The deformity to be overcome in ectropion is not only the turning outwards of the lid; in cases which have existed for any length of time the lid border becomes permanently elongated and requires to be shortened before it will keep in position. The exposed conjunctiva, especially in cases secondary to blepharitis, becomes thickened near the lid margin, and, though it may regain a more or less normal appearance after the lid has been replaced in position, the thickened margin frequently prevents the proper apposition of the canaliculus, and in these cases it is often desirable to remove this tissue (see Fergus’s operation). OPERATIONS FOR PASSIVE ECTROPION =Snellen’s suture method.= The object of this operation is to pass sutures through the lower lid from rather above the apex of the eversion out on to the cheek, so that when tightened they draw the lid up into position. The inflammation which occurs around the sutures leaves a permanent band of cicatricial tissue which continues the action of the sutures after they have been removed. [Illustration: FIG. 148. SNELLEN’S SUTURES. A B A. A suture in position. B. The suture tightened. ] =Indications.= Snellen’s sutures are useful in moderate degrees of the senile form of ectropion in which there is not much thickening of the lid margins. Although the results are satisfactory in carefully selected cases, the operation is attended with considerable pain and is very liable to be followed by a marked inflammation along the stitch tracks; indeed, the final results are not very satisfactory unless some inflammation does occur. =Instruments.= Two, and occasionally three, sutures of thick silk armed at either end with 3-inch straight needles. =Operation.= A general anæsthetic is desirable, although not absolutely necessary. The needles belonging to each stitch are inserted about 3 millimetres apart, from the conjunctival surface above the apex of the everted lid, and after passing deeply near the lower cul-de-sac on the posterior surface of the tarsus, they are brought out on the cheek low down and tied over a piece of drainage tube. The loops, when drawn tight, draw the lid margin inwards (Fig. 148). Two of these sutures are usually required at such a distance apart as to divide the lower lid into thirds. They should be left in place some two or three weeks. =Fergus’s operation.= This operation consists in excision of the apex of the everted lid. =Indications.= It is a most satisfactory operation for cases in which the lid margin has undergone thickening from blepharitis and for cases of slight senile ectropion. =Instruments.= Beer’s knife, fixation forceps, and sharp-pointed scissors.