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PERIORBITAL AND ORBITAL SWELLINGS Swellings related to the supraorbital margin Dermoid cysts Dermoid cysts are benign congenital choristomas of the orbit that originate from fetal bone suture lines during development, most commonly the frontozygomatic suture ...

Penetrating eye injuries These occur when the globe is penetrated, often in road tra ffi c and other major accidents ( Figure 49.23 ) and also in injuries from sharp instruments. The compulsory wearing of seat belts in motor vehicles has substantially reduced t...

RECENT DEVELOPMENTS IN EYE SURGERY In the last three decades, eye surgery has become a micro surgical specialty . Cataract surgery has been transformed by changes in local anaesthesia, implants, phacoemulsification and small-incision surgery , which allows comp...

SURGICAL PROCEDURES Excision of an eyeball/enucleation 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 op...

SURGICAL PROCEDURES Excision of an eyeball/enucleation 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 op...

Subconjunctival haemorrhage This presents as a bright red eye, often noticed incidentally with only minimal discomfort and normal vision. Causes include coughing, sneezing, minor trauma, hypertension and, rarely , a bleeding disorder. Subconjunctival haemorrha...

Swellings of the lacrimal system Lacrimal sac mucocele This occurs from obstruction of the lacrimal duct beyond the sac and results in a fluctuant swelling that bulges out just below the medial canthus. It can become infected to give rise to a painful tense sw...

Swellings of the lacrimal system Lacrimal sac mucocele This occurs from obstruction of the lacrimal duct beyond the sac and results in a fluctuant swelling that bulges out just below the medial canthus. It can become infected to give rise to a painful tense sw...

Swellings of the lids Meibomian cysts (chalazion) These are the most common lid swellings ( Figure 49.4 ). A meibomian cyst is a chronic granulomatous inflammation of a meibomian gland. It may occur on either upper or lower lids and presents as a smooth, painl...

The globe The cornea is the 12-mm-diameter window of the eye, 550 /uni00A0 µm thick centrally on average; its clarity is due to the regular Heinrich Meibom (Meibomius) , 1638–1700, Professor of Medicine, History and Poetry , Helmstadt, Germany , described th...

Treatment Treatment is directed to the cause of the lesion, taking care to prevent exposure of the eye, diplopia or visual impairment from optic nerve compression. Treatment Treatment is directed to the cause of the lesion, taking care to prevent exposure o...

Uveitis This can be anterior (iritis) or, more rarely , posterior. In anterior uveitis, the pupil is sometimes small and/or irregular owing to formation of posterior synechiae (adhesions between the iris and the lens). There is often circumcorneal injection a...

ACUTE APPENDICITIS In early appendicitis, there is a fever of 37.3–38.4°C, anorexia, a few vomits and central abdominal pain settling in the right iliac fossa. Persistent guarding in the right iliac fossa Johann Conrad Peyer , 1653–1712, Swiss anatomist. - - ...

ACUTE SCROTAL DISORDERS Testicular torsion Intravaginal (bell clapper) testicular torsion is well recognised in adolescents but may occur at any age. Abnormal posterior anchoring of the testis allows torsion within the tunica vagina lis. Torsion compromises b...

ANORECTAL PROBLEMS Constipation The passage of hard or infrequent stools may be secondary to an anal fissure, Hirschsprung’s disease, an anorectal malforma tion, a neuropathic bowel, a mega-rectosigmoid or idiopathic constipation. A detailed history and examin...

Ascending testes Some scrotal testes in infancy are later found in the high scro - tum or groin with ascent attributed to insu ffi cient cord growth; - a few were retractile in infancy . An orchidopexy is required. An argument exists for screening all boys for a...

Epididymo-orchitis Bacterial or viral inflammation is occasionally found on exploration for suspected torsion. Epididymitis is seen before 6 months and is caused by infected urine travelling up the vas. Chlamydia trachomatis, Neisseria gonorrhoea Epididymo-orch...

GASTROSTOMY A gastrostomy may be requested for nutritional support. Options include an open Stamm gastrostomy , a Ponsky– Gauderer percutaneous endoscopic gastrostomy (PEG) or a laparoscopic approach using a Seldinger technique. The Stamm gastrostomy employs t...