TRICHIASIS. 



Befides thefe caufes, there are others which may produce 

 the complaint. Chronic ophthalmies of long continuance 

 fomctimes have this injurious effeft, in confequence of the Ikin 

 of the eye-lid being kept for a long time in a ftate of diften- 

 tion and oedema, tertninating in a relaxation of them. The car- 

 tilaginous margin of the eye-lid then lofes the proper fupport 

 of the integuments, inclines towards the eye-ball, and after- 

 wards turns inwards, drawing the eyc-laihes along with it in 

 the fame improper direction. Long-continued puriform 

 difcharges from the ciliary glands, likewife fpoil the fhape 

 and confluence of the cartilage of the eye-lid, and therefore 

 not unfrequently occafion trichiafis. Scarpa doubts, whe- 

 ther a fpafmodic contrailion of the orbicularis palpebrarum 

 mufcle can ever be a caufe of the difeafe, notwithitanding 

 what Mr. B. Bell has afferted upon the fubjeft. 



The annoyance which muil neceflarily refult from the 

 Jiairs perpetually preffing upon the cornea and white of the 

 eye, may be eafily imagined, even by thofe'who have little 

 acquaintance with furgery. The evil is rendered ftill 

 greater, by the hairs which are turned inwards becomin;^ 

 much longer and thicker than thofe which retain their 

 natural direftion. And although the trichiafis be confined 

 to one eye, both the eyes ufually fuffer from the effetls of 

 the difeafe. Indeed, generally the eye on the found fide 

 cannot be moved without occafioning pain in that which is 

 expofed to the irritation and friftion of the infletled hairs. 

 In almoft all inftances, both the eyes are very irritable, and 

 incapable of bearing the light. As, in cafes of incomplete 

 trichiafis, the patient retains fome little power of opening 

 the eye-lids for the purpofe of feeing, and that mod fre- 

 quently towards the internal angle of the eye, the head and 

 neck are often inclined in an awkward manner, fo that in 

 children a diftortion of the neck and fiioulders is at laft pro- 

 duced, which cannot be reftified without difficulty, even 

 after the trichiafis is cured. Unfortunately, alfo, children 

 are impatient of the uncafinefs arifing from the inflefted 

 hairs, and, therefore, are continually rubbing the eye -lids, 

 which aft very much increafes all the ill efFefts of the com- 

 plaint, fuch as the varicofe chronic ophthalmy, opacity, and 

 ulceration of the cornea. 



The cure of the fecond fpecies of trichiafis, or that which 

 is commonly met with in praftice, is accomplifiied by arti- 

 ficially everting the eye -lid, and fixing it permanently in hi 

 natural pofition, together with the eye-lafhes, which fo 

 grievoufly irritate and prefs againft the globe of the eye. 

 According to profeffor Scarpa, this indication is perfeftly 

 fulfilled by the excifion of a piece of the fkin clofe to the 

 edge of the eye-lid, of fuch a breadth and extent, that when 

 the cicatrix is formed, the tarfus and margin of the eye-lid 

 may be turned outwards, and fufficicntly feparated from 

 the eye-ball, the cicatrix of the integuments affording ;i 

 point of fupport fully adequate to keeping the parts in tncir 

 natural pofition and direfticn. Scarpa believes that there are 

 now very few modern furgeons, who, with a view to the radi- 

 cal cure of this difeafe, place any confidence either in pluck- 

 ing out the inverted eye-la(hes, bending them outwards, and 

 retaining them fo by means of adhefive plafter, or in pluck- 

 ing them out and dellroying their roots with caultic : much 

 lefs in extirpating the edge of the eye-lid along with the 

 hairs, or dividing the orbicularis mufcle on the internal fur- 

 face of the eye-lid, under an idea that the difeafe is fome- 

 times produced by a fpafmodic contraction of it. 



