Our Eyes, and How to Take Care of Them: Iii

BAD PRINT.

NO protest can be too earnest against the manner in which many books, especially school-books, are printed. Surely, if an author’s work has any value, it deserves better than to be sent forth in so poor a garb What is worth printing at all, at least as regards books intended to be constantly used or extensively read, is worth being well printed, with clear type upon a fair page. Everything should be done, so far as the arts may serve the interests of learning and science, to make study a pleasure instead of rendering it an irksome and injurious task.

If and while eyes are strong, they may offer only feeble remonstrance against the harm they suffer in being forced to decipher that which bad type, ink, and paper have combined to make illegible ; but the day of reckoning comes at last, and many eyes must cease their labors, and many minds, full of useful projects, must abandon their plans, because the eyes, those long-enduring instruments of research, have given way to the continued strain to which they have been needlessly subjected.

WOUNDS AND INJURIES OF THE EYE.

The subject of accidental injuries of the eye is one of great importance, as the recovery or loss of sight may often depend on what is done immediately after the accident, before the eye is seen by a physician.

Travellers, especially by railroad, are liable to the lodgement of small particles of dust or cinders inside the lid or upon the front of the eyeball, causing great suffering. These should be removed as soon as possible, before the eye becomes excessively sensitive, and before they give rise to inflammation. Sometimes these foreign bodies are to be seen, on close inspection, lodged in the front of the cornea, where they are not felt when the eye is open, though every movement of the lid over them causes much pain. If not firmly imbedded they may be removed by means of a bit of wood, say a toothpick, sharpened to a flat point, or even by a camel’s hair brush ; but when forcibly implanted they are sometimes so firmly held in place that their extraction requires a skilful hand. When fixed in the centre of the cornea, with the dark pupil as background, they are frequently overlooked at a first inspection. If the foreign body is not found in this situation, it will be discovered, in nine cases out of ten, inside the upper eyelid, and generally at about the centre of the lid near its border. Thus placed, it scratches the cornea at each motion of the lid or eyeball, and causes great irritation. Such particles once slightly imbedded in the membrane lining the lid may remain there a long time before being expelled by natural efforts.

If the eyelids are closed for a few minutes, soon after the entrance of the foreign body, so as to allow the tears to accumulate, and the skin at the centre of the upper lid is then taken hold of with the thumb and finger and drawn forward so as to lift the lid from the eyeball, the intruding particle is often washed away with the outflow of tears.

If relief is not obtained after two or three trials of this plan, and no physician is at hand, it will be best to ask a travelling companion to turn the lid and remove the offending substance. But if this should be a grain of lightcolored dust or sand, good eyes or eyeglasses will be needed to detect it.

The upper eyelid may be easily turned by taking hold of the eyelashes and edge of the lid with the thumb and finger of the left hand and drawing the lid outwards and upwards, while at the same time a small pencil, a knittingneedle, or some similar thing held in the right hand is placed against the centre of the lid, pressing it backwards and downwards towards the eyeball. The person should look down, as this greatly facilitates the eversion of the lid, which may be easily accomplished if these directions are followed. The cinder or dust may then be wiped off with a handkerchief or the finger.

Smoothly worn bits of shell from the beach are sometimes inserted as “ eyestones,” the popular idea being that they pursue the foreign body and bring it out, vi et armis. But these generally only add to the sufferer’s discomfort ; and in the few instances where their introduction is followed, after more or less delay, by the escape of the original intruding substance, they merely serve by their bulk to separate the eyelid from close contact with the globe and thus allow the sand or cinder to be washed from its position by the abundant tears. Much harm is often done by their presence, the remedy proving even worse than the disease.

It is so common for machinists and stone-cutters to have atoms of metal driven into the cornea, that in most shops some one of the workmen acquires repute for a certain skill in removing them. But when the metal is deeply lodged their efforts often fail, and the cornea is sometimes injured by their attempts, or so much abraded that the eye becomes exquisitely sensitive, and when the sufferer applies for professional aid, it is almost impossible for him to keep the eye still enough to allow of the extraction of the metallic fragment. Sometimes etherization is necessary in such cases before the removal of the foreign body can be effected.

But workmen are also liable to far graver injuries, from bits of metal which penetrate the eyeball instead of lodging upon its surface. In using a hammer and cold-chisel small bits of steel are often broken from the edge of the tool and driven with great force into the eye. Having once passed through the tough external coats of the eyeball, there is little to prevent their going on to the very bottom of the eye. These accidents are very deceptive ; the workman perhaps thinks his eye has only been hit, externally, by a bit ot metal which he was chipping off ; and as he feels at first very little pain, and his vision, it may be, is not much affected, he is unwilling to believe that anything has entered the globe. But if examined, conclusive traces are often found of the course of the missile towards the back of the eye ; or it may sometimes be seen lodged in the iris or the crystalline lens ; or the ophthalmoscope may even detect its presence in the deeper parts of the globe. Usually the man is soon convinced, by the continued irritability of the eye and the increasing failure of his sight, that his is more than an ordinary trivial injury.

