=Operation.= The operation may be performed under cocaine and adrenalin, a little solid cocaine being rubbed into the area to be expressed. In severe cases in which both eyes are affected, and in small children, a general anæsthetic may be necessary. Although a number of instruments are in use, perhaps the best, and certainly the least painful, is Graddy’s forceps. In the case of the upper lid it is everted, one blade of the forceps being passed into the fornix, the other being placed over the upper surface of the everted lid. A gentle steady pressure is applied, and the lid is drawn out between the blades. In this way as much of the conjunctiva is gone over as is necessary. The lower fornix is best expressed by picking up the loose fold of the fornix with ordinary forceps and then expressing with Graddy’s. [Illustration: FIG. 129. GRADDY’S FORCEPS.] If only one or two follicles be present they can be picked up with the ordinary fine dissecting forceps and expressed, but when situated on the tarsus the follicles are best enucleated with a spud; a solution of 1 in 50 perchloride of mercury in glycerine is then rubbed into the conjunctiva. The operation may have to be repeated several times as new follicles form. CONJUNCTIVOPLASTY Conjunctivoplasty is an operation for the transplantation of a flap of conjunctiva to cover some loss of substance or defect in the continuity of the globe. =Indications.= The operation may be necessary-- (i) To close large recent wounds of the cornea. (ii) To close the wound made by the excision of a cystoid scar. (iii) To facilitate the healing of a clean ulcer such as Mooren’s ulcer, or to cover the aperture made by an ulcer that has perforated. (iv) In the treatment of conical cornea by excision of the apex of the cone, it might facilitate the rapid closure of the wound and assist in flattening of the cornea. =Operation.= _First method._ Under cocaine. A flap of conjunctiva is raised from around the limbus, having its base as near the area to be covered as possible; its breadth should be one and a half times the width of the area to be covered. This flap is drawn across the defect in the cornea and stitched to the conjunctiva on the other side; the wound made in raising the flap should be allowed to heal by granulation. The stitches holding the flap in position cut through in two or three days, but by that time their purpose will have been served. If the flap be still adherent to the wound its base may be divided and any superfluous tissue removed; the remainder will disappear rapidly. _Second method._ The conjunctiva is dissected up all round the cornea as close to the limbus as possible, and backwards as far as the insertion of the recti. A purse-string suture is then inserted around its margins and drawn tight so that the whole cornea is covered by conjunctiva. The operation is suitable for cases in which large areas have to be covered. REMOVAL OF TARSAL CYSTS