Fusion of the eyelids together is either a congenital condition or the result of injury, and may take the form of bands or firm fibrous union. It is rarely complete and is often associated with symblepharon. The union should be divided on a director, or by careful dissection, taking care not to wound the underlying globe. The raw surfaces are kept apart by daily dressing until they are covered by epithelium. No externa[l] dressing should be applied. OPERATIONS FOR SYMBLEPHARON _Partial adhesion of the lid to the globe_ in which a few bands pass from the lid to the globe are best treated by division followed by union of the ocular conjunctiva over the raw surface; no external dressing should be applied. Any tendency to fresh adhesion may be prevented by daily inspection. _In extensive adhesion of the lid to the globe_, where the lids are entirely adherent to the globe and the cornea is destroyed, interference is inadvisable. In less extensive adhesion, the lid is first separated from the globe, reunion being prevented by covering the denuded area on the globe with a flap of bulbar conjunctiva transplanted from an area that does not come in contact with the raw surface on the eyelid (Teale’s operation), or by Thiersch’s grafts from a situation where there are no hairs; or by grafting mucous membrane from the mouth of the patient or a frog. Teale’s operation, or some modification, is by far the most satisfactory, but unfortunately it cannot always be carried out when the loss of conjunctiva is large. OPERATIONS UPON THE PALPEBRAL APERTURE CANTHOPLASTY =Indications.= In contraction of the palpebral aperture, either due to a congenital condition, or the result of a wound, trachoma, or other cicatricial contraction. =Instruments.= Speculum, forceps, scissors, and three sutures. =Operation.= The speculum is inserted and opened as widely as possible. One blade of the scissors is passed into the cul-de-sac at the outer angle of the lid and the palpebral aperture enlarged by dividing the outer canthus horizontally. The external tarsal ligament which is split longitudinally is then cut across with scissors passed into the upper and lower wound. The conjunctiva is drawn up into the wound and stitched to the skin at the margin to prevent reunion. The stitches should be removed about the sixth day. CANTHOTOMY Canthotomy is simple division of the outer canthus without stitching the conjunctiva into the wound. It is useful in some cases of blepharospasm associated with fissure at the outer canthus. CANTHORRHAPHY Union of the eyelids, usually at the outer canthus. =Indications.= (i) When the eyelids do not cover the globe as the result of-- (_a_) Cicatricial contraction of wounds, burns, &c., about the lid. (_b_) Long-standing facial paralysis. (_c_) Exophthalmic goître. (ii) To help maintain the lid in position after ectropion operations. =Instruments.= Beer’s knife, fixation forceps, spatula, and sutures.