Many eyes are yearly lost from bits of percussion-caps, which boys amuse themselves in exploding by carelessly striking them with a stone or hammer. Such dangerous playthings should be absolutely forbidden.

In any of these cases no time should be lost before consulting a skilful oculist if possible ; if not, the ablest medical practitioner within reach ; as the chance not only of retaining any vision in the wounded eye, but of preserving it in the other, may depend on the advice given and the treatment adopted immediately after the injury. The possibility or expediency of the removal of the foreign body should be determined by a man of experience ; as, if such a substance is allowed to remain in certain parts of the eyeball, it excites, in very many cases, a peculiar form of sympathetic inflammation in the other eye and destroys the sight.

Grains of powder are frequently driven into the eye by premature explosions, etc. If near the centre of the cornea and of some size, they should be carefully picked out, as far as may be, soon after the accident. But small particles may remain even in the cornea, without doing harm ; and if they have been some time in the eye, they become incorporated in the surrounding tissues, and should not be disturbed unless they cause conspicuous deformity.

Burns, or injuries from acids or other chemical substances, or freezing of the cornea during exposure to intense cold, are usually followed by dangerous ulceration or even by complete loss of vitality in the cornea. Such cases should never be neglected.

Clean cuts of the eyeball, with sharp instruments or pieces of glass, even when quite large, often result in a good recovery. Lacerated wounds, made by blunt instruments, sticks, horns, and the like, terminate less favorably. In all these cases the friends of the injured person should avoid curious meddling with the eye “ to see how much it is hurt,” and it is well to keep both the eyes closed and quiet, as if asleep, that the wound may be as little disturbed as possible, until it can be seen by a physician. No other applications should be made than a thin folded rag wet with cold water ; close heavy bandages, which might press heavily upon the eye, and everything like poultices, being especially avoided. No eye-water, of any description, should be used, except under the direction of the medical adviser ; for the redness and swelling of the eyeball and lids depend on the existence of the wound, and will subside as this is healed, but are not to be got rid of by mischievous activity in the use of such remedies as might be serviceable in a different form of inflammation.

Penetrating wounds of the eye from scissors, pin-darts, needles, etc., may be trivial, if the important internal parts are not involved ; but they are often more serious than appears at first sight, and the fact that a child makes little complaint after such an injury should not put a parent off his guard. For in these cases, as in most lacerated wounds and those produced by blows from blunt objects, we have to fear, not merely loss of vision, but shrinking or deformity of the eyeball ; and, what is far more serious, there is in many cases a risk of loss of the other eye from sympathetic inflammation. This last consequence is especially likely to happen if the injured eye continues irritable and sensitive, or if it becomes so after having been for a time free from active symptoms.

The very frequent occurrence of total loss of sight from sympathetic disease, coming on insidiously in the internal parts, and with very little warning, ought to be kept in view in every case of injury of the eyeball, until such time as the danger is pronounced by some competent authority to be past ; and if threatening symptoms present themselves there should be no hesitation in sacrificing the injured globe, if necessary to the safety of the other eye.

SYMPATHETIC INFLAMMATION OF THE EYE.

When one eyeball has been seriously injured, or a foreign body remains within it, especially in the ciliary region, a little behind the line of union of the transparent cornea with the sclera, or in some instances of displacement or disorganization of internal parts, the other eye, previously healthy, becomes affected with a slow internal inflammation of a most destructive nature.

The early symptoms are often so slight as not to attract notice, unless they have been watched for ; and they are at length observed only too late for effective treatment, if they are looked for only in the uninjured eye. The first premonitory signs are to be seen in the eye which has been diseased or hurt, and it should be vigilantly watched as long as any sensitiveness lingers to justify suspicion.

Should warnings in the injured eye be disregarded, the other eye may begin to show a faint blush of redness just beyond the margin of the cornea ; the movements of the pupil become sluggish ; and it is perhaps found that vision is less good than usual in a feeble light. These changes increase, though varying and seeming to improve at times, until at last the eye becomes very red, watery, and perhaps painful, the pupil is closed by a deposit of opaque material, and the globe finally shrinks and is sightless.

Occasionally an eye escapes without loss of vision after these processes have begun, provided the injured eye, the source of the sympathetic irritation, is promptly removed ; but it is best, where the state of the other eye indicates a tendency to mischief, not to wait for the appearance of even slight symptoms of disease in the sound eye, as, unfortunately, they cannot always be arrested, when once established, by even the promptest action on the part of the surgeon.

When an eyeball is removed under these circumstances, there is often an immediate sense of relief from dull pain which had previously existed in the eyes and forehead. The globe being enucleated without the removal of the muscles and other contents of the orbit, a sufficient support is left for an artificial eye. Though such an operation is formidable in anticipation, it is painless in execution after etherization, and the wound is readily healed, often within two or three days.

