The amount of suffering caused by a foreign body in the eye depends less on its size than on the character of its surface, whether smooth or rough, and on its situation. When near the margin of the upper lid it is carried over the eye at every movement, but if it should be higher up near the angle of reflection or in the fold itself, the irritation will be much less. I was summoned one evening last winter to a lady who had met with an accident. On entering her apartment I saw the patient seated in her chair, her face turned towards me but her eyes fixed in another direction. I learned that in the course of the afternoon when driving in an open carriage a fragment of straw from a waggon had blown into her eye, and notwithstanding every attempt at removal it had obstinately remained, causing exquisite suffering at each movement of the eye or lid, the eye being only easy in one constrained position. Everting the lid with some difficulty from the strong spasm which existed, the sharp particle of straw was seen just within the margin of the upper lid near its centre, so that it partook freely of its movements. The relief afforded by removal of the straw was immediate. In strong contrast to the above stands the following. A farmer residing near Rutland, consulted me, March 19th, 1857. He stated that in the previous October, whilst thrashing barley, some husk was blown into his left eye, and had there remained, causing discomfort, but little pain. He washed and poulticed the eye, which was always inflamed and discharging matter. The upper eyelid was swollen, thickened, and red; the conjunctiva of the eye vascular, and the cornea hazy. On everting the lid, its lining membrane was found to be deep crimson, and highly granular; towards the upper fold the papillæ resembled in shape small mushrooms. Everting the lid to the utmost, and then drawing it from the eye with a flat probe, there was seen buried at the highest point a white substance; this was drawn out with some difficulty from its being firmly attached at one end, and proved to be a beard of barley, three fourths of an inch in length, and having serrated edges; it had been in the eye five months. Mr. Guthrie' mentions that he removed from the eye of a medical student a piece of the husk of a grass-seed, which had lodged there sixteen months; it had merely given rise to a little occasional irritation, which was augmented on his taking cold, and three or four red vessels running from the spot were then increased in size. It had caused a small depression in which it was lodged, but whence it was easily removed, and all inconvenience immediately subsided. Dr. Mackenzie2 refers to three cases in which particles of seed-husks adhering to the cornea in children were mistaken for specks or pustules, and treated accordingly, until the real nature of the case was discovered by that gentleman. Bird-fanciers frequently suffer from the husks of seeds flying into their eyes when engaged in cleaning cages. I have known severe neuralgia produced by the unsuspected presence of one of these foreign bodies; and M. Magne communicated to the Society of Practical Medicine in Paris a case, in which distressing neuralgia was excited by a particle of millet-seed fixed in the cornea,3 There are various occupations which are injurious to the eyes, either by causing direct mechanical injury, or by setting up inflammation as a consequence of irritation. I may specially mention drug and pepper grinders, lime burners, cinder sifters, dustmen, chimney sweeps, millers, 'On the Operative Surgery of the Eye,' p. 135. 2A Practical Treatise on the Diseases of the Eye,' 321. wool and feather cleaners, besides those exposed to more serious accidents, as miners, quarrymen, workers in metal, engine-drivers, &c. Chimney-sweeps suffer from the stimulating effect of ammonia contained in soot, in addition to the irritation of the soot itself. There appears to be an affection common in North America, which is injurious to the eyes. The ashes remaining from the various kinds of wood used as fuel are sold to boys, and their eyes become diseased from the light powdery dust containing large quantities of salts of potash, lodging within the eyelids, which become thickened, very red, and deprived of eyelashes.1 In certain villages in Alicante, in Spain, the manufacture of Esteras, a tissue made with the Stirpa tenacissima of Linnæus, causes a disease of the eyes among the workmen. The Euphorbium is the plant most dreaded by drug grinders. It causes such great irritation, that it is necessary to protect their faces and eyes with masks, having glass apertures to see through; not only will the dust cause violent ophthalmia, but if inhaled, it sometimes produces insanity. Pereira was informed at one drug-mill of an Irish labourer, who, under its influence, insisted on saying his prayers at the tail of the mill-horse. Cantharides, too, is very injurious to the eyes of workmen, and even the vapour of cantharidin will produce powerful effects. A pupil of Roubiquet was watching the crystallization of cantharidin, when he was seized with acute pain in the eye, followed by inflammation of the conjunctiva, attended with small vesicles, and loss of sight for several days. I am informed by Mr. Squire, that the preparation of the following articles is injurious to the eyes. Oil of mustard, 'Dr. Gibb, in 'Journal of Society of Arts,' vol. iii, p. 124. infusion of black mustard, made at a temperature of 160°, powder of hellebore, gamboge, squills, and veratria. The vapours of iodine, bromine, and chlorine, are very irritating, as are the fumes of ammonia and strong acetic acid. The antennæ and elytra of beetles occasionally lodge in the eye, and are somewhat difficult of removal. A clergyman called on me in May, 1856, and stated that three evenings previously, whilst walking in his garden, a small beetle flew into his eye with some force. It caused considerable pain, and though he wiped out the body of the insect, he saw and felt a portion remaining attached to the cornea. A surgeon endeavoured to remove it, but after many painful and fruitless attempts, advised his patient to come to town. The eye was now painful and inflamed, and the brown shining wing-case of the beetle was very apparent, adhering to the cornea near its upper and outer margin: the point of Hey's needle lifted it off with facility. In Australia the flies are a dreadful pest, depositing their eggs wherever there is the slightest breach of surface. A gentleman working at the diggings hurt his eye with the handle of a windlass: the next morning, feeling a strange creeping sensation in it, he got up, and to his horror saw it actually alive with maggots.1 Larrey2 mentions emphatically the horrible pest the flies were to the wounded during the Egyptian campaign; lotions of a strong decoction of rue and sage were found the most efficacious means of destroying the eggs and larvæ when deposited in the wounds. If a particle adheres to the conjunctiva covering the sclerotica, very little irritation may follow, and even when a 'Howitt, 'Two Years in Victoria,' p. 180. smooth substance attaches itself to the cornea but trifling annoyance may arise. Some years ago I received a letter asking my advice, and stating that a lady was suffering from a singular affection of one of her eyes, apparently prolapse of the iris just at the margin of the cornea, attended with but slight pain and inconvenience. This was so contrary to all experience that I felt satisfied there must be some mistake, and requested an interview with the lady. The supposed prolapse proved to be the brown, smooth, convex wing-case of a small beetle, which some weeks before had flown into her eye, and left the wing-cover sticking to the cornea. The opposite condition is shown by the following case: An officer was walking in the streets of Portsmouth in February, 1858, when a particle was blown into his left eye, and for a fortnight became the source of the greatest possible distress; when I saw him at the end of that time there was considerable conjunctivitis and some chemosis, photophobia of both eyes, and the lids of the left eye were spasmodically closed. With some difficulty I obtained a view of the cornea, and saw the foreign body near its centre; it was detached with Hey's needle, and proved to be a minute fragment of glass; the removal was attended with much pain, but the relief was so great that in four days the eye recovered its natural condition. A Sparks from lucifer matches cause much irritation. gentleman was lighting a match, when an ignited particle flew into his right eye, from which he in vain endeavoured to remove it. When seen by me three days afterwards the eye was acutely inflamed, and a brown speck, the size of a small pin's head, was visible, adhering to the inner margin of the cornea. The foreign body being removed, a deep dimple appeared in the cornea, burnt by the flaming composition. |