This failing, Gaillard’s sutures may succeed. With a pair of forceps with looped, transversely elongated blades, pinch up skin and muscle sufficient to correct the entropion, and passing a needle twice through this fold with an interval of 3 mm., tie the suture over a small roll of cotton. The stitches may be removed in two days and the cicatrices may permanently obviate the deformity.
The older plastic operation is more trustworthy: The skin of the affected lid is pinched up to such an extent in length and breadth, as to correct the entropion and is then excised with sharp scissors or bistuory so as to leave a long elliptical sore. The edges of this are then carefully sutured together and the resulting union corrects deformity. In case the entropion is caused by an old standing cicatrix, it may be necessary, first, to make a careful incision along the edge of the lid so as to separate the tarsus and conjunctiva from the cilia and Meibomian ducts, and then to proceed with the plastic operation on the skin.
TURNING OUT OF THE EYELID. ECTROPION.
In large dogs, in old age, debility, conjunctival swelling, cicatrized skin of lids, distortions of lids. Symptoms: exposure of palpebral mucosa, weeping eyes, conjunctival hypertrophy (chemosis). Treatment: scarify or excise a fold of mucosa, astringent antiseptics, Snellen’s suture, Diefenbach’s operation, Wharton-Jones operation.
This is much more common than entropion, but much less injurious as the tarsi and lashes do not irritate the conjunctiva. It is especially common in large dogs (hounds, mastiff) and usually affects the inner part of the lower lid. Old age and debility contribute materially to the condition, the lack of tone or paresis being an important factor. It may, however, occur in any animal, from conjunctivitis and swelling of the mucosa, from cicatrices or old standing disease of the skin of the eyelids, or from imperfectly healed wounds leaving distortions of the lower lid. It is most frequent in the lower lid, and the slightest pendulous condition, which detaches the tarsus from the bulb, and exposes a narrow zone of the conjunctiva is considered to be an ectropion.
Symptoms. Beside the exposure of the zone of mucosa, there is the overflow of tears, and in old standing and bad cases a hypertrophy of the exposed conjunctiva, which projects as a fleshy-looking mass, and weighs down the lid, with a continual tendency to aggravation.
Treatment. Where the main factor seems to be the infiltration of the mucosa this may be reduced by scarification, or by the complete excision of a fold of the membrane. Use an antiseptic wash (boric acid) and the retraction of healing tends to brace up the lid against the bulb.
Snellen’s suture is sometimes employed successfully. A silk thread is armed at each end with a needle, and the needles are passed into the conjunctiva just inside the tarsus and brought out through the skin near the margin of the orbit, where they are tied round a small roll of cotton. Several of these may be inserted side by side so as to extend the whole length of the ectropion and they should be drawn tight enough to correct the deformity. If left some days they will usually determine cicatrices which will overcome the deformity.
The most common operation (Dieffenbach’s) is the excision of a triangular portion of skin from just outside the lower lid and having its base or upper side running horizontally outward from the outer canthus. Then pare the margin of the lower lid for a distance equal to the base of the triangle. Then bring together and suture the skin forming the right and left sides of the triangle, and the raw edge of the lid to the skin that formed the base of the triangle. In this way the triangular sore formed by the operation is completely covered and the margin of the lower lid is shortened so as to brace it up against the bulb.
In case of cicatricial ectropion the Wharton-Jones operation is to be adopted. A V-shaped incision is made in the skin of the lower lid commencing just beneath the tarsus and carried down so that the two lines of incision meet well down beneath the cicatrix. The triangular flap of skin thus made, is detached by a bistuory from the cicatricial tissue beneath, and allowed to shrink upward toward the tarsus. Finally the two edges are sewed together from the angle upward, as far as may be necessary to allow the proper application of the tarsus against the bulb, and the remainder of these edges are sutured to those of the triangular flap.