Atlas and epitome of operative ophthalmology . , if necessary, corrected as in the foregoingoperation; or the operation is terminated at once. Asuture is inserted in the conjunctiva, and the after-treat-ment is the same as in the foregoing operation. (3) Tenotomy after Snellen is similar to the fore-going. Snellen makes a horizontal incision in the cornea,over the center of the tendon (as von Gräfe occasionally didand advised); undermines the mucous membrane laterallyon both sides and in the direction of the tendon (in thecase of the internus as far as the caruncle), seizes thetendon with the
Atlas and epitome of operative ophthalmology . , if necessary, corrected as in the foregoingoperation; or the operation is terminated at once. Asuture is inserted in the conjunctiva, and the after-treat-ment is the same as in the foregoing operation. (3) Tenotomy after Snellen is similar to the fore-going. Snellen makes a horizontal incision in the cornea,over the center of the tendon (as von Gräfe occasionally didand advised); undermines the mucous membrane laterallyon both sides and in the direction of the tendon (in thecase of the internus as far as the caruncle), seizes thetendon with the conjunctival forceps; and first makes asmall opening at the center of its insertion. Introducingthe scissors through this opening, he then gently pushesthe instrument well under the insertion of the tendon,both above and below, so as to divide the tendon with theleast amount of damage and without distorting or dis-placing it. The after-treatment is the same as in the fore-going operation. Tenotomy, which restricts the sphere of action of the. 247 248 OPERATIONS ON THE EYE. muscle, often needs to be combined with an operation toincrease the action of the corresponding antagonist. Thus,in severe cases of divergent squint, unilateral or bilateraltenotomy of the externus would not accomplish the desiredresult if one or both inward rotators were not also util-ized to correct the condition, and the same is true of theoutward rotators in the case of severe convergent an operation to increase the action of a muscle isindicated specially in paralytic squint and when, as aresult of strabismus of long standing, the action of theantagonist of the squinting muscle, abduction in conver-gent squint, has become very deficient. The correctiveoperation may also become necessary to advance a musclethat has receded too far after tenotomy or myotomy, andto strengthen its action. This latter indication led to the development of advancement oftendons, which was performed in the early day
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