Entropeon, (from iv, and I-pow, to turn,) named also entropium, ptosis, phalangosis, trichiasis, tri chosis, distichiasis and tristichiasis, is an inversion or irregular direction of one or more of the eye lashes, either alone or accompanied with an altera tion of the curvature of the eye lid, which produces great irritation, and even inflammation ending in opacity of the cornea, which sometimes resembles a macerated ligament. Occasionally the other eye also becomes affected. When the eye-lashes merely are attacked, it has been proposed to pull them out, and also to burn their roots ; but these seldom suc ceed, and therefore in such mild cases, a longitudi nal portion of the integuments of the eye-lid should be removed with scissors, and the wound approxi mated with fine ligatures and adhesive plaster. In severe cases, besides the removal of this longitudi nal portion of the integuments, it is necessary to make a transverse one on each side of the inverted hairs, through the tarsus, guarding against wound ing the punctum lacrymale, and healing these late ral incisions slowly by granulations. When the lower eye-lid is the seat of the disease, a transverse incision at the outer canthus is generally all that is necessary.
Ectropium or Ectropeon is an eversion of the eyelids, commonly the lower ; occasionally how ever both, and then the eye has an annular shape ; and when confined to the upper eye lid, it is termed lagophthalmos. In mild cases, the nitrate of sil ver shaped like a pencil and passed along the con junctiva longitudinally, the eye being bathed im mediately after with warm water or oil, will effect a cure ; but in severe cases, if the preceding treat ment fails, a longitudinal portion of the conjunctiva should be removed with the knife or scissors, and a corresponding incision in the integuments made, the eye-lid brought down, and fixed with adhesive plaster, compress and bandage ; care being taken that no adhesion occurs between the conjunctiva palpebrx and the eye-ball. The nitrates of silver or copper may be still necessary to establish a cure. When the lower eye-lid is everted from a scald or I n any cicatrix, the adhesion of the cicatrix is to be detached from the bone, and then a triangular por tion of the eye-lid is to be removed, the margin of the eye-lid forming a base ; and the limbs of the triangle are next approximated by suture. The edges of the eye-lids are sometimes united at birth, which is termed ancyloblepharon, and is cured by a simple division. The eye-lid occasionally ad heres to the ball of the eye, and is named symble pharon, which is cured by division and preventing re-union by anointing from time to time the sur faces with olive oil.
The cornea has been found ossified, and also so convex, that the individual has not been able to see at the distance of two inches, which condition, when originating from disease, is termed myopia, and is to be remedied by concave glasses ; likewise in some instances both convex and irregular on its surface, and requiring the same remedy. At other times, the cornea is flat and relaxed, which can only be remedied by convex glasses. See a most phi
losophical explanation of these by Dr. BREWSTER, in WARDROP ON THE EYE, Vol. I. p. 132. The eye has been transformed into a calcareous mass ; the cornea, the capsule of the lens, the lens itself, the iris, the hyaloid membrane, and choroid coat have been ossified.
Under adhesion the Tagliacotian operation has been considered, and under fractures, injuries of this organ. In the article MEDICINE, Vol. Xli. p. 815, inflammation with increased secretion of the mucous membrane is described, and we shall merely add, that venesection should be more frequently had recourse to, so as to prevent the baneful consequen ces of this disease. Inflammation of this membrane occasionally produces abscess of the frontal and su perior maxillary sinuses. That of the frontal is characterized by violent pain in the region of the sinuses, darting along the forehead, and sometimes down the neck, with a profuse discharge of most of fensive matter, intolerable both to the patient and the bystander, and convulsions or epilepsy on some occasions occur. The best treatment is the inhaling the vapour of water, the remaining in a moderately dry warm room, farinaceous diet, and preserving the bowels open. When the disease becomes chro nic, the smoking of tobacco is beneficial ; but if it continues severe, the sinus should be trephined, and afterwards mild warm diluents, and ultimately cold astringents injected. Abscess of the antrum max Mare also originates from carious teeth, and from injury occasioned by their extraction. It begins with acute pain in the fangs of the teeth, darting upwards to the nostril and cheek, and ultimately producing tumefaction of the latter, which then moderates the pain, while the cheek itself feels hard and painful when pressed upon, the pain often darts along the pharynx, and the patient ima gines the secretion comes from them. When the patient inclines the head to the opposite side, a most offensive discharge flows out at the nostril. The external wall of the antrum be comes extremely thin, ulcerates, and then involves the muscles and integuments of the cheek, forming fistulous apertures ; at other times, the matter ex cites absorption and caries of the alveolar sockets by which the matter is discharged ; while at oth ers the palate ulcerates and the discharge flows into the mouth. Whenever, therefore, the diagnosis clearly shows that matter has been deposited in the antrum, the second anterior molar tooth or bicus pis ought to be extracted, and the antrum perforated with a small style, but occasionally this tooth com municates with the cavity, and no perforation is re quired. This disease ought to be afterwards treated as recommended for abscess of the frontal sinus. If the osseous structure be carious, it be comes sometimes necessary to open the cavity freely by dissecting the lining membrane of the mouth upwards, and removing gently and carefully the diseased bone, taking care not to induce inflamma tion. Tincture of bark and myrrh form a good in jection in such cases.