MALPOSITION OF THE EYELIDS 501 



Several operations have been used successfully in relieving 

 this condition. The removal of a V-shaped portion of the 

 lower lid, leaving the margin of the lid free, and bringing the 

 edges of the wound together with sutures has been successful. 

 This forces the margin of the lid upward and inward. The 

 amount of tissue removed will depend upon the degree of 

 correction to be made. 



Another method frequently employed is to remove a tri- 

 angular piece of skin just outside of the external canthus* 

 and on a direct line with the lower lid, the base of the triangle 

 being upward. Sutures are applied and the traction of the 

 sutures and the cicatricial tissue formed keeps the lower lid 

 pulled upward. In this case the size of the triangle will 

 depend on the degree of ectropion present. 



These operations should be made under strict antiseptic 

 precautions and the parts protected. If necessary a head 

 bandage with eye protector can be used. 



Ptosis. — Blepharoptosis.— Definition.— A dropping or fall- 

 ing of the upper lid so that it continuously covers the eye. 

 It may occur as a symptomatic condition in conjunction 

 with other local affections, such as atrophy of the eyeball, 

 enophthalmos, etc. 



Etiology.— The causes are various: 



(a) It may be sympathetic, resulting from paralysis of the 

 cervical sympathetic nerves. Wounds and injuries to the 

 nerve, or growths, or enlarged glands, in its cervical or intra- 

 thoracic course will produce ptosis. 



(b) Ptosis is often paralytic produced by a paralysis of the 

 muscles of the upper eyelid, either due to a lesion of the 

 muscle or its nerve supply. 



(c) It may result from fracture of the orbital rim or process 

 of the frontal bone. 



(d) Tumors pressing on the cerebrum or cerebellum have 

 been known to cause it. 



(e) Ptosis often follows distemper, and other general dis- 

 eases. 



(/) Very often tumor formation on the upper eyelid will 

 gradually overcome the muscular action and drag the eyelid 

 downward. 



