. The principles and practice of surgery. ll elliptical piece of integument. In thisway the clanger of sloughing is avoided ; but Stellwag prefers completeexcision of the hair follicles to either of the two preceding have advised destruc-tion of each separate follicleby heated iron points, by caus-tics, or by setons. The fact is, however, that,as Stellwag candidly admits,all of these methods havetheir serious disadvantages,the operations often resultingin deformities and defectsmore grave than those wrhichit was proposed to , therefore, anything is tobe done beyond the
. The principles and practice of surgery. ll elliptical piece of integument. In thisway the clanger of sloughing is avoided ; but Stellwag prefers completeexcision of the hair follicles to either of the two preceding have advised destruc-tion of each separate follicleby heated iron points, by caus-tics, or by setons. The fact is, however, that,as Stellwag candidly admits,all of these methods havetheir serious disadvantages,the operations often resultingin deformities and defectsmore grave than those wrhichit was proposed to , therefore, anything is tobe done beyond the occasionalextraction of the cilia, it mustbe to resort to some one of those expedients hereafter to be recommended fortropion. True Distichiasis is in most cases a congenital abnormity, and doesnot usually require surgical interference; but when the cilia arrangethemselves in double rows in consequence of chronic blepharitis cilia-ris or other tarsal diseases, and irritate the conjunctiva, the treatmentmust be the same as for Graefes Operation for Trichiasis. the cure of en- 542 DISEASES OF THE EYELIDS. Inversion of the Lids. Syn., Entropion, R. C.—Entropion may bedue to a contraction of the orbicular muscle alone; or to a contractionof this muscle, the inversion being favored by atrophy of the cartilage,and a consequent rounding off of the inner tarsal margin, or by cica-trization and contraction of the tarsal margin and conjunctiva. When it is due to spasmodic contraction of the muscle, as may hap-pen in any of those forms of ophthalmia which are accompanied withphotophobia, no surgical interference is generally demanded. It hasbeen suggested, however, that in certain very intractable cases it maybe proper to make the operation of canthoplasty ; dividing the externalportion of the orbicularis by an incision, commencing at the externalcanthus and extending obliquely upwards and outwards, or downwardsand outwards, according as it may be the upper or lower lid whi
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