Encanthis, (from WO0c, the angle of the eye.) is an enlargement of the caruncula lacrymalis, which ultimately involves the plica seminularis, and when inveterate extends along the eye-lids and surface of the eye-ball to the cornea, and even the whole eye, it being then purely cancerous. It ought therefore to he excised as early as possible ; for, in its ad vanced stage, the whole eye may require to be ex tirpated.
Pterygium (from a wing) is a triangular object or tumour situated on the conjunctiva, gene rally at the inner canthus of the eye, with its base towards the caruncula and apex towards the cornea.
There are two species of this, the memhranous and the fleshy pterygium, both of which require to be removed with the forceps and knife or scissors, since they are liable to degenerate into a malignant or cancerous nature, although they often remain dormant for years. When they become cancerous, the whole eye should be extirpated. A small depo sition of matter sometimes takes place near the edge of the cornea, which should be removed. Small oval substances, of a dirty yellow colour, also form in advanced life, in this place, which may be left alone so long as they remain inert. Fleshy and cartilaginous tumours are not unfrequently formed beneath the conjunctiva, and require extirpation. A small pale red, hard and itching tumour of the size of a pin's head is found on the lower eye-lid, near the plica semilunaris, occurring in chlorotic young and likewise requires removal with the knife.
Lippitudo, or blear-eyedness, is a diseased secre tion of the ciliary glands and conjunctiva palpebla rum, the eye-lids are red and excoriated, are glued firmly during sleep, and vision is in some degree weakened or impaired. The treatment consists of warm anodyne applications in the first instance, and afterwards of cold astringents and stimulant ointments as mentioned under ophthalmia. The preceding affection often gives rise to diseases of the lacrymal passages ; and on everting the eye lids, they present a vinous granulated appearance, with swollen ulcerated ciliary glands ; and in scro fulous patients the lacrymal sac is frequently in flamed from this source. In which case, there is a circumscribed hard tumour of the shape of a bean, in the situation of the sac, attended with lancinating pains when touched, and soon having a red external appearance, which is more or less erysipelatous. The lacrymal puncta or papilla are shrunk and in visible ; the tears flow over the cheeks, and the af fected nostril is at first moist, but soon becomes dry. There is more or less headach and even symptomatic fever. The inflammation ultimately extends to the conjunctiva of the eye-lids, the carun cula lacrymalis and plina semilunaris, producing a copious secretion of tears, mucus, and purulent matter ; coagulable lymph is effused into the nasal duct, the sac enlarges, the skin becomes of a deep red with a white point in the centre, and ultimately bursts, forming a listulous opening. The moment
that the sac tumefies, and the tears are shed over the cheek, that instant it should be freely lanced, and afterwards treated on the common principles laid down under inflammation and suppuration ; atten tion being paid at the same time to the ciliary glands and conjunctiva, as recommended under ophthalmia ; and likewise, to the nasal duct, which is more or less obstructed. At first a simple gum bougie should be inserted into the duct, and worn as long as it produces no painful feeling or inflam mation. This should be repeated either daily or every second day, first washing out the sac and duct with warm water, and afterwards with a solution of the sulphate of zinc in rose water, gradually increas ing its strength. The hougie is to be progressively enlarged, to the size of a large crow quill, and an ointed with a weak ointment of the red oxide of mercury, which ought also to be gradually aug mented. If the lacrymal sac does not advance to ulceration and rupture, a discharge of puriform mucus takes place, named blenorrhcea, in which affection the tears flow over the cheek. This re quires to be treated as the preceding, otherwise it gives rise to repeated attacks of erysipelatous in flammation of the integuments over the sac, which ultimately induces closure of the .nasal duct, or a communication with the sac named spurious fistula of the sac ; or ulceration of the sac and integuments forming true fistula lacrymalis, in which latter case obstinate blenorrhma occurs with stillicidium lacry marum. Dropsy of the sac or mucocele also occa sionally results, and must be also treated in the same way. Sometimes the puncta lacrymalia, and cana liculi are obliterated, causing stillicidium lacryma rum for life, in which event the Iacrymal bone should be pierced from the inner canthus- immedi ately inferior to the caruncula, and a bougie inserted daily until it forms a mucous tube. When the na sal or lacrymal duct becomes obstructed from such diseases, or if it is congenital, the same treatment ought to be adopted as mentioned under inflamma tion with suppuration of the sac ; and if this is found impracticable, a small trocar and canula, as that used for piercing the membrana tympani, is to be inserted along the duct to the naris, and followed by a bougie ; and if even this is impracticable from the obliteration of the duct, the anterior fossa of the lacrymal bone must be pierced with a small style, and then a bougie inserted. The after treat ment is the same as that mentioned above. Some recommend the dilatation of the nasal duct in these obstructions, by a probe inserted from the lower extremity in the naris, but this is with difficulty effected. Various other modes of treatment have been recommended from the time of Fabricius to the interesting work of M'Kenzie on Laeryinal Dis eases.