TRICHIASIS. 



the wound are to be put into exaft coiitaft, by means of 

 ftrips of adhefive plaller, which fhould extend from the 

 fuperior arch of the orbit to the zygoma, and the fupport 

 of the wound in appofition will be dill more fecurely 

 effefted by placing two comprefles, one on the eye-brow, 

 and another on the zygoma, together with a bandage. 



On taking off the firft dreffings, the third day after the 

 operation, the furgeon will find that the patient can open 

 his eye with eafe, and that the inverted tarfus and eye- 

 lafhes have refumed their natural pofition and direAion. 

 In the partial or incomplete trichiaiis, or that which only 

 occupies a half, or a third of the whole length of the tarfus, 

 and in fubjeCls who have had the Ikin of the eye-lids very 

 loofe, Scarpa has often had the pleafure of finding the 

 wound perfedlly united on removing the firil drefling. 



When, however, only a part of the incifion has healed, 

 while the reft feems difpofed to heal by fuppuration and 

 granulation, the furgeon covers the wound with a fmall 

 piece of lint, fpread with the unguentum cerufiae ; and if 

 the fore (hould become flabby, it muft be touched, every 

 now and then, with the argentum nitratum, until the cure 

 is perfecled, which commonly happens in the conrfe of a 

 fortnight. 



Thus far, Scarpa's obfervations have related to the ra- 

 dical cure of the fecond, or moll frequent kind of trichiafis. 

 With regard to the firft form of this difeafe,or that in which 

 the eye-laflies projedl againft the eye-ball, without the natural 

 pofition of the tarfus being at all altered (a cafe which is 

 fortunately very rare), the accomplifhment of a cure is very 

 difficult, fince, as we have already explained, neither the 

 pulhng out of the hairs, nor burning the fituation of their 

 roots, are means at all to be depended upon for producmg 

 a complete cure of the diforder ; and fince turning the 

 tarfus out of its natural pofition would make the patient 

 liable to an irremediable flowing of the tears over the cheek, 

 attended with a chronic thickening of the lining of the eye- 

 lid. The treatment of this fpecies of trichiafis is ftill im- 

 perfeflly underftood, and feems to claim more attention 

 than appears hitherto to have been paid to it. In the in- 

 ftance of this form of the difeafe which Scarpa met with, 

 only two or three of the eye-lafties inclined againft the eye- 

 ball. He found, on turning the eye-lid a httle out, oppofite 

 to the fituation of the faulty hairs, that he could not, in- 

 deed, completely put them in their natural pofition ; but 

 he faw that he could thus remove them fo far from the 

 cornea, that they would not rub againft it, without altering 

 the pofition of the eye-lids fo much as to occafion a per- 

 petual difcharge of the tears over the cheek. And, as in 

 the patient alluded to, the flcin about the eye-lid was very 

 tenfe, Scarpa deviated from the above rule, by making an 

 incifion with the back of a lancet, near the tarfus, tlu-ee 

 lines long, and he took away a fmall piece of iliin of the 

 fame length ; but very little more than one line broad. 

 When the cut healed, the operation was found to anfwer 

 as well as the nature of the cafe would allow, though the 

 cure vi-as not complete, nor would it have obviated all in- 

 conveniences in cafes of greater extent. 



The trichiafis being cured, fomething more always re- 

 mains to be done, fur the purpofe of correAing the caufe 

 of the difeafe, as well as curing the diforder of the eye, 

 occafioned by the previous friftion and irritation of the 

 inverted hairs. The ufual indications are, to reftore the 

 tone of the veffels of the conjunftiva, to lefTen the fwoUen 

 Meibomian glands, and to remove any cloudinefs of the 

 cornea. 



Two new methods of performing the operation, for the 



cure of trichiafis, have been recently propofed by Dr. 

 Crampton and Mr. Saunders. 



The following is the account which Dr. Crampton gives 

 of his plan, which he tried in one inftance with complete 

 fuccefs. " Let the eye-lid be well turned outwards by an 

 afliftant ; let the operator then with a lancet divide the 

 broad margin of the tarfus completely through, by two per- 

 pendicular incifions, one on each fide of the inverted hair 

 or hairs ; let him then, by a tranfverfe feftion of the conjunc- 

 tiva of the eye-lid, unite the extremities of the perpendi- 

 cular incifions. The portion of cartilage contained within 

 the incifions, can then, if inverted, with eafe be reftored 

 to its original fituation, and retained there by fmall ftrips 

 of adhefive plafter, or perhaps, what is better, by a fufpen- 

 forium palpebrae, adapted to the length of the portion of 

 the tarfus which it is intended to fuftain, fhould one or two 

 hairs be difplaced without inverfion of the tarfus." Eftay 

 on the Entropeon, p. 55. 



Mr. Saunders entertained a favourable opinion of Dr. 

 Crampton's operation for the cure of the difeafe in its 

 early ftage ; but he contended, fuch a vifcious bending of 

 the tarlus inward was often the confequence of repeated 

 ophthalmy, attended with ulceration of the conjunftiva and 

 infide of the eye-lid ; and that every endeavour to reftify the 

 wrong pofition of the tarfus, and reftore its original direc- 

 tion, would be fruitlefs. Hence, he believed, that its exci- 

 fion was decidedly indicated ; an operation which is faid to 

 be followed by no pain nor uneafinefs, and which is fure in its 

 cfteft. No particular (hortening of the eye-lid enfues ; the 

 deformity is materially lefiened ; and unlefs the cornea be 

 already too opaque, perfeft vifion is re-eftabliftied. 



Mr. Saunders direfts a piece of thin horn, or a plate of 

 filver, having a curvature correfponding to that of the eye- 

 lid, to be introduced under this part, with its concavity to- 

 wards the eye-ball. On this inftrument the eye-lid is to be 

 ftretched. An incifion is to be made through the integu- 

 ments and orbicularis palpebrarum, down to the tarfus, 

 immediately behind the roots of the cilia. The cut ftiould 

 extend from the punAum lachrymale to the external angle. 

 The exterior furface of the tarfus is then to be diftefted, 

 until the orbital margin is expofed, when the conjunftiva is 

 to be cut through direAly by the fide of the tarfus, which 

 muft now be difengaged at each extremity. The punftum 

 lachrymale muft be left uninjured. The operation is de- 

 fcribed as being exceedingly fimple, and if any embarraiT- 

 ment arifes, it is from the haemorrhage of the ciliary artery, 

 the blood fometimes obfcuring the punftum lachrymale, juft 

 when the operator is about to divide the tarfus by the fide 

 of it. No dreffings are required, it being merely neceflary 

 to keep the eye covered for a few days. The fl<in will 

 continue to be elevated, juft as the perfeft eye-lid was ; 

 and though lefs completely, yet enough to leave the pupil 

 clear, when the eye is moderately direfted upward. In all 

 the cafes in which Mr. Saunders operated, a fungus grew 

 from the wound. He recommends the excrefcence to be 

 deftroyed with cauftic, or the knife. 



Refpefting this operation, we fliall merely obfervc, that 

 it is more fevere than that advifed by profeffijr Scarpa, and 

 muft leave more disfigurement. Unlefs, therefore, the latter 

 method prove ineffeftual, we fee no reafon for abandoning it. 



Inverfion of the lower eye-lid is much lefs common than 

 that of the upper one. Tlie late Mr. Saunders never faw 

 this difeafe anfe from the fame caufes which induce it m 

 the upper eye-lid, though he acknowledges the poffibihty 

 of fuch a cafe. However, he met with fevoral inftances of 

 the affedion, in confequence of cncylled tumours, which. 



