Text-book of ophthalmology . ars. III. Expression and Grattage 819. In performing expression for trachoma we attempt to remove thegranules without destroying the conjunctiva. This may be done either bypuncturing the granulations individually with a sharp knife and thensqueezing them out (Sattler), or by passing the retrotarsal folds through theblades of Knapps roller forceps. In the latter instrument each blade car-ries a fluted roller, and [when the lids are everted] the conjunctiva is drawnin between the two rollers, which fit closely into each other, and the tra-choma granules are squeezed
Text-book of ophthalmology . ars. III. Expression and Grattage 819. In performing expression for trachoma we attempt to remove thegranules without destroying the conjunctiva. This may be done either bypuncturing the granulations individually with a sharp knife and thensqueezing them out (Sattler), or by passing the retrotarsal folds through theblades of Knapps roller forceps. In the latter instrument each blade car-ries a fluted roller, and [when the lids are everted] the conjunctiva is drawnin between the two rollers, which fit closely into each other, and the tra-choma granules are squeezed out. [Many scarify the retrotarsal folds with a small triple-bladed scarifier beforeexpressing the granulations. Kuhnt uses an expressor, which has smooth bladesand simply squeezes the granules out without making traction on the conjunctiva ortearing it. Others prefer br088aget which consists in brushing the everted lids vigor-ously with horizontal sweeps of a small sterile toothbrush. Grattage is brassage with r p— -1 mmm. OPERATIONS ON THE CONJUNCTIVA 937 preliminary scarification, the toothbrush being soaked in a 1:500 or 1:2000 sublimatesolution. All these operations are quite painful and in children require general anaes-thesia. In others they may be performed with local anaesthesia, particularly if, follow-ing Guttmans suggestion, we inject a very weaksolution of cocaine directly into the retrotarsalfolds. The translators experience, agreeing withthat of others, is that expression with the rollerforceps is a satisfactory method, which, if prop-erly performed, is rarely attended with unduereaction or untoward symptoms. The expressionmay be applied not only to the retrotarsal foldsbut to the tarsus as well. In this case one branchof the forceps is placed on the cutaneous, theother on the tarsal surface of the lids, and the. latter is squeezed by the forceps, which is rolled *^?^7/7fl^>w* in different directions.—D.] Fig. 414.—Operation for Pterygium.— Dotted line
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Keywords: ., bookcentury1900, bookdecade1910, booksubjecteye, booksubjectophth
