OPERATIONS ON THE LIDS 47 



is described as follows by Meller in his work on ''Oph- 

 thalmic Surgery." He divides the operation into four 

 steps: The first step consists in ''sphtting the lower 

 lid in the intermarginal border." He uses a lancet or 

 keratome for this purpose, passing it in between the 

 skin and the tarsus, using the thumb and index-finger 

 as a guide, so that the tarsus or skin will not be wounded. 

 •He starts ''sUghtly to the inner side of the middle of the 

 lid and goes exactly to the external canthus." 





v>^ --^. 



A.. 



'%f^::,^:^^,^^' 



Fig. 12. — Showing the formation of the triangle of skin, which is later 

 removed, (de Schweinitz, " Diseases of the Eye.") 



As the Hd is very vascular, hemorrhage must be stopped 

 with adrenalin or compression. 



'The second step is the excision of a triangular piece 

 from the tarsus." The size of this piece depends upon 

 the degree of the deformity. This piece is best excised 

 with a strong pair of straight scissors. The overlying 

 conjunctiva is, of course, included in the excision. 



"The third step consists in the excision of a triangular 



