L. WEBSTKK F«>X. M. [)., 
1304 W»LNUT SihKH, 
Implantation of a Glass Ball in the Orbit 
after Enucleation of an Eye. 
BY 
L. WEBSTER FOX, M.D., 
Professor of Ophthalmology in the Medico-Chirurgical College, 
Philadelphia. IMPLANTATION OF A GLASS BALL 
IN THE ORBIT AFTER ENUCLEA- 
TION OF AN EYE. 
By L. WEBSTER FOX, M.D., 
Professor of Ophthalmology In the Medico-Chi- 
rurglcal College, Philadelphia. 
The success attending evisceration of an 
eyeball and inserting an artificial vitreous 
in thirty operations has led me to devise a 
similar method of improvement in cases 
where the eyeball has been removed in toto. 
The retraction of orbital tissue and con- 
sequently the sunken appearance which an 
artificial eye bears to its fellow always make 
the patient a marked individual. The sinis- 
ter stare and want of movement in the arti- 
ficial eye makes the rejnoval of an eyeball, 
for whatever cause, an unfortunate calamity 
to any individual. I have at last succeeded 
in successfully implanting a glass ball in 
orbital cavities of two patients. (Fig. i.) 
In my first patient the glass ball does 
not lie directly in the centre of the orbital 
cavity, and consequently the adjustment of 
an artificial eye is not entirely successful, 
although there has been great improvement over conditions existing prior to this opera- 
tion. The orbital tissues contracted to such 
an extent that no eye could be worn at all. 
The eyeball was removed by myself twelve 
years ago at the Germantown Hospital. 
Fig i. 
In the second case I have been more suc- 
cessful, having succeeded in keeping the 
glass ball directly in the centre of the orbital 
cavity. My method is as follows: An incis- 
ion is made through the conjunctiva and tis- 
4 sues of the orbit in the horizontal direction, 
corresponding to scant the diameter of the 
glass ball to be inserted—for instance, if 
the glass ball is one centimetre in diam- 
eter the cut would be two millimetres less. 
The upper lip of the conjunctiva is raised 
and with a sharp-pointed curved scissors 
the conjunctiva and such connective tissue 
which lies close to it is dissected off in all 
directions around the incision, making a 
pouch into which the glass ball will fit. 
Fig. 7. 
(Fig. 2.) On account of the vascularity of 
the parts, considerable bleeding follows this 
dissection, but it is easily controlled by pres- 
sure; after the bleeding stops the glass ball 
is inserted into the cul-de-sac with the in- 
jector. The edges of the conjunctiva are 
brought together by five or six stitches and 
the after-dressing is the same as I follow in 
the evisceration cases. 
Immediately after the operation the arti- 
ficial stump does not show very markedly; 
but after all swelling disappears we have a 
5 Fig. 3. beautiful stump for the adjustment of an 
artificial eye. It would be almost impossi- 
ble to note the difference between implan- 
tation or evisceration, for the movement is 
almost the same. 
The patient (see Fig. 3) shows the result 
of the operation with the artificial eye ad- 
justed. The patient was brought to the 
Medico-Chirurgical Hospital by Dr. John 
N. Leuker, of Wiconisco, Pa., for vague 
pains in her right eye and also with the 
hope that something might be done to im- 
prove the appearance of the artificial eye. 
It had a sunken appearance. The left eye 
had been lost by a general inflammation 
of the eyeball, which necessitated its re- 
moval, and was done most successfully last 
November by my friend, Dr. J. Walter Park, 
of Harrisburg. The orbital cavity was 
faultless. When the artificial eye was ad- 
justed, however, it had the fault of all such 
cases,—the rotation was limited and the 
enophthalmus pronounced. 
1304 Walnut Street.