Any of the ordinary tumors which affect similar tissues elsewhere may be seen about the eyelids. The more common are the vascular tumors, especially small nevi. Epithelioma occasionally commences along the palpebral margin, but is more often an extension from neighboring tissues.

BLEPHARITIS.

The margins of the lids are frequently involved in a mildly infectious inflammatory condition called blepharitis, in which nearly all the structures participate; when the borders alone are involved it is referred to as blepharitis marginalis. The condition is largely due to dirt, and to irritation in which the Meibomian ducts seem to share. It is accompanied by chronic conjunctivitis. The condition is seen more often in the ill-nourished, the rickety, and the tuberculous. The best local treatment consists in the use of an ointment of yellow oxide or yellow sulphate of mercury. The former may be used in 2 per cent. strength, and the latter not stronger than 1 per cent. This should be applied along the lid margins at night, and thoroughly rubbed in. A commencing phlegmon and stye may be aborted by one of these preparations.

TRICHIASIS.

Another very annoying complication, and usually the sequel of the condition already mentioned, is trichiasis, or turning inward of the eyelashes. Chronic irritation and cicatricial contraction on the inner aspect of the eyelids, or a chronic blepharospasm, which may be the result of corneal infections, serve to draw the lids inward, especially with the margins of the hair follicles, so that the eye-winkers grow toward the ocular surfaces, which they constantly irritate. The result is a vicious circle, each morbid condition intensifying the other. In time there is produced a condition of entropion, which is to be remedied only by operation. It is not sufficient to treat trichiasis by epilation, as the hairs will grow again and continuously cause trouble. The cause should be removed and the effect treated.

ENTROPION.

By this term is meant a condition of inversion of the margin of one or both lids, by which the external surface is brought into actual contact with the surface of the eyeball. It is a chronic condition brought about through the action of several contributing causes. Any condition of the cornea or deeper portion of the eye which leads to photophobia and spasmodic closure of the eyelids will produce in time hypertrophy of the orbicularis, with corresponding strengthening of the muscle and exaggeration of its activity. Chronic blepharospasm will thus in time lead to a mild degree of entropion, while any affection of the inner palpebral surfaces which leads to cicatricial contraction will still more intensify it. So soon as trichiasis or irritation by the eyelashes is added to what has gone before, every feature is exaggerated and the cornea is made to lie practically in contact with the skin surface of the eyelid. A further consequence is corneal disease, often with ulceration and opacity, with even worse structural changes.

The condition is really a serious one and is to be treated not alone by operation upon the lid, but care should be given to all the contributing features. So far as the lid condition alone is concerned, I have found the operation suggested by Hotz the most satisfactory of any, at least in average cases. An incision is made from one end of the lid to the other, along the distal border of the tarsal cartilage, and down to it. Through this a bundle of those orbicularis fibers which run parallel with the incision is dissected away. In extreme cases the tarsal cartilage, which is incurved as the result of the old condition, may be either incised or a strip excised from its structure. Sutures are then inserted which include not only the borders of the skin incision, but the exposed border of the tarsus and the tarsoörbital fascia. By applying the central suture first, and then one on either side, it will usually be found that as the sutures are tightened the edge of the lid is drawn outward and the desired effect obtained.

The large number of operative methods which have been suggested for the cure of entropion bespeak the variety of causes which may produce it and the many devices to which different ingenious ophthalmic surgeons have resorted.

Fig. 390