Deficiency of Lid Contour (Upper and Lower Lids—Unilateral and Bilateral).—The lack of contour in the eyelids is not as frequently met with as redundancy of their integumentary structure; there are cases, however, where the eyes seem to lie deep in their sockets, owing to a sinking in or a collapse of the surrounding lids.
This condition is often found to be hereditary, in other cases it is the result of malnutrition, a peculiar lack of adipose tissue about the orbit for no known reason, or fatty degeneration in past middle life.
The fault is usually bilateral. In rare instances trauma about the orbital borders may result in lack of nutrition. Such cases are usually unilateral, and the upper lid is affected in the majority of cases.
The correction of these defects is found to be rather difficult, owing to the thickness of the tissue under consideration.
The use of hard paraffin plays havoc with eyelid tissue, rendering it hard, immobile, and causing a hyperplasia of the new connective tissue formed thereby, as well as the peculiar yellowish pigmentary spots of irregular form resembling on casual inspection xanthalasma. This discoloration has been fully described earlier in the work.
The author has had occasion to remove these hard irregular masses investing the lower lid in several cases where paraffin had been injected, also two cases in which the pigmentary discoloration involved both upper and lower lids associated with the same hard fibrous masses. Excision under local anesthesia and silk suture was the method of correction employed.
From an experience of twenty-two cases the author believes these conditions most amenable for correction by the injection of sterile oils in preference to any other substance. Even white vaselin does not here seem to answer the purpose, owing to its stimulating property of causing the resultant growth of connective tissue.
While vaselin injected in the lids causes less of this new tissue to be formed, such tissue is never of the consistency required. This is especially true of the upper lids.
The oil injected, sterilized sperm oil being employed by the writer, is prone to absorption of more or less degree, but the result is gratifying, and lasts from six months to one year, leaving no untoward effect.