ECTROPION.
The treatment of this condition, which is also known as Eversion of the eyelids, may be conveniently considered along with that of the opposite state—Entropion, or Inversion.
Ectropion of muscular or spastic origin is often met with in the lower eyelids of patients who suffer from chronic swelling of the conjunctiva. The affection in its early stage usually yields to the free use of astringent eye lotions as Sulphate of Zinc (r gr. per oz.) or Boric Acid (S grs. per oz.). As seen in the lower lids of senile patients it is due to a displaced position of the lachrymal punctum caused by loss of tone in the skin of the cheeks and in the orbicularis muscle. When treated early these cases usually yield to conjunctival astringents and slitting of the canaliculus.
More radical operative procedures must he undertaken in very chronic cases; thus where there is much thickening of the conjunctiva a long narrow slip of the marginal portion is to be dissected from the lower lid, mid the remaining healthy conjunctiva, after freeing it from underlying tissues, is to he attached by sutures to the lid at its margin as in the Free land-Fergus operation, or an attempt may he made in less chronic cases to procure the same result by application of the solid stick of Nitrate of Silver or by the galvano-cauterv. In the absence of hypertrophied or
inflamed tissue the lid may sometimes he restored to its normal position by Sm.lien's sutures without a cutting operation.
Kuhnt's operation is the best for senile ectropion; this consists in short ening the lower lid by splitting it in its central portion into two layers; out of the posterior one, which contains the tarsus and conjunctiva, a triangular piece with its base along the free margin is then excised, and the lips brought together by sutures.
The ectropion which follows burns and ulcers of the face can only be remedied by a careful dissection of the cicatrised tissue, which enables the displaced lid to be restored to its normal position, in which it is main tained by sutures, whilst one graft of skin or a number of Thiersch grafts • are attached to the raw surface exposed by the dissection.