DEPARTMENT OF SURGERY. 
369 
very simple but painful ; patients treated in this manner should 
be given a general anaesthetic. The eyelid is inverted and the 
conjunctiva involved scarified as far back as the fornix, and 
when the ocular portion of the conjunctiva is involved, it should 
be subjected to the same treatment, if the granulations do not 
extend over too much of the anterior surface of the eyeball 
(when a large area of the ocular conjunctiva is trachomatous, 
the best method of treating is by expression). The most con¬ 
venient instrument for scarifying is a three-bladed scarifier, al¬ 
though this can be accomplished with any similar instrument. 
When the diseased portion is thoroughly scarified, it is scrubbed 
with a sterilized nail-brush until all the trachomatous tissue is 
removed ; it is then thoroughly washed with sterilized water or 
some mild antiseptic solution. After careful cleaning, ice com¬ 
presses, or cloths wrung out of ice-cold water, must be applied 
to the eye. The object of these cold applications is to relieve 
pain and prevent swelling, and should be kept in place and 
changed, or cold water poured over the compress for at least 
two hours after the operation, and repeated thereafter at inter¬ 
vals as often as indicated. 
If the operation is done aseptically, and care taken not to 
mutilate the subconjunctival tissue more than necessary, but 
little reaction follows and the wound improves rapidly. 
The after-care consists in preventing undesirable sequelae, 
such as secondary infection or adhesions of ocular and palpe¬ 
bral conjunctiva. To prevent these adhesions a sterilized probe 
or spatula must be introduced once a day into the cul-de-sac 
and all unions of the two membranes carefully broken down. 
The subsequent treatment will be governed by the condition 
of the parts involved, mild antiseptics, astringents, mydria- 
tics, etc. 
The Operation of Expression .—This is an operation that is 
performed in various ways and the deviation is generally gov¬ 
erned by the extent and severity of the disease. When the 
folds or granulations are located in small groups they can be 
expressed with the. thumb-nails, artery or dissecting forceps, but 
when a large area is involved this method is too tedious. Sev- 
eral varieties of forceps have been devised for this purpose, and 
among the most useful are Knapp’s roller forceps (Fig. 5 6-B) 
and Noyes’ trachoma forceps (Fig. 56 -A). 
The procedure in general is as follows : The eyelid is in¬ 
verted with an artery forceps applied to the ciliary margin, un¬ 
til as much of the conjunctiva as possible is exposed, then the 
