The Head and Neck 



59 



As in Ectropion, it may be caused by the formation of cicatricial 

 tissue following wounds, by chronic blepharitis, eczema, follicular 

 mange, etc. Spasmodic inversion accompanying acute conjuncti- 

 vitis and keratitis must not be confounded with the true deformity. 

 This lesion occurs most often in the upper lid, but both lids may 

 be affected. 



Symptoms and Diagnosis. The lid is turned inward and com- 

 ing in contact with the eye actively irritates the latter, sometimes 

 to the extent of starting up Ulcerative keratitis. There is usually 

 convulsive closure of the lids and much secretion of mucus and tears. 

 The conjunctiva are injected. 



Treatment. This trouble is remedied by excision of an elliptical 

 portion of skin covering the lid. With entropion forceps a fold 

 of skin is seized, parallel to the ciliary border, of sufficient size to 

 cause the inturned lid to assume 

 a normal position, care being 

 taken to avoid including the 

 conjunctiva. The strip of skin 

 in the grasp of the forceps is 

 then excised with scissors close 

 to the forceps so that at least a 

 quarter of an inch of skin exists 

 between the wound and ciliary 

 border. The margins of the 

 wound are brought together 



with subcuticular silk sutures. no. ll. operation for Entropion. 



TSICHIASIS. 



Turning in of the eye-lashes occurs as a complication of en- 

 tropion, but it also takes place independently of the latter trouble. 

 It may lead to serious results as the constant rubbing of the cilia 

 against the cornea causes ulceration. 



Treatment. The offending lashes must be plucked out with for- 

 ceps as often as is necessary. If this proves insufficient total ex- 

 cision of the hair follicle must be practised by making two parallel 

 incisions along the margins of the lids on either side of the row of 

 hairs, and of such depth as to ensure complete removal of the 

 roots. 



