1844 The Lancet  
lapsus iridis, in which the healing process is accompanied by little or no severe inflammation. The reverse, however, is the case where these textures have been previously inflamed, and iritis, or general ophthalmitis, is suddenly and actively set up, and unless energetic measures are adopted, the globe is lost by suppuration or subsequent atrophy. Let it be carefully inquired, therefore, when the disease, which resulted in closure of the pupil, originated ? how long it existed? whether it had
more » ... ed? whether it had been subsequently renewed, and how often ? whether at any period symptoms appeared indicative of implication of the posterior tunics ? Especially let inquiries be made as to the existence of muscae, flashes, and luminous spectra. Let the organ be minutely examined ; if the iris be much changed in colour, its fibres indistinct, its polish lost, the aqueous fluid dull ; if slight handling of the lids, and exposure of the organ to the light, call into the sclerotic vessels the pink blush and zone around the cornea, or induce pain or lachrymation, then the time is not come for the safe performance of the operation for artificial pupil ; tben is it far more prudent to wait awhile, to apply such treatment as may remove lingering chronic inflammation, or restore strength to the organ and tonicity to its vessels. Amongst the many operations that have been suggested and practised for the relief of closed pupils, are several forms which agree in the attempt to make an artificial pupil, and to get rid of the lens, at one and the same time. This is effected by cutting up, depressing, or extracting the lens, while an incision is made into, or a piece cut out from the iris, and these complicated operations are recommended by cases and names high in ophthalmological science. The ill success that has notoriously attended most forms of operation for an artificial pupil, has resulted, in my belief, in the desire to effect too much at once, but we should ever remember that, unlike the operation for the removal of ordinary cataract, we are called upon to manipulate upon an organ that has been previously the seat of severe, and, perhaps, disorganising inflammation. Hence the necessity of avoiding all undue violence, and of winning your way, step by step, advancing a little, and but a little, at such attempt, until we succeed in the three-fold object of removing the
doi:10.1016/s0140-6736(02)75288-4 fatcat:gv2w54g24jd5xn6bm2y4dibzhq