Third step. The gland, which is seen as a nodule, is drawn forward with forceps. By means of the scissors the gland is separated from its attachments along its whole length, starting on the inner side, the wound being subsequently closed with a few points of catgut suture.
REMOVAL OF THE ORBITAL PORTION
Indications. It is usually undertaken for tumours (endotheliomata, &c.) and retention cysts.
Instruments. Knife, artery and dissecting forceps, retractors, ligatures.
Operation. Performed under a general anæsthetic.
First step. An incision, three inches long, is made through the skin immediately below the outer third of the orbital margin. The underlying orbicularis palpebrarum is divided, and the orbital fascia covering the gland is defined and incised.
Second step. The gland is first separated from the periosteum of the depression in the bone in which it lies, and is drawn forward and carefully dissected out from the lid. The wound is then closed with sutures.
An abscess in the lachrymal gland should be opened by an incision similar to, but not so long as that in the above operation.