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Show ‘>'I-~ ~- uw - err, .--:,>,--,;..c..-c.v,-.~< a,- . - {new mun i ‘. .V i'i. i .W'I'T'Jr‘<mn'b‘ 'LJ‘"""‘\‘ ‘. OF THE INVERTED LYELID'. or THE mVEn'rnD EYELID. EVERSION or THE EYELIDS. (Ectropz'on). No spasm or violent action of the muscles of the eyelids will produce this inversion, nor will the paralysis of the same mus< cles have any tendency to form it. It is one of the many Tm; conjunctiva having been inflamed, there sometimes re consequences of chronic inflammation, which making, as it mains a tumefaction in the conjunctiva, with a weak chronic inflammation. The edge of the eyelid is turned outward, and there is a semilunar, pale, fleshy tumour betwixt it and the eyeball. The cornea sometimes appears sunk within a circular tumour. The eyelids no longer wipe the dust from the cornea; they are removed from it; the eye is hot, and the tears fall over the cheek, there being no longer the gut- ters left between the meeting of the ciliary cartilages, to con-vey the tears to the punctase, and there occur of course frequent attacks of more violent inflammation, and in the end an opacity or ulceration of the cornea takes place. In slight cases the tumours are only to be scarified, or the surface, (if it shall have granulated) may be destroyed with the lunar caustic. The object in both these ways is to produce a cicatrization and consequent contraction of the conjunctiva. When the disease is more confirmed and the semilunar tu.‘ mour of the conjunctiva considerable, the whole protruding part is to be cut off. To do this, it is seized with the hook or forceps, and with the crooked scissors it is to be cut ofl'. were, a permanent growth of the superficial part of the eyelid, while the conjunctiva remains contracted it follows of course, that the edge of the eyelid is turned in. It is then in all respects the exact reverse of the eversion, and tumour of the conjunctiva. But perhaps this position of the tarsus is not merely the consequence of a fulncss of the cellular membrane, or growth of the skin, but in consequence of ulcers; the inner surface of the eyelid and tarsus may be contracted by the forming of the cieatrix. _ The surgeon then has to determine by careful examination, whether or not the inversion be owing to the growth or rc~ laxation of the outward skin and cellular membrane of the eyelid, and if it be, there is this method recommended of removing the evil. . With the finger and thumb a portion of the skin of the After this a few touches of the knife may still be necessary, and during the cure the end may be further secured, by touching any prominent granulation with the caustic and by the use of astringent washes. "'5' "IFWVM‘": 'Wwfsr-¢-~_...¢.V, a." _. OF THE INVEllTL‘D EYLLID. ixvnnsrox of the eye is where the margin of the eyelids and consequently the eyelashes are turned inwards upon the eye, proving a continued source of irritation and inflammation. as There is It lesser ng‘I‘CC offing (liQCEISC‘, mmmon to Old Female. ".b;,.',._ :5 710‘; mount it: ‘3»; trinkcn ng‘hpm E i It .51 eyelid is raised, so as to hold a ply or double of the skin, parallel to ‘the margin of the eyelid. In doing this the sur- geon will be able to distinguish betwixt the skin and the muscle, and will of course be careful to avoid catching hold of the orbicularis muscle. The scissors are now applied so that an oval piece of skin, or rather a piece of the form of a myrtle leaf is cut out. The appearance of the eye is frightful, but first by means of an adhesive plaistcr, and then by a coinpress and bandage the skin of the eyebrow is brought down so as to allow the margins of the wound to approach. The cicatrix forming consolidates and gives firmness to the out- ward skin, so as to keep the cilia: from being longer inverted upon the eye. But if this inversion of the eyelid be a consequence of ulcers and contraction of the inner and cartilagenous edge of the eyelid, forming a kind of stricture which prevents the inner edge from rising fully over the eyeball, and which drags in and inverts the margin of the eyelid, then a different ope: vor. 1r, t |