ENTROPION, or inversion, when spastic, sometimes, but very seldom, may in slight cases be remedied by a temporary fastening of the lower lid in its normal position by strapping. When due to senile changes a long strip of skin, including the fibres of the orbicularis muscle along the margin of the lid, should be excised and the margin of the lid loosely sutured to the skin wound so as to draw the lid outwards as the cicatrix shortens. The marginal fibres of the orbicularis should be at the same time divided at the external canthus. A better result is obtained in severe cases by avoiding sutures altogether. Iloltz's operation is more reliable when the upper lid is affected; it consists in making a longitudinal incision at some distance from the margin of the lid for its entire length, and after removal of muscular fibres the margins of the skin wound are attached by sutures to the tarsal cartilage.
In entropion caused by thickening of the conjunctiva and deformity of the tarsus following granular ophthalmia, a wedge-shaped portion of the cartilage will require excision by Snellen's operation. An incision is made for the entire length of the lid and a strip of orbicularis muscle is removed and a long triangular or wedge-shaped piece of the tarsus cut out by a sharp knife, after which, by careful suturing, a complete eversion of the margin of the lid is effected.
ilerlin's operation an incision is made at a short distance along the margin of the lid dividing skin and conjunctiva, after which an oval strip of the tarsal cartilage with its conjunctival covering is excised and the wound sutured.
In less severe cases the operations suitable for Trichiasis or Distichiasis are indicated.
Arlt's operation consists in splitting the lid into two layers for its entire length, after which an oval flap of skin is dissected out at a short distance from the margin of the lid without removing the fibres of the orbicularis and bringing the edges of the skin wound together. The margin of the lid with its inturned hairs is everted or tilted forwards.
In Von Milligen's operation the lid is split into two layers, as in Arles method, and into the entire length of the upper part of the resulting hiatus, which is kept open by sutures, a thin strip of mucous membrane dissected from the inner aspect of the patient's lip is adjusted with a probe or held in position by a few sutures when necessary. This forms a new edge to the lid between the globe and the line of the inverted eyelashes.