Fig. 145. Lid Clamp.
Fig. 146. Streatfield’s Entropion Operation.
Instruments. Beer’s knife, fixation forceps, lid clamp (Fig. 145), spatula, and sutures with a glass bead threaded on each.
Operation. The operation is performed under a general anæsthetic.
First step. The lid is fixed in a clamp. The surgeon makes an incision in the skin directly above the lash-bearing area throughout the whole length of the lid and parallel to its margin. A second incision is made about 3 millimetres above this, and its extremities are curved downwards to join the first. The piece of skin and orbicularis muscle between them is removed and the tarsal cartilage is exposed.
Second step. A wedge-shaped strip is removed from the tarsal cartilage throughout the whole length of the lid, the apex of the wedge reaching just through the cartilage, but not the conjunctiva on its under surface.
Third step. Mattress sutures are then inserted. Each suture should have a needle at either end. A bead may be threaded on the stitch to prevent it cutting into the lid margin. The needles are passed from the margin of the lid directly above the eyelashes, about 3 millimetres apart, and brought out through the lower margin of the wound. They are then passed from within outwards through the tarsal plate and the upper margin of the wound, being brought out through the skin about half an inch above it and tied (Fig. 146). A few points of suture in the skin may be added if necessary.