In the case of large wens on visible parts of scalp or face, the author avoids scar, by the following plan:-- Make a small incision, two lines at most, through skin only, then with a blunt probe separate the cyst from the skin subcutaneously; then, pulling it to the wound with catch-forceps, empty the cyst and gradually pull it out, as if taking out an ovarian cyst. No scar but a dimple will remain. FOOTNOTES: [80] See case by the author in the _Edin. Med. Jour._ for June 1868. CHAPTER V. OPERATIONS ON EYE. _Operations on the Eye and its Appendages._ OPERATIONS ON THE LIDS.-- [Illustration: FIG. VII.[81]] [Illustration: FIG. VIII.[82]] 1. FOR ENTROPIUM OR INVERSION OF THE LIDS, OFTEN COMBINED WITH TRICHIASIS, IRREGULARITY OF THE CILIÆ.--As in many cases the entropium seems to depend partly on a too great laxity of the skin of the lid, combined occasionally with spasm of the orbicularis, the simplest and most natural plan of operation is (_a_) to remove (Fig. VII. _a_) an elliptical portion of skin, extending transversely along the whole length of the affected lid, including the fibres of the orbicularis lying below it, and then to unite the edges with several points of fine suture. (_b_) An improvement on this in obstinate cases is proposed by Mr. Streatfeild (Fig. VIII.) He continues the same incision, but in addition removes a long narrow wedge-shaped portion of the tarsal cartilage, grooving it without entirely cutting it through, in such a manner that the retraction of the skin bends the cartilage backwards, thus everting to a very considerable extent the previously inverted ciliæ.[83] 2. ECTROPIUM is the opposite condition from entropium; in it the eyelids are everted and the palpebral conjunctiva is exposed. If the result of cicatrix, of a burn, or of disease of bone, the treatment must be varied according to circumstances, and in many cases, skin must be transplanted to fill the gap. In the more usual cases resulting from chronic inflammation the following simple operations are required:--1. In mild cases the excision of an elliptical portion of conjunctiva may suffice, the edges must not be left to contract, but should be brought carefully together. 2. In more chronic cases, where all the tissues of the lid are very lax, it is necessary to remove (Fig. VII. _b_) a V-shaped portion of lid and skin, and then stitch it very carefully up with interrupted sutures. TUMOURS OF EYELIDS.--1. _Encysted tumours; cysts of the lids; tarsal tumour._--Under these and similar names are recognised a very frequent form of disease, chiefly in the upper lid: small tumours which rarely exceed half a pea in size, convex towards the skin, which is freely moveable over them; they give no pain, and are annoying only from their bulk and deformity.