OPERATIONS UPON THE LACHRYMAL GLAND
REMOVAL OF THE PALPEBRAL PORTION
Fig. 170. Excision of the Palpebral Portion of the Lachrymal Gland. The lid is doubly everted and the gland is dissected out from within outwards.
Indications. For obstinate epiphora after removal of the lachrymal sac.
Instruments. Fixation forceps (two pairs), two sharp hooks, strabismus scissors, suture.
Operation. Usually performed under adrenalin and cocaine.
First step. The upper lid is doubly everted. The eversion is best carried out by holding the singly everted lid between forceps and then re-everting it; the forceps are then given to an assistant to hold. With a syringe a few drops of 5% cocaine are injected through the conjunctiva into the area to be operated upon.
Second step. The gland is seen beneath the conjunctiva at the outer part of the upper fornix, seized with forceps, and drawn forwards. A horizontal incision is made with scissors through the conjunctiva, which is dissected backwards. The edges of the wound are then held apart by means of sharp hooks (Fig. 170).