The following operations are usually only undertaken for congenital ptosis, but they are occasionally required for the paralytic and traumatic varieties. All the operations are far from satisfactory, and should only be undertaken when the lid covers the pupil completely or so nearly that the head has to be thrown back to see objects directly in a line with the eyes. The relative value of the various operations apart from their indications is a matter of opinion amongst ophthalmic surgeons; therefore the various types of operations which are performed are given below. There are four types of operation, which respectively aim at-- 1. Shortening the eyelid by excision of a portion of the tarsal plate. 2. Attachment of the lid to the occipito-frontalis muscle. 3. Advancement of the levator palpebræ muscle. 4. Grafting of part of the superior rectus muscle into the lid to take the place of the levator palpebræ superioris. SHORTENING THE EYELID BY EXCISION OF A PORTION OF THE TARSAL PLATE =Fergus’s operation (modified).= The object of this operation is to shorten the eyelid by removing the upper portion of the tarsal plate, the cut margin of which is subsequently sutured to the tendon of the levator palpebræ and the palpebral ligament. The results of the operation are satisfactory, especially in cases in which there is some movement in the eyelid. The author, who has performed most of the ptosis operations on several occasions, has had most uniform results by this method, the modification of which was first suggested to him by Mr. Treacher Collins. It has the advantage that the amount of retraction required may be more easily estimated, the corneal complications are of much rarer occurrence, and the resulting scar forms a natural fold in the lid. It is obviously not applicable to cases in which the eyelid is already short, as in the cases of ‘Chinese eye’ in which little can be done beyond enlarging the palpebral aperture. =Instruments.= Spatula, scalpel, artery and dissecting forceps, scissors, and sutures. =Operation.= _First step._ The spatula is inserted into the superior fornix. A curved incision is made directly below the orbital margin throughout its whole length. The skin and orbicularis muscle are divided and dissected downwards so as to expose the upper surface of the tarsal plate. A suture is then passed through this flap so that it may be drawn down by an assistant. _Second step._ A narrow strip about 3 millimetres broad is excised from the whole length of the tarsal plate; in doing this care must be taken not to button-hole the conjunctiva or flap of skin.