PALPEBR2E, DISEASES OF THE. Inflammation of the Eyelids. (See BLEPHARITIS, volume i.) Injuries of the Eyelids.
The lids may be the seat of all kinds of injuries, and, on account of the looseness of the skin over the overlying tissues, cedema and ecchymosis are usually pres ent.
Abscesses of the lid give rise to a localized red swelling, associated with more or less cedema and hyperaemia of the entire lid and the conjunctiva lining it. Throbbing pain in the eye and head and some fever accompany its formation.
Abscess of the lid is usually the result of traumatism, but may be secondary to periostitis or caries of the margin of the orbit.
—If there be a solution in the continuity of the lid, the edges of the wound should be carefully approxi mated with sutures and evaporating lo tions, like dilute lead-water and lauda num, should be applied. Simple ecchy mosis of the lids, usually designated as "black eye," should be treated with ice compresses and lead-water and lauda num. When an abscess is present, hot fomentations are useful until fluctuation is detected. An incision should then be made into the abscess parallel to the muscle-fibres.
In contusions of the lids, if patient is seen early, treatment consists of cold compresses or cooling or evaporating lo tions. If patient is seen later hot com presses and massage are indicated to hasten the disappearance of the discolor ation. Cold compresses are to be ap plied continuously at first, but not by means of an ice-bag or a piece of ice wrapped in a handkerchief and applied directly to the swollen lids. Small com presses of lint or flannel, fourfold or six fold, measuring one and one and one-half inches in diameter, are to be cooled upon a block of ice and then transferred to the lids. An exchange is made between the Nvanu one on the lids and a cool one from the ice every minute or two. Care should be taken not to allow the cold compresses to cover the nose, since acute coryza may be caused. Cold compresses of this sort are to be applied during the first twenty-four hours, either continu ously or every second or third hour for an hour at a time. The application of cooling and evaporating lotions are of service. though less potent than iced compresses. Such cooling lotions consist of:— Acidi borici, 2 drachms. Spit. vini, 2 ounces.
Aqua, q. s. ad 1 pint.
Or: — Tinct. arnic, 2 ounces. Aqua?, q. s. ad 1 pint.
Both of these are to be applied cold, the compresses being wrung out of the boric acid or the arnica mixture and changed frequently. When the swelling has subsided and discoloration shows it self in a more pronounced manner, the lengthy duration of this stage can be cut short by hot applications and by massage. Flannel cloths are to be wrung out of hot water—as hot as can be borne —and allowed to lie upon the lids, being changed every minute or two; such ap plications are continued for an hour at a time, and applied three times a day, or oftener. When the skin is very sensi tive, it is well to apply a little white vasclin or any variety of bland salve to the eyelids previous to the use of hot compresses, so as to prevent soreness and irritation of the skin. In using massage
the area involved is smeared with the ointment of the yellow oxide of mer cury or white vasefin, and then gentle massage is practiced for five or ten min utes at a time, or longer, several times a day. If it is particularly desired to cause a very rapid disappearance of the blood-stain, the hot compresses may be used continuously, and the massage for a number of hours. By these means the disfigurement may be almost, if not entirely, removed within twenty-four hours, or even sooner, after the sub sidence of the swelling. C. H. May (Med. Rec.; Brit. Med. Jour., Oct. 22, 'OS).
Hordeolum (Stye).—Hordeolum is a circumscribed purulent inflammation sit uated at the follicle of an eyelash. At first there is a hard swelling, with more or less involvement of the entire lid. A yellow head soon caps the little tumor, and, if allowed to go on, this will break open and the contents be discharged. There is usually a feeling of great ten sion in the lid until the abscess is opened, and there may be slight febrile disturb ance.
Hordeolum is found chiefly in the young, especially in anwmic girls, where it is the expression of a constitutional disturbance. Habitual constipation has been assigned as a common source of the inflammation. Uncorrected ametropia is a frequent cause.
—The inflammation may at times be aborted in the earliest stages by hot boric lotion, by massage with yel low oxide of mercury, by applications of silver nitrate, or by painting the swelling with collodion. If this fail, suppuration should be encouraged by hot applications, and a free incision be made as soon as pus is suspected. Sulphide of calcium in ternally is frequently of service.
Recurrence must be prevented by de stroying the pus-producing fungus on which they depend. This may be accom plished by causing the patient to scrub the edges of the closed lids, the lids themselves, the brow, and all the neigh boring skin with a solution of mercury bichloride of the strength of 1 to 1000.
The solution should be freshly prepared each time, the scrubbing conscientiously practiced night and morning, and the treatment continued for at least two weeks. H. D. Bruns (N. Y. Med. Jour., Aug. 16, 1902).
Chalazion.—Chalazion is a hard swell ing which forms in the lids in connection with a lleibomian gland. It varies in size from the head of a pin to a large pea. Suppuration may occur, and the viscid contents of the tumor be discharged on the conjunctival surface of the lid, or the growth may be wholly absorbed and dis appear. As a rule, it causes but little pain; rarely at times, however, it takes an acute form, when the symptoms re semble those of hordeolum. Chalazion originates in a chronic inflammatory process in the connective tissue surround ing a Meibomian gland, especially where there is uncorrected ametropia. It usu ally occurs in adults.