The following is the mode of proceeding recommended 

 hy Scarpa : the patient being feated in a chair, if an adult, 

 or, if a child, laid upon a table, with the head raifed, and 

 firmly held by aji affiflant, who mud ftand behind the pa- 

 ;icnt, the furgeon is to pulli outward, with the end of a 



probe, the hairs which irritate the eye. Then, with a pair 

 of difiefting forceps, or the ends of his fore-finger and 

 thumb, (which anfwer equally well, and, in many cafes, 

 much better than forceps,) the operator (hould lift up a 

 fold of the Ikin of the affefted eye-Ud, taking great care 

 that the piece which is taken hold of, correfponds exadlly 

 to the middle of the whole extent of the trichiafis ; for, as 

 we have already explained, fometimes the whole, fometiraes 

 a half, and, in other inftances, only a third of the extent of 

 the tarfus is inverted. The furgeon, with his left-hand, 

 muft raife the fold of the (Icin, more or lefs, according as 

 the relaxation of the integuments, and the inverfion of the 

 tarfus, are more or lefs confiderable. The reafon of this 

 is exceedingly evident, viz. that the greater the quantity of 

 (l<in is which is raifed, the greater is the quantity which 

 will be cut away. Suppofing the patient to be an adult, 

 as foon as the fold of (kin has been raifed in a certain 

 degree, the furgeon muft requeft him to open his eye, and 

 if, in this aft, the tarfus and eye-lafhes refume their natural 

 place and direftion, the portion of (kin already raifed will 

 be fufScient for the purpofe. We muft truft to our own 

 judgment with regard to children, as they feldom let us 

 have recourfe to the mode of difcrimination juft related- 

 When the integuments are elevated by means of a pair of 

 difiefting forceps, and care is taken to lay hold of the fkin 

 precifely at the middle point of the whole extent of the 

 trichiafis, it neceflarily follows, that the confequent feftion 

 of the Ikin will form an oval, and that the greatell width of 

 the wound will correfpond exaftly, or nearly fo, to the 

 middle of the eye-hd, and its narroweft parts to the angles, 

 or commifl'ures of the fame. This contributes very mate- 

 rially to make the cicatrix correfpond to the natural fold of 

 the eye-lid, and hinder the origin of a difeafe of an oppofite 

 nature to the one about to be remedied, towards the angles 

 of the eye, ■uh. an everfion of the commillures of the cye- 

 hds. See EcTROPiUM. 



Befides this caution relative to the fituation and figure of 

 the fold of the integuments to be cut oft, the furgeon muft 

 be careful that the divifion of the ikin be made very near the 

 inverted tarfus. Were this circumftance neglefted, the 

 operator might have the mortification of finding, after the 

 wound is healed, that although the eye-lid is ftiortened, on 

 the whole, from the eye-brow to the place of the recifion, 

 yet it is not equally fo at the fpace which is between the edge 

 cf the eye-hd and the cicatrix of the ikin. Hence the 

 tarfus would remain inverted as before, or not be fufficiently 

 turned outward to keep the eye-lafhes from rubbing againft 

 the eye. This inconvenience would obhge the patient to 

 fubmit to a fecond operation, done lower down than the 

 firft. 



Things being thus arranged, the furgeon, holding up the 

 fold of fkin by means of the forceps in his left-hand, 

 is with a pair of probe-pointed, fharp curved fcifTars, to 

 cut off the whole of the duphcature, being firft fure that 

 one of the blades of the inftrument is apphed clofe to the 

 edge of the eye-lid. If both eye-lids (hould be affefted, 

 the fame operation muft immediately be done upon both of 

 them, with fuch cautions, and in fuch proportion, as the 

 extent of the difeafe, and the degree of inverfion of eacli 

 eye-hd may require. 



Scarpa next difTuades us from employing any future to 

 unite the wound, and reprefents, that it will be fufficient to 

 keep the eye-brow as much downward as pofTible, if the 

 operation has been done on the upper eye-hd, or, if on the 

 lower, to fupport it againft the inferior arch of the orbit, 

 by preffing it from below upwards, fo as to keep the edges 

 of the wound from becoming feparated. Then the lips of 



the 



