ECTROPION. — Ectropion, eversion of the eyelid, may be caused by traumatisms, especially burns, the cicatricial contrac tions drawing its tissues outwardly. Muscular or senile ectropion is seen in the aged, as a consequence of atrophy of the palpebral portion of the orbicularis and relaxation of the tissues.
Treatment.—In senile ectropion the deformity may usually be overcome by means of Suellen's sutures. This con sists in burying a suture, which is en tered at two points, one-third of an inch distant from each other, in the mucous surface of the lid, and passing deeply into the tissues between the skin and the mucous membrane. It is brought out upon the cheek, where the ends are tied over a piece of drainage-tube.
Very simple expedient for the correc tion of the deformity observed in cases of extreme non-cicatricial ectropion of the low er lid is as follows:— The eanaliculus is slit, and an incision made in the conjunctiva about one milli metre removed from the opening of the Meibomian ducts, this incision being car ried the whole length of the palpebral aperture vertically through the conjunc tiva and tarsus by means of a Graefe knife. From the middle portion of the tarsus the conjunctiva is then separated for a few millimetres, after which the tarsus is divided. Each free end is grasped in turn by means of a forceps, and dissected out to its extreme limits, care being taken not to excise any conjunctival tissue. Steven's tenotomy scissors arc the best used. A bandage is worn for a few days. The lid is mass aged with vaselin, in an upward and inward direction. A. E. Prince (Amer. Jour. of Oplith., vol. xv, No. 5, '93).
In cicatricial ectrcpion it is necessary to include in the incision the scar-tissue which has occasioned the eversion of the lid. If the cicatrix is small, Wharton Jones's operation will suffice. This con sists in excising the cicatrix by means of a V-shaped incision. After the edges of the incision have been freely loosened from the sublying tissue they are imated so as to form a Y. If the cicatrix be extensive, or if there has been much destruction of the skin of the lids and the neighboring tissues, transplantation of skin from neighboring or distant parts is necessary.
ENTROPION.—Inversion of the eyelid, the margin, its lids being rolled inward, may be spasmodic,—i e., due to overaction of the orbicularis through irritation from concomitant disorders, conjunctivitis, keratitis, etc., or to undue application of bandages after operation; and organic, due to injuries, burns, ulcers.
Treatment.—The spasmodic form may readily he corrected by excising a narrow strip of skin from the lid parallel with its ciliary border. In organic entropion, on the other hand, it is necessary to include the tarsus in the operation, as this is usu ally distorted by the previous inflamma tion.
One of the best procedures for the cure of this deformity is that of Hotz. This is performed as follows: A transverse in cision from canthus to canthus is made through skin and subjacent tissues, but, instead of being made near and parallel with the free border (as in the former methods), the incision is to follow the upper border of the tarsus. It therefore describes a slight curve beginning and ending at a point about two millimetres above the canthus, but being six to eight millimetres distant from the free border in the centre of the lid. While an as sistant is holding the edges of the wound well separated, the surgeon lifts up with forceps and excises with scissors a narrow bundle of the muscular fibres which run transversely along the upper border of the tarsus. The sutures, which are to in clude nothing but the cutaneous wound borders and the upper border of the tarsus, are then inserted. The first suture is placed in the centre of the lid; the curved needle, armed with fine, black, aseptic silk, is passed through the lower wound border; there taken again in the needle-holder, it is boldly thrust through the upper border of the tarsus and re turned through the tarso-orbital fascia just above this border; and finally it is carried through the upper wound bor der. One similar suture is placed at each side of the central one, and these three stitches are usually sufficient for to draw the skin of the eyelid up toward the upper border of the tarsus and establish a firm union between these parts. This arti ficial union produces a slight tension of the tarsal skin, which, however, is suffi cient to relieve any ordinary degree of entropion. But when the lids have been badly contracted—when the palpebral aperture has become unnaturally narrow or the free border of the lid has become entirely merged into the plane of the conjunctiva—these complicated cases re quire, in addition to the above operation, such surgical measures as canthotomy, the restoration of the free border either by grooving the tarsus or by grafting.