ce emphysema. In suturing wounds of the lids care must be taken
to secure accurate apposition at the free margins, and to avoid
constricting the canaliculi.

_Contusion_ of the eyelids and circum-orbital region--the ordinary
"black eye"--is associated with extravasation of blood into the loose
cellular tissue of these parts, and is followed within a few hours of
the injury by marked ecchymosis. The lids may swell to such an extent
that the eye is completely closed. In some cases the impinging object
lacerates the vessels of the conjunctiva and produces a
sub-conjunctival ecchymosis, which may be situated under the palpebral
conjunctiva of the lower lid, or close to the corneal margin on the
front of the globe. The blood effused under the conjunctiva remains
bright red as it is aerated from the atmospheric air. The
characteristic play of colours which attends the disappearance of
effused blood is observed within a week or ten days of the injury.

Firm pressure applied by means of a pad of cotton wadding and an
elastic bandage, if employed early, may limit the effusion of blood;
and massage is useful in hastening its absorption.

A black eye is to be distinguished from the effusion which sometimes
follows such injuries as fracture of the anterior fossa of the skull,
fracture of the orbital ridges, or a bruise of the frontal region of
the scalp, chiefly by the facts that in the former the discoloration
comes on within a very short time of the injury, the swelling appears
simultaneously in both lids, and the sub-conjunctival ecchymosis, when
present, is coeval with the ecchymosis of the lids. In fractures of
the orbital plate and bruises of the forehead, on the other hand, the
ecchymosis does not appear in the eyelids for several days, and that
under the conjunctiva is usually disposed on the globe as a triangular
patch towards the lateral canthus.

_Wounds_ of the orbit result from the introduction of pointed objects,
such as knitting pins, pencils, or fencing foils, or from chips of
stone or metal, or small shot. They are attended with considerable
extravasation of blood, which may be diffused throughout the cellular
tissue of the orbit, or may form a defined haematoma. In either case
the eyeball is protruded, and the cornea is exposed to irritation and
may become inflamed and ulcerated. The optic nerve may be lacerated,
and complete and permanent loss of vision result. Sometimes the ocular
muscles and nerves are dama