Surgical procedures

Excision of an eyeball

Indications include a blind, painful eye, a blind, cosmetically poor eye, intraocular neoplasm and in cadavers for use in corneal grafting. The operation. The speculum is introduced between the lids and opened. The conjuctiva is picked up with toothed forceps and divided completely all round as near as possible to the cornea, Tenon’s capsule is entered, and each of the rectus tendons hooked up on a stabismus hook and divided close to the sclera. The speculum is now pressed backwards and the eyeball projects forwards, blunt scissors, curved on the flat, are insinuated on the inner side of the globe, and these are used to sever the optic nerve. The eyeball can now be drawn forwards with the forceps, and the oblique muscles, together with any other strands of tissue which are still attaching the globe to the orbit, are divided. A swab moistened with hot water and pressed into the orbit will control the haemorrhage. If an oribital implant is inserted to give better eye movement, the muscles are sutured to the implant at the appropriate sites.

Evisceration of an eyeball

As a result of the danger of opening up lymphatic spaces at the back of the globe, and thus favouring meningitis, evisceration is to be preferred to excision in panophthalmitis. The sclera is transfixed with a pointed knife a little behind the corneosclerotic junction, and the cornea is removed entirely by completing the encircling incision in the sclera. The contents of the globe are then removed with a curette, care being exercised to remove all of the uveal tract. At the end of the operation the interior must appear perfectly white.

Incision and curettage of chalazion (meibomian cyst)

The lid margin is everted to allow the application of a meibomian clamp. The ring of the clamp is placed on the palpebral conjunctiva with the granuloma in the centre. An incision is made with a sterile

blade in the axis of the gland. The herniating granulomatous tissue is -removed with a curette and the gland is scraped clear. Recurrent cysts may have to have the cyst wall dissected away with scissors. A biopsy may be necessary in recurrent cysts to exclude malignant change.