The _fourth step_ is the division of the optic nerve. The globe is rotated strongly outwards, either by pulling on the tendon of the internal rectus or by pulling the globe outwards with the finger; the optic nerve is felt for by passing the strong curved scissors behind the globe. When the nerve is defined the blades are opened widely, pressed backwards, and the nerve divided. The globe is then pulled forward with the finger, and the oblique muscles and remaining attachments divided. Hæmorrhage is easily controlled by pressure and the use of adrenalin. _Fifth step._ When the bleeding has ceased, the conjunctival wound is united in a horizontal direction by means of a thick silk suture running over and over; no knot is required and the ends are left long, so that it may subsequently be removed easily (Fig. 134). The usual dressings are applied with a firm pressure bandage for the first six hours. The suture should be removed at the end of the seventh day. No artificial eye should be worn for at least six weeks after the operation, and then only for a few hours at a time until the conjunctiva becomes accustomed to it. It should always be taken out at night. =Complications.= These may be immediate or remote. =Immediate.= _Cutting into the globe._ This may occur during the division of the optic nerve, and is usually due to imperfect dislocation of the globe. Although of little consequence as a rule, it may be extremely serious, as for instance in the case of an intra-ocular growth, when it is conceivable that a portion of it might be left behind. If this accident should happen, the portion of the sclerotic and choroid left behind should be carefully sought for and removed. _Adhesion of Tenon’s capsule._ Eyes that have been the subject of acute inflammation are much more difficult to enucleate, owing to adhesion of the surfaces of Tenon’s capsule. In these cases the globe has practically to be dissected out of that structure. =Remote.= _Hæmorrhage_ into the stump may occur, leading to proptosis of the conjunctiva and extravasation into the eyelids and beneath the skin of the face. The use of a firm pressure bandage and the omission of the suture is usually sufficient to prevent this occurring, but the blood-clot may have to be turned out and the bleeding point sought for and ligatured. _Granulations and polypi_ in the socket are usually the result of leaving some tag of tissue between the margins of the wound, and are therefore more likely to occur when no suture is used to close the wound. They should be removed with forceps and scissors. _Polypoid masses_ sometimes form in a socket as the result of an imperfect artificial eye causing an œdematous condition of the conjunctiva. They should not be removed, owing to the contraction caused thereby, but the artificial eye should be left out, when they will often disappear.