Text-book of ophthalmology . rformed by excising with the forceps and scissors a narrow strip of skin from both the lower andthe upper lid close to their inner angles. The long and slender wounds thusproduced should meet in an acute angle at a point on the inside ofthe innercommissure (m, Fig. 432). They are then united to each other throughtheir entire extent by means of interrupted sutures. If a firmer adhesionis desired, this operation, too, like external tarsorrhaphy, may be made withthe formation of a small skin is indicated— 1. In ectropion.—In this the lower lid is rai
Text-book of ophthalmology . rformed by excising with the forceps and scissors a narrow strip of skin from both the lower andthe upper lid close to their inner angles. The long and slender wounds thusproduced should meet in an acute angle at a point on the inside ofthe innercommissure (m, Fig. 432). They are then united to each other throughtheir entire extent by means of interrupted sutures. If a firmer adhesionis desired, this operation, too, like external tarsorrhaphy, may be made withthe formation of a small skin is indicated— 1. In ectropion.—In this the lower lid is raised by attaching it to theupper. Tarsorrhaphy is most effective in senile and paralytic ectropion,and also in slight cases of cicatricial ectropion. Tarsorrhaphy is very oftenperformed, in conjunction-with blepharoplasty, in order to insure the lidsremaining in the proper position. 2. In laqophthalmus, because the closure of the palpebral fissure isfacilitated by shortening the latter. The form of lagophthalmus that most. OPERATIONS ON THE LIDS 955 often gives occasion for the performance of tarsorrhaphy is that whichdevelops in Basedows disease in consequence of the exophthalmus,inasmuch as here we have no other means of relieving it. As a rule, lateral tarsorrhaphy is the operation which is done. Mediantarsorrhaphy is scarcely ever employed except in paralytic ectropion, andis done then only because in this condition the lower lid generally droopsmore in its inner than in its outer half. When the lower lid has been in a condition of ectropion for a pretty long time,it is ordinarily found to have become elongated by the stretching it has order to make the lid short again, a procedure by which it is at the same time putupon the stretch and pressed against the eyeball, the lower lid, in the performanceof tarsorrhaphy, is pared to a greater extent than is the upper. When the elonga-tion is particularly marked, the lid is shortened by excising a triangular piece a
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