Caustic potash recommended in the treatment of senile entropion due to trachoma. Before cauterization the lid is soaked for ten or fifteen minutes in a strong solution of cocaine. The crayon of caustic is sharpened by rubbing on wet blotting-paper. The aim is to pro duce an eschar, three of four millimetres wide, extending the whole length of the tarsus parallel to the margin, but no where nearer to it than two millimetres. The lid being everted and put upon the stretch, the crayon is drawn back and forth along the line about four milli metres from the lid-border until the epi dermis is destroyed and the tissues be neath begin to assume a brownish color. When the action of the caustic has ex tended sufficiently, it is checked by the application of an acid solution, as diluted vinegar. No dressing is necessary. S. Theobald (Trans. Amer. Ophthal. Soc., '98).
Distichiasis and Trichiasis.
While distichiasis refers to the growth of the cilia along the outer marginal por tion of the eyelid, trichiasis means a mis placement of the eyelashes. Both condi tions are usually associated with entro pion, especially when this condition is the result of chronic inflammation of the border of the lids.
TREATMENT.—Epilation or removal of the cilia by forceps may be tried if the stray cilia be not too numerous. ysis may also be used in similar cases.
Usually, however, excision of the placed cilia with the corresponding por tion of the margin of the lid is necessary. This may be accomplished by making a.
incision into the lid and by ex cising the flap so obtained, along with the truant cilia.
if the deformity be extensive, trans plantation of the row of cilia is usually effected, and this is best accomplished by the Jaesche-Arlt operation. After a Knapp or a Snellin clamp has been ap plied to stop bleeding the lid is split in its whole length by a sharp knife; a sec ond incision is then made through the skin of the lid about five millimetres from its free margin and running its entire length. A semilunar flap of skin is then removed from the lid by carrying a third incision in a curve the entire length of the second incision. The edges of this incision are approximated by sutures, and the cilia drawn upward away from the globe.