More or less serious changes may occur within the eye as the result of concussion, without external wound ; as, for instance, from a hit by a cork from a bottle, the end of a whip-lash, a ball, or any other sudden shock. The anterior chamber, the space between the cornea and the iris, is often at once filled with blood, and vision temporarily lost ; but the blood is reabsorbed and sight restored in a few days, if no other harm has been received. The iris may be partially torn or separated at its border, forming a second pupil, but not seriously damaging the visual functions. Sometimes the crystalline lens is dislocated, or the capsule enclosing it is ruptured. This may lead to inflammation, by pressure upon neighboring sensitive parts ; or; where no change is immediately apparent, may result in the formation of cataract, the lens gradually becoming cloudy within a few months ; or the retina may be separated from its connections, and its perceptive faculty destroyed. As in any such injury from concussion there is a possibility of sympathetic ophthalmia at a subsequent period, all such cases should receive careful attention.

ARTIFICIAL EYES.

When vision is lost in one eye, and the globe is more or less disfigured or shrunken, a person is often desirous to conceal the deformity, in order not to attract notice and to restore the natural expression of the features.

An artificial eye may be worn when the eyeball is but slightly lessened in size, or when the globe has been removed ; but the most favorable condition for its use is where the anterior parts of the eye have been destroyed or removed, leaving a somewhat diminished globe, to which the muscles remain attached. It is important that no extensive adhesions should exist between the eyeball and the lids.

Artificial eyes are in the form of a thin shell, made of a sort of glass termed enamel, and as light as possible, that they may be moved readily by the muscles of the globe in harmony with the movements of the other eye. They should not be too large, as in this case their movements will be limited. The form should be adapted to that of the socket in which they are to be worn, their edge not pressing too much against any part of it. They should appear, when worn, a little smaller, rather than larger, than the ether eye, as a staring look is thus avoided. In color and in size of the iris and pupil they should correspond as nearly as possible with the other eye ; but a difference of color is of less importance than to have the eye of a form and size which will be comfortable and movable.

Very slight differences greatly alter the effect of the eye when inserted. It is therefore very difficult to obtain a suitably fitting eye, except by personal selection from a large number of specimens ; and, if once well fitted, a person would do well to order other eyes of the same pattern, otherwise it may not be easy to replace an eye with another as well adapted, when the first becomes rough or is broken.

Like other modern substitutes for natural deficiences, — hair, teeth, wooden legs, etc., — artificial eyes should be laid aside at night. In fact, it is well to take them out occasionally in the daytime and bathe the orbital cavity, in order to avoid the slight irritation caused by their constant presence, and to preserve the eyes from becoming roughened by constant soaking in the tears and other discharges. But even with these precautions, the surface of the enamel loses its polish after a while, usually in from one to three years, and the eye must then be exchanged for another. If worn after becoming rough, the secretions from the lining of the cavity are greatly increased, and it becomes inflamed and covered with fungous granulations to such an extent that the artificial eye can no longer be introduced. But these granulations, however large, must be left to shrink away under the soothing effect of frequent lotions with water or other mild means. If they are cut off, the cavity is almost always rendered smaller, and subsequently will not admit the false eye. Of course, in these circumstances, the eye must be laid aside until the recovery of the healthy condition.

Where a good fit, well matched with the other eye, is obtained, artificial eyes are not to be detected by an ordinary observer, and they restore good looks and a natural expression to the face so completely that after a time even a person’s friends forget the counterfelt. They require care, however, both in their selection and use, and those to whom looks are a matter of slight consideration sometimes find them more trouble and expense than they think them worth.

CREDULITY AND PRESUMPTION IN REGARD TO THE EYE.

The willingness of the public to patronize pretended oculists, and to recommend certain popular remedies as being infallible for the cure of eyedisease, is a source of pain to every one who witnesses in our hospitals and blind asylums the lamentable consequences. Intelligent people would be slow to confide their important business, their farms and merchandise, to the hands of travelling lawyers of uncertain reputation, whom they saw for the first time and never expected to see again ; yet they intrust their eyes, worth more than house or lands, to the care of roaming pretenders, whose own assurances are the only warrant of their skill, and who, when their ignorance and failures become too glaringly evident in one place, flee into another. Or, again, a mother thinks it no harm to follow the recommendation of nurse or neighbor, and apply a poultice to the inflamed eyelids of her babe, little dreaming that in so doing she is dooming it to blindness, and never asking herself how much the presumptuous adviser could know about the matter. An individual who has suffered from some affection of the eye, and found relief in a certain remedy, too often seems to feel himself authorized to advise all the rest of mankind attacked with eye disease to use the wonderful specific to which he ascribes his cure. One person spoils the eye of a friend’s child by recommending a wash containing sugar of lead. Another, equally ignorant where he assumes to be wise, destroys sight by advising in a case of internal disease a wholly inappropriate eye-water, because it had suited his own case of external inflammation.

The dictates of good sense would really seem to be forgotten where the eye is in question ; for surely, if there be any faculty of the body of pre-eminent importance and value, it is the faculty of seeing ; and if there be any organ whose delicate and intricate structure demands the most patient and intelligent study and finished skill for its proper comprehension and successful management, it is the organ of vision. Yet this seems to be a lesson which the community is most unwilling to learn ; and multitudes of eyes, too valuable to be thus thrown away, are sacrificed to ignorance and neglect.

Henry W. Williams, M. D.