Cancer of the eye begins either in the lacrymal gland, the conjunctiva, or the eye-ball itself, at tacks the constitution after the meridian of life, and is characterized by acute stinging pains like the pricking of needles or lancets, the eye presenting an irregular nodulated tumefied appearance, the cornea becoming opaque, varicose blood-vessels forming on the conjunctiva, which become ulti mately like flesh, and even the whole eye resembles firm flesh. When the conjunctiva is first affected. it is a common ulcerated fungus, hard and cartila ginous, attended with darting lancinating pains, exquisite sensibility, icorous discharge, and vari cose enlargement of the blood-vessels, and ulti mately involves the eye. If confined to the con junctiva, we may then consider whether it ought to be removed together with the eye-ball, but if the eye-ball itself is affected, the whole ought to be ex tirpated. The eye-ball is to be transfixed with a curved needle, armed with a broad ligature, and if the eye-lids can be preserved, an incision is to be made between them at the outer canthus, to enable the operator to use more freedom; the conjunctiva at its angle of reflection between the eye-lids and eye-ball is then to be divided completely round; next the insertions of the superior and inferior oblique muscles; the knife is then carried close around the bone, and deep into the orbit, pulling gently at the same time the ligature, and lastly dividing the origins of the recti muscles, and the optic and other nerves. Great care should be taken to remove every portion of the disease, and if there be much bleeding, a piece of dry sponge should be inserted, or the actual cautery applied; but if not, the orbit ought to be gently filled with lint, with a small compress over the eye-lids, and a bandage around all; the patient put to bed, and an opiate administered. Inflammation may be appre hended, and the patient ought to be treated ac cordingly.
Fungous hmmatodes also attacks the eye, com mencing in the retina and optic nerve, the vessels of which secrete the peculiar medullary matter that fills up the whole cavity of the eye-ball, pre senting an irregular nodulated appearance, with a muddy cornea, and a dark livid coloured con junctiva. At first, the cornea is so transparent as to resemble a piece of polished steel, or a con cave silver plate, and the bottom of the eye is greenish, or of a dark amber colour, the pupil being dilated and immoveable. As the tumour advances to the iris, it can be seen to be a solid body of a yellow or brown colour and an irregular shape, with arteries ramified upon it. The aqueous, crystalline and vitreous humours are ab sorbed, together with the retina and choroid coats; the optic nerve becomes thickened, of a brownish colour, and divided by the tumour into threads. The nerve is sometimes involved even backwards to the thalamus and anterior lobe of the brain. The cornea or sclerotic coat ulcerates, and a fungus protrudes of an irregular, red colour, covered with coagulated blood, bleeding on the slightest touch, and discharging a fetid matter. The lymphatic glands in the region of the parotid and submaxillary glands become affected. On rare
the disease begins in the cellular tissue, connecting the conjunctiva to the cornea. This affection also requires extirpation of the eye, but unless the operation be early performed, it rarely succeeds. It attacks chiefly children under twelve years of age.
Cancer of the lacrymal gland is a very rare dis ease, and is characterized by lancinating pains in the region of the organ, which from its irregular hardness and enlargement, presses the eye-ball downwards and outwards, which cannot be turned towards the external canthus without producing violent pain. This also requires removal by the knife, although it is objected to by Beer and others. An incision should be made over the tumour parallel with the superciliary ridge through the integuments, orbicularis palpebrarum, and ligament, which descends from the frontal bone until the tumour is exposed, which is then to be insulated from the bone and muscles of the eye. and removed. if hemorrhage follows, it must be stemmed with dry sponge and pressure. The lacrymal gland is occasionally subject to inflam mation and suppuration, and an encysted watery vesicle, for the encysted lacrymal swelling, and the watery vesicle of the lacrymal gland are the same disease. During inflammation, there is a suspension of the secretion of the tears. The encysted swelling arises from the obstruction of the ducts of the gland, for the tears collect and form a pouch, which should be punctured, and a seton inserted from the conjunctiva to the skin at the external canthus, or a portion of the pouch re moved with scissors, in order to obliterate the sac.
Tumours of the eye-lids are very common, from a simple stye to a cancerous watery excrescence. Hordeolum or stye is a small phlegmon generally on the margin of the lower eye-lid, and is commonly one of the ciliary glands, which advances slowly to suppuration and bursts ; and it occurs most fre quently in the scrofulous constitution, and may be treated as a common phlegmon.
If hordeolum does not suppurate, it is liable to de generate into a hard tumour, named chalazion, grando, lythiasis, tophus, porosis, &c. which are sometimes small fleshy tumours containing calcare ous matter. These require to be extirpated, for if allowed to remain, they often produce a malignant ulceration. Other small tumours of a fatty or chalky nature, or hydated vesicles, termed phlycte nulx, occur on the eye lids, which require to be lanced, and their contents squeezed out. Warty excrescences should be excised. Encysted tumours are very prevalent on the eye-lids, occurring some times between the tarsus and skin, on other occa sions between the tarsus and conjunctiva, in which latter situation they ought to be extirpated, if pos sible, from the inside of the eye-lid, by making an incision parallel with its margin ; and after its re moval, the wound should be anointed with oil of olives fo prevent adhesion. As inflammation is lia ble to follow this operation, the patient must re main in a darkened room on low diet.