Turning Out of the Eyelid. Ectropion. 349 



Symptoms. Beside the exposure of the zone of mucosa, there 

 is the overflow of tears, and in old standing and bad cases a 

 hypertrophy of the exposed conjunctiva, which projects as a 

 ■fleshy-looking mass, and weighs down the lid, with a continual 

 tendency to aggravation. 



Treatment. Where the main factor seems to be the infiltration 

 of the mucosa this may be reduced by scarification, or by the 

 complete excision of a fold of the membrane. Use an antiseptic 

 Tvash (boric acid) and the retraction of healing tends to brace up 

 the lid against the bulb. 



Snellen's suture is sometimes employed successfully. A silk 

 thread is armed at each end with a needle, and the needles are 

 • passed into the conjunctiva just inside the tarsus and brought 

 out through the skin near the margin of the orbit, where they 

 are tied round a srnall roll of cotton. Several of these may be 

 inserted side by side so as to extend the whole length of the 

 ectropion and they should be drawn tight enough to correct the 

 deformity. If left some days they will usually determine cica- 

 trices which will overcome the deformity. 



The most common operation (Dieffenbach's) is the excision of 

 a triangular portion of skin from just outside the lower lid and 

 having its base or upper side running horizontally outward from 

 the outer canthus. Then pare the margin of the lower lid for a 

 distance equal to the base of the triangle. Then bring together 

 and suture the skin forming the right and left sides of the tri- 

 angle, and the raw edge of the lid to the skin that formed the 

 base of the triangle. In this way the triangular sore formed by 

 the operation is completely covered and the margin of the lower 

 lid is shortened so as to brace it up against the bulb. 



In case of cicatricial ectropion the Wharton- Jones operation is 

 to be adopted. A V-shaped incision is made in the skin of the 

 lower lid commencing just beneath the tarsus and carried down 

 so that the two lines of incision meet well down beneath the cica- 

 trix. The triangular flap of skin thus made, is detached by a 

 bistuory from the cicatricial tissue beneath, and allowed to shrink 

 upward toward the tarsus. Finally the two edges are sewed to- 

 gether from the angle upward, as far as may be necessary to allow 

 the proper application of the tarsus against the bulb, and the re- 

 mainder of these edges are sutured to those of the triangular flap. 



