[National Library of Medicine.  HF 1613.  This transfer made: 12/21/05.  Length: 00:15:00]

[UNITED STATES NAVY TRAINING FILM.  NONCLASSIFIED]

[EYE SURGERY]

[REMOVAL OF INTRA-OCULAR FOREIGN BODIES.  MN-2477B.  1945.]

Rapid evacuation by air to a base hospital is essential in the treatment of eye injuries involving intra-ocular foreign bodies.

Loss of time may result in critical degenerative changes.

Immediately upon arrival x-ray examination is made to confirm the presence of a foreign body.

An anterior posterior plate is made.

Then another is taken in the lateral direction.

In the anterior posterior view a foreign body is seen.

The lateral plate also confirms the diagnosis, and it is now necessary to localize its position.

A contact glass technique is used.

The cornea is anesthetized with Pontocaine.

The contact glass has four radio opaque dots which appear on the x-ray plate, and are used in measurements to locate the foreign body.

This glass is inserted under the lids and over the cornea.

Two x-rays are again taken, with the contact glass in place.

The eyes are fixed by having the patient look through the peepholes.

In the front view, a foreign body is seen in relation to the opaque dots of the contact glass.

The lateral plate of the orbit also shows the dots of the contact glass, one above, one below, and two in the center

superimposed all in a vertical line.

Measurements are then taken from the horizontal and vertical meridians, and the angle is plotted.

The distance the foreign body is located from the limbus is measured.

With this information the surgeon is enabled to know where to make the incision.

Surface anesthesia is obtained with one-half percent Pontocaine, and regional anesthesia with two percent procaine.

The site of the foreign body as computed on the localization chart is determined by measuring the distances on the surface of the globe

and the position is marked by a black suture.

The conjunctiva is incised and undermined, exposing the sclera.

Following this, diathermic cautery procedure is performed.

Multiple punctures are made through the sclera with the Lockaray needle.

These punctures are made all around the area of the intended incision.

The purpose of these punctures is to prevent a detachment of the retina.

An opening is made through the sclera with a one and a half millimeter trephine over the site of the foreign body.

By slanting the instrument as it is cutting through the sclera, a hinge of the scleral tissue is made.

A catgut suture is placed through the free margins of the plug.

The needles are passed through the opposite edge of the sclera.

The tip of a magnet is placed at the lips of the incision.

A current is applied, and the magnetic foreign body is extracted.

The foreign body is seen on the tip of the magnet.

Pencillin therapy is instituted to gaurd against the spreading infection.

After the foreign body has been removed, the scleral opening is closed by tying the catgut sutures.

The conjunctival incision is sutured.

The speculum is removed, and sulfathiazole ointment and a dressing are applied.

[Non-Magnetic Foreign Bodies]

In the care of a non-magnetic foreign body, which cannot be removed with a magnet, another procedure is followed.

The instrument specifically designed to aid the surgeon in the removal of non-magnetic foreign bodies is the Thorpe ocular endoscope.

This instrument is designed on the principle of a cystoscope, with a light bulb for intra-ocular illumination and with grasping forceps attached.

These grasping forceps may be moved up and down to get the proper depth, or revolved around the axis.

By employing a contact glass technique for localization, the foreign body is charted.

In this case the exact position is found to be posterior to the equator, near the surface, and just below the border of the lateral rectus muscle.

A speculum is inserted, first under the upper lid, and then under the lower lid.

After anesthesia, the conjunctiva is incised over the region of the foreign body, and reflected backward exposing the sclera.

The lateral rectus muscle is isolated,

a muscle hook is placed under it, and the suture is passed through its tendon at the insertion.

The muscle is then cut, thus giving a good exposure of the sclera.

The location of the foreign body is measured on the scleral surface corresponding with the spot on the localization chart.

The location is marked with a black silk suture.

A scleral flap seven millimeters long and four millimeters wide is outlined with a double-bladed knife.

The incision is deepened with a cataract knife.

The two ends of the incision are joined by a third incision

and the flap is lifted and dissected back, carefully avoiding tramautism of the choroid.

A catgut suture is placed through the end of the flap.

The choroid and the retina are then incised.

The tip of the ocular endoscope, with the light and grasping forceps, is now placed into the eye.

The assistant holds the instrument, preventing it from going too far

while the operator searches for the foreign body while looking through the eyepiece.

Here is an actual view of the endoscope in the eye grasping the foreign body.

The foreign body may now be seen on the end of the thumb.

It is a piece of copper from a detonator cap.

The catgut suture which was placed through the flap is then carried through the opposite edge of the scleral incision.

The flap is then sutured with tantalum wire, which has great strength, is non-absorbable, and need not be removed.

The tantalum suture is then tied.

Another suture of the same material is placed through the edge of the flap and the opposing edge of the scleral incision.

This type of suture is ideal for this operation, due to its high tensile strength, and because it causes very little tissue reaction.

Cortory punctures are made all around the region surrounding the incision with one millimeter Walker needles to prevent a detachment of the retina.

The needles are then removed.

The cut end of the lateral rectus muscle is sutured back to its insertion.

Tenon's capsule and the conjunctiva are sutured with catgut.

Conjunctival sac is irrigated, the speculum is removed, and sulfathiazole ointment and a dressing are applied.

[THE END]