Third step. An incision is carried through the tarsal plate parallel to and near its upper border well into the substance of the orbicularis muscle on the other side. The needles on each end of the doubly armed sutures holding the isolated portion of the superior rectus muscle are passed through the hole in the tarsal plate and are carried downwards between the orbicularis muscle and the tarsal plate to near the lid margin, where they are brought out through the skin and tied over a piece of drainage tube. The conjunctival wound is closed by sutures.
Complications. Ulceration of the cornea is more likely to occur after those operations in which the lid is much over-retracted, such as Hess’s, Panas’ operation, and the advancement of the levator palpebræ. It usually affects the lower corneal margin and may be merely roughening and opacity of the epithelium or deep septic ulceration. If the ulceration be severe, the sutures holding the lid in position should be taken out and the eye treated as for corneal ulceration; on the other hand, slight abrasion of the epithelium will often heal without taking out the sutures.
Sepsis. The difficulty of keeping the wound aseptic after these operations is considerable, and not infrequently inflammation may take place; provided it does not go on to suppuration, the final result is improved thereby; should suppuration take place the sutures must be removed.
CHAPTER IX
OPERATIONS FOR ENTROPION, REPAIR OF THE EYELIDS
TRICHIASIS, AND ECTROPION
The operations commonly performed for entropion and trichiasis are of three types:—
1. Operations for the destruction of the individual hair follicles.
2. Rectification of a faulty curvature of the tarsus.
3. Transplantation of the lash-bearing area.