Atlas and epitome of operative ophthalmology . rally, an effortmust be made to secure elevation of the lid through othermuscles, either of the occipitofrontalis or the superior rec-tus of the eyeball. People with ptosis, as a rule, use thefrontal muscle of their own accord for drawing the lidupward, and therefore present the characteristic deepwrinkles in the brow (see my Atlas on External Diseasesof the Eye, Plate 9). If the ptosis is very great, suchpatients also find themselves obliged to throw the headbackward, so as to bring the pupil into the palpebral fis-sure. To determine what part in
Atlas and epitome of operative ophthalmology . rally, an effortmust be made to secure elevation of the lid through othermuscles, either of the occipitofrontalis or the superior rec-tus of the eyeball. People with ptosis, as a rule, use thefrontal muscle of their own accord for drawing the lidupward, and therefore present the characteristic deepwrinkles in the brow (see my Atlas on External Diseasesof the Eye, Plate 9). If the ptosis is very great, suchpatients also find themselves obliged to throw the headbackward, so as to bring the pupil into the palpebral fis-sure. To determine what part in the elevation of the eye isplayed by the frontal muscle in a patient of this kind,pressure should be made with the flat of the hand on theforehead, which causes him to close the eyes. He is thenrequested to open the eyes wide and look straight aheador slightly upward. As the action of the frontal muscle 296 OPERATIONS ON THE EYE. is then excluded by the operators hand, any elevation ofthe lid that takes place must be effected by the Fig. 118.—This is the same patient as the one shown in Plate 12. The largewound cavity remaining after the operation is here seen to be covered withpedunculated flaps taken from the forehead, while the wound in the foreheadhas been covered with flaps, after the method of Thiersch. The operationwas performed by Krönlein. This picture was taken eight weeks after theoperation. There are a number of operations having for their objectto increase the elevation of the lid in ptosis by means ofthe frontal muscle, chiefly bv means of cicatricial bands OPERATIONS ON LIDS AND CONJUNCTIVAL SAC 297 attaching the upper border of the lid to the region of theeyebrow. Among these operations are : 1. Pagenstechers Ptosis Operation.—This is per-formed with either one or two sutures, each of which isarmed with two needles. One needle is introduced underthe skin of the upper lid, at a point 1 to 2 mm. from thepalpebral margin, and running parallel with i
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