Great inconvenience is caused by the state of eversion: the surface
of the eyeball is subject to inflammation, in consequence of being
insufficiently protected; the change of its investing membrane is
a serious evil; and in some cases the cornea becomes extensively
ulcerated, unusually vascular, and opaque.
When the conjunctiva only is in fault, the deformity is slight, and
the state of matters is readily ameliorated by excision of the relaxed
portion. This is done by sharp curved scissors. As the wound gradually
contracts, the eyelid is drawn inwards, and, on cicatrisation taking
place, the parts have become restored to their healthy condition. Care,
however, should be taken that too much of the swollen conjunctiva is
not removed, otherwise the subsequent contraction may cause inversion
of the lid. Combined with the above practice, relaxation of the lid
itself will in many cases be remedied by removal of a portion of it
in the form of the letter V, by means of a sharp-pointed bistoury:
the edges of the incisions are afterwards put together by a point
of interrupted suture. When eversion arises from a cicatrix of the
integuments, the part in fault may be divided; but a temporary benefit
only can be procured. For, during the healing of the wound, the parts
again contract; and, though a portion of the conjunctiva is at the
same time removed, the contraction internally will hardly counteract
that which is going on externally. In order fully to obviate the evil
of this contraction of the cicatrix in inveterate cases of ectropion,
a form of plastic operation may be successfully resorted to. The
cicatrix being dissected out, and the tarsal cartilage brought neatly
into position, a piece of integument from the temple or cheek may be
adapted, and a portion of a new eyelid formed. The parts may sometimes
be brought into a good position without the necessity of borrowing
any portion of integument. A V-shaped incision can be made, the apex
pointing downwards, so as to loosen the under lid; and after it has
been drawn upwards and put straight, the edges of the lower part of the
exposed space are united by suture.
[Illustration]
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