(c) When the canaliculus has been divided the end attached to the lachrymal sac should be sought for and divided for a short distance inwards from the wound (see [p. 291]), the entrance being kept open daily by a probe to prevent traumatic stricture.

OPERATIONS FOR ANKYLOBLEPHARON

Fusion of the eyelids together is either a congenital condition or the result of injury, and may take the form of bands or firm fibrous union. It is rarely complete and is often associated with symblepharon. The union should be divided on a director, or by careful dissection, taking care not to wound the underlying globe. The raw surfaces are kept apart by daily dressing until they are covered by epithelium. No externa[l] dressing should be applied.

OPERATIONS FOR SYMBLEPHARON

Partial adhesion of the lid to the globe in which a few bands pass from the lid to the globe are best treated by division followed by union of the ocular conjunctiva over the raw surface; no external dressing should be applied. Any tendency to fresh adhesion may be prevented by daily inspection.

In extensive adhesion of the lid to the globe, where the lids are entirely adherent to the globe and the cornea is destroyed, interference is inadvisable. In less extensive adhesion, the lid is first separated from the globe, reunion being prevented by covering the denuded area on the globe with a flap of bulbar conjunctiva transplanted from an area that does not come in contact with the raw surface on the eyelid (Teale’s operation), or by Thiersch’s grafts from a situation where there are no hairs; or by grafting mucous membrane from the mouth of the patient or a frog. Teale’s operation, or some modification, is by far the most satisfactory, but unfortunately it cannot always be carried out when the loss of conjunctiva is large.

OPERATIONS UPON THE PALPEBRAL APERTURE

CANTHOPLASTY

Indications. In contraction of the palpebral aperture, either due to a congenital condition, or the result of a wound, trachoma, or other cicatricial contraction.

Instruments. Speculum, forceps, scissors, and three sutures.