A slight regional conjunctivitis usually follows this operation, yielding readily to simple treatment, often requiring no special care but the hygiene of secondary-wound antisepsis. PTOSIS This is a drooping of the upper eyelid, due to congenital or paralytic causes. It may be unilateral or bilateral. Apart from internal and proper external electrical and other treatment the simplest surgical method to be employed is to remove an elliptical piece of skin from the eyelid and to suture the margins of the wound together. Care should be taken not to take out too much tissue, as this would involve inability to close the lid. ANKYLOBLEPHARON A condition in which the two lid margins are united by cicatricial adhesion. These should be removed and the margin of the lids be rebuilt by any of the methods suggested if possible. Mucous-membrane flaps are naturally to be preferred. WRINKLED EYELIDS A common condition after middle life, when not due to other causes than normal changes in the skin and subcutaneous tissue. Edematous pressure due to disease is a common factor. The wrinkling may be marked or slight. To correct the condition is to remove the redundant or baggy tissue by excision, as massage in any form accomplishes little if any benefit. The shape of the incision should be made to include the loose tissue and varied somewhat, as shown in Figs. 112 and 113. [Illustration: FIG. 112. FIG. 113. BLEPHAROPLASTIES, AUTHOR’S METHOD.] The superior line of incision in operations of the lower lid should be made as close to the tarsal line as is practical, so as to show as little of the resulting scar as possible. The best distance is about an eighth of an inch below the tarsal cartilage fold. Accuracy in making the superior line of the incision is furthered by outlining the flap to be removed with a very fine bistoury. In operations about the upper lid a somewhat widened elliptical piece of skin is excised with its inferior margin about one fourth to one half inch above the tarsal line, so as to allow the line of union to lie above it and within the curved fold when the eye is open. [Illustration: FIG. 114.—CURVED EYE SCISSORS.] For the excision it will be found best to use a fine pair of curved eye scissors, beginning the incision by raising the skin at the outer canthus with a fixation forceps or tenaculum. Another guide to outline the necessary amount of tissue to be removed is to mark the area, prior to operation, with India ink or an indelible pencil. The parts can then be snipped away readily without fear of causing ectropion. There is usually very little bleeding, and in most cases the tissue is exceedingly thin. The margins of the wound are brought together with very fine twisted silk, using the continuous suture preferably on account of the ease with which it can be removed.