=Operation.= Under adrenalin and cocaine, a little solid cocaine being rubbed into the conjunctiva. A strip of thickened conjunctiva and subconjunctival tissue corresponding to the apex of the eversion is removed along the whole length of the lid (Fig. 149). The wound produced is united with sutures. The pull of the conjunctiva, which is stitched to the lid margin, is sufficient to draw that structure inwards into position. [Illustration: FIG. 149. FERGUS’S OPERATION FOR SLIGHT ECTROPION OF THE LOWER LID. Showing the lines of the incision.] =Kuhnt’s operation= (modified). The object of this operation is the removal of a triangular piece of conjunctiva and tarsal cartilage from the centre of the lower lid, the base of the triangle being placed towards the free margin of the lid so as to produce sufficient shortening of the elongated lid border to hold it in position. The skin of the lid is also shortened by removal of a triangular portion at the external canthus. =Indications.= It is especially suitable for cases of paralytic ectropion (lagophthalmos) and severe degrees of senile ectropion of the lower lid. =Instruments.= Lid spatula, Beer’s knife, scissors, forceps and sutures. =Operation.= A general anæsthetic is required. _First step._ The lower lid being held between the finger and thumb is split in the intermarginal line along the outer two-thirds of its length, and the incision deepened till the lower border of the tarsus is reached. For this purpose some surgeons use a broad keratome instead of a Beer’s knife. _Second step._ A triangular piece of conjunctiva and the whole thickness of the tarsus are removed from the centre of the lower lid, the base of the triangle being towards the free margin of the lid and being of sufficient length to produce the shortening desired to bring the lid up into position (Fig. 150); this is best estimated by making the incision forming the inner limb of the V and overlapping the outer flap until the lid is pulled upwards into position. _Third step._ A triangular piece of skin with its base upwards is excised from the outer canthus in the following manner (Fig. 150). An incision is made outwards and slightly upwards from the canthus. A vertical incision, twice the length of the preceding one, is made directly downwards from its outer end to the outer canthus, and the lower end of this is then joined by an incision completing the triangle. The skin marked out by this triangle is then dissected up and removed. The undermining of the flap formed by the skin and subcutaneous tissue of the outer part of the lid is continued inwards until the flap, when pulled up into place, restores the lid to its proper position. [Illustration: FIG. 150. MODIFIED KUHNT’S OPERATION FOR SEVERE ECTROPION. _Second step._ The outer half of the lid is split and a V-shaped portion of the tarsal plate removed. The triangular piece of skin at the outer canthus is entirely removed.]