THE EYE AND ITS APPENDAGES 117 



Operation for Relief of Entropion. — In performing this operation a 

 long, narrow, elliptical piece of the cutaneous layer of the lid should 

 be excised, and the free edges of the wound are then brought into 

 apposition by the insertion of two or three small interrupted sutures. 



Some operators do not suture, but maintain that the contraction 

 of the cicatricial tissue which forms over the wound, provides 

 sufficient traction to restore the inner aspect of the lid to its normal 

 conformation. This is brought about by the shortening of the 

 outer cutaneous layer, and the consequent pulling outwards of the 

 lower or free edge of the lid. 



Excessive outward curvature of the lid is known as Ectropion. 

 In this case the conjunctiva becomes exposed and inflamed. 



Operation for Relief of Ectropion. — The principle which underlies 

 the treatment of this affection is similar to that upon which the 

 treatment of Entropion is based. In this case an endeavour is made to 

 pull the free edge of the lid inwards or towards the surface of the cornea, 

 by causing a contraction of the layer of conjunctiva which lines the 

 lid. To effect this a small elliptical portion of the conjunctiva is excised. 



Trichiasis. — This term is applied to the condition when the eye- 

 lashes are incurved, and set up intense irritation of the conjunctiva 

 covering the anterior face of the eyeball, which irritation leads to the 

 production of symptoms of inflammation. The condition is relieved 

 by the extraction of the incurved lashes with a pair of forceps. 



Careful examination of the upper lid will reveal on its ocular 

 aspect and near the temporal canthus the minute openings of the 

 ducts of the lachrymal gland. These should be noted, for occasionally 

 they become blocked, and it then becomes necessary to restore their 

 patency by the passage of very delicate flexible probes. Failing 

 probes of sufficient delicacy a firm bristle will suffice. 



The Piincta Lachrymalia are near the opposite or nasal canthus. 

 These are two in number, and they are placed one on either side the 

 small, dark, rounded nodule which is known as the caruncula lachrymalis . 



