_Third step._ An incision is carried through the tarsal plate parallel to and near its upper border well into the substance of the orbicularis muscle on the other side. The needles on each end of the doubly armed sutures holding the isolated portion of the superior rectus muscle are passed through the hole in the tarsal plate and are carried downwards between the orbicularis muscle and the tarsal plate to near the lid margin, where they are brought out through the skin and tied over a piece of drainage tube. The conjunctival wound is closed by sutures. =Complications.= _Ulceration of the cornea_ is more likely to occur after those operations in which the lid is much over-retracted, such as Hess’s, Panas’ operation, and the advancement of the levator palpebræ. It usually affects the lower corneal margin and may be merely roughening and opacity of the epithelium or deep septic ulceration. If the ulceration be severe, the sutures holding the lid in position should be taken out and the eye treated as for corneal ulceration; on the other hand, slight abrasion of the epithelium will often heal without taking out the sutures. _Sepsis._ The difficulty of keeping the wound aseptic after these operations is considerable, and not infrequently inflammation may take place; provided it does not go on to suppuration, the final result is improved thereby; should suppuration take place the sutures must be removed. CHAPTER IX OPERATIONS FOR ENTROPION, REPAIR OF THE EYELIDS TRICHIASIS, AND ECTROPION The operations commonly performed for entropion and trichiasis are of three types:-- 1. Operations for the destruction of the individual hair follicles. 2. Rectification of a faulty curvature of the tarsus. 3. Transplantation of the lash-bearing area. ELECTROLYSIS =Indications.= In cases of trichiasis where a few eyelashes turn in on the conjunctiva or cornea they may be removed by this method. =Operation.= A platinum electrolysis needle (negative pole) is passed alongside each lash into the follicle, and a constant current of about 5 milliampères allowed to pass for a half to one minute. There is usually some bubbling seen around the hair, which will fall out when touched if the operation has been properly performed. It is a comparatively painless operation and free from scarring if the hair follicle be not penetrated by the needle. This is best ensured by using a rather blunt point and not turning on the current until the needle is in position. SKIN AND MUSCLE OPERATION =Indications.= This operation is especially suitable for the senile or spastic forms of entropion of the lower lid, not infrequently seen after much bandaging in old people, which has failed to yield to treatment by pulling the lid outwards with strapping. =Instruments.= Straight scissors, fixation and entropion forceps.