontalis muscle by means of a skin-flap. This flap is obtained by inserting a horn-spatula under the upper lid, and by making a horizontal incision about five millimetres above the margin of the lid through the skin and subcutaneous tissue; another incision, parallel to this and about one millimetre long, is made through the eye brow, and is extended as far as the peri osteum. Two incisions are then made at
right angles to the first inferiorly, the flap of skin remaining between the two primary incisions is undermined, and the tongue of skin drawn up under the bridge and held in position there by sutures.
Lagophthalmos.— By this term is meant an inability to close the eyelids. It is either clue to paralysis of the facial nerve or is the result of some condition within the orbit, or in the eyeball itself, which causes the globe to protrude be tween the lids. As a result of the ex posure to which the cornea is subjected, it frequently ulcerates, and, unless proper procedures be inaugurated, the eye is lost.
TREATMENT.—If due to paralysis of the seventh nerve, the cornea should be protected by carefully bandaging the eye during sleep, and by cleansing the con junctival cul-de-sac with frequent wash ings of boric-acid solution. The primary cause of the paralysis must also be treated, and galvanism and hypodermic injections of strychnine may be tried. If the degree of lagophthalmos be excessive, the bandage should be worn constantly, and at times tarsorrhaphy is necessitated.
This operation consists in uniting the margins of the lids by means of sutures after their skin has been removed from the ciliary border by a sharp knife.
Congenital Anomalies of the Eyelids.
Absence of a part of or all of an eye lid or of both eyelids has been noted, though very rarely. Cleft eyelid, or Loma of the lid, has also been observed usually in the upper lid. At times this deformity occurs on both sides. EPICANTHUS.—This applies to the de velopment of a broad fold of skin which extends from the inner border of the eye brow to the side of the nose, its outer border being concave. This anomaly is usually associated with ptosis, or droop ing of the upper lid over the globe.
Deformity of epicanthus associated with a deep depression over the root of the nose overcome by a canthoplasty fol lowed by a plastic operation which re moves the crescentic folds and elevates the bridge of the nose. After the per formance cf the first procedure, two par allel and vertical incisions, one centi metre apart, are made at each side of the median line over the nose. From the middle of each of these incisions a rect angular flap is cut toward the inner can thi. After the lateral flaps are freely loosened and the central bridge of skin over the nose dissected up, the former is passed under the latter and the stitches are introduced through the three super imposed layers. Noyes (N. Y. Eye and Ear Infirmary Reports, '94).
Acquired Anomalies of the Eyelids.
It sometimes happens after injury, and especially after burns, that the edges of the lids become united to each other. This condition is known as auk yloblepli aron. If the adhesion occurs at the outer angle of the lids, blepharophimosis is said to be present.