become green, sometimes bright, at other times of a dull olive tint. The bright colour depends in some degree on the aqueous humour having become yellow, as I have proved by puncturing the cornea and allowing that fluid to escape. I may here remark that the cornea and aqueous humour influence the colour of the natural iris. Many times, when operating for cataract on a bright blue eye, have I been struck with the dull, leaden-gray tint of the iris, as seen when laid bare.

When a foreign body has lodged in the deep parts of the eye, and cannot be extracted, atrophy of the globe is the common result. The active symptoms-of which neuralgia is one of the most distressing and most persistent-gradually subside; the iris remains permanently discoloured; the pupil either closed by false membrane, or distorted and motionless, is bound by dark adhesions to the capsule of the lens; the lens or its capsule may undergo osseous degeneration, or if the capsule has been opened, the lens may be absorbed. The sclerotic, thinned in structure, permits the hue of the choroid to be seen, imparting to it a dusky tint, whilst the globe, soft and shrunken to the touch, is traversed in front by a few large tortuous purple vessels.

The cornea and iris of these withered eyes sometimes retain in a remarkable degree their relative forms and proportions; the shrinking is not merely by diminution in the contents of the globe, but all parts partake of it. I have seen atrophied eyes in which the cornea and iris were reduced to the size of half a pea; yet the proportions were maintained as they would be in a miniature natural eye.

It occasionally, though rarely, happens that a globe which has been softened again becomes plump; but we must not allow ourselves to hope that this will lead to the restoration of sight. There may be an increase in the perception of

light and of large objects, but useful vision is not to be expected.

Occasionally a globe atrophied from injury will take on acute inflammation. Mr. Watson mentions a case of collapse of the eyeball, resulting from injury seven years previously, in which inflammation came on, and the eye enlarged to a much greater size than the other, with great pain from the rapid effusion of fluid. When the inflammation abated, the eye again became somewhat collapsed.

Some years ago, a similar case occurred in my own practice. A gentleman residing in India received an injury which burst his left eye, and he was in the habit of wearing a false eye. Two years afterwards he returned to England in a bad state of health, and almost immediately on landing, acute ophthalmitis, with enormous distension of the globe, took place. To relieve this, an incision was made by me in the cornea, which gave exit to a quantity of fetid pus. The eye gradually shrank, and, after some weeks, the false eye was again worn.

Ossific deposit in the crystalline lens after injury is common; but this degeneration is by no means confined to the lens. The posterior portions of the globe often exhibit it in a marked degree, as shown in several preparations in the museum at Moorfields. The choroid may adhere to a shell of osseous matter occupying the position of the hyaloid membrane, or there may be a simple ring of bone around the entrance of the optic nerve. An interesting specimen is described,' in which a bony tube, continuous posteriorly with the central artery of the retina, and opening in front against the capsule of the lens, ran up the interior of the osseous shell. Between this central pillar and the outer wall were

1 Trans. Pathol. Society,' vol. vi.

numerous spicula of bone, which spicula contained numerous well-formed lacunæ, with their branching canaliculi. The tube and the spaces between the spicula were filled with masses of cholesterine.1 The presence of cholesterine is not uncommon, and there is also often present in these atrophic eyes brownish or yellowish serum, in which the remains of blood-discs are discernible.

An opportunity seldom occurs of ascertaining the nature of the changes in an eye long the seat of an impacted foreign body.

Dr. Von Ammon examined the eye of a man eighty years of age, which presented indications of marasmus of the cornea and choroid, the pupil being replaced by an elongated fissure, the edges of which were united by a brownish pigment, and which adhered to a mass which occupied the place of the crystalline, and was implanted in the extremity of the optic nerve. At first sight he took this for a calcareous concretion, the more so as there were concretions in various parts of the choroid; but chemical analysis showed the nucleus to consist of a particle of iron, probably detached from a hammer, the man having been long engaged in breaking

stones.

Extraction of a foreign body from the interior of the eye is at all times a delicate and often a very difficult proceeding. The difficulty may not be great if the body be loose in the anterior chamber; but it will be increased if there are adhesions, and will be at its maximum if the foreign body has passed out of view into the posterior chamber.

If a chip of metal, grain of shot, or similar substance, has

'In the spring of 1852 Mr. Canton exhibited, at the Medical Society of London, a beautiful specimen of complete ossification of the retina and capsule of the lens, removed after death from the eye of a man, which had atrophied in consequence of an accident many years previously.

passed through the cornea and dropped into the anterior chamber, it may thus be extracted:

Fig. 11.

The patient being properly placed, and the lids secured, an incision through the cornea, corresponding with the position of the foreign body, is to be made with a knife (fig. 11). As the knife is withdrawn, the foreign body will probably follow, washed out by a jet of aqueous humour; if not, the lid should be dropped (if chloroform be not used), and the eye allowed to rest awhile. The operator next, taking a scoop or pair of fine forceps, as may be most convenient, raises the lid, and his assistant should fix the eye by seizing the conjunctiva with forceps, for its steadiness is of the utmost importance.

If possible, the foreign body should be gently lifted out of the eye with the scoop (fig. 6); but if forceps are used, the utmost care is necessary that no fibres of the iris be seized, for the iris will now be in direct apposition with the cornea. There may be unexpected adhesions, and traction on the foreign body may risk the separation of the iris from its ciliary attachment. In such a case, I pass a fine probe into the eye, and press back the iris from the foreign body, at the same time that with the other hand the intruder is withdrawn. It may be necessary to snip off with scissors the fibres to which it is attached. In that case the cut should be made towards the pupil, so that the two openings may be thrown into one. In these proceedings the utmost gentleness is necessary, or the iris may be lacerated, will then bleed, and further steps be rendered most difficult.

I

may

Fig. 12.

here remark on the great aid afforded by chloroform in these delicate operations; it tranquillises the irritable eye, shortens the operation, and spares the patient pain; for although the eye in its natural state bears operations well, it is far otherwise when inflammation has been excited; and those only who have undertaken its performance can imagine the difficulty of extracting a foreign body from the interior of an eye intolerant of light, streaming with tears, and with lids and ocular muscles in powerful spasm.

If there is a sufficient wound in the cornea, and the patient is scen immediately after the accident, the surgeon may possibly succeed in drawing out the foreign body; a slight enlargement of the wound with the blunt-pointed knife (fig. 12), may be advantageous; but if the wound be irregular, or in an unfavorable situation, as the centre of the cornea, it will be best to make a clean incision with the knife (fig. 11), in the most convenient situation, as this will greatly facilitate the extraction of the foreign body.

This may be hidden by a coagulum of blood; if so, the operation should be deferred, for aimless groping with instruments in the eye is greatly to be deprecated.

If the foreign body is behind the iris, but below the pupil, the incision should be towards the upper part of the cornea; the canula-forceps will be here most useful, as they can be passed through an opening of small size, and yet will seize and retain a mass of some dimensions. The main difficulty arises when the shape or polish of the surface prevents