Diseases of the eye and ophthalmoscopy : a handbook for physicians and students / by A. Eugen Fick ; authorized translation by Albert B. Hale.

  • Adolf Gaston Eugen Fick
Date:
1896
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Licence: Public Domain Mark

Credit: Diseases of the eye and ophthalmoscopy : a handbook for physicians and students / by A. Eugen Fick ; authorized translation by Albert B. Hale. Source: Wellcome Collection.

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    drawn into place, the other end should be attached to the cheek. If these simple means do not suffice, an operation must be per- formed. Gaillard's suture seems to be most in use and is made in the following way : Raise the skin with a bit of the muscle beneath into a horizontal fold parallel to the under lid, and pierce the base of this fold perpendicularly from below upward, so that the point of the needle makes its exit J to ^ mm. below the edge of the lid; now reverse the needle, and about 2 mm. from the point of exit enter the needle again and carry it downward through a fold of the skin, tying a knot over a roll of cotton. Two or three of such sutures may be made along the lid. After two days the threads are to be taken out. The scars corresponding to the paths of the thread are said to make the immediate effect of the suture a permanent one. I have seen so many failures after Gaillard's suture for entropium that I have aban- doned the method. Instead of it I prefer the classical excision of a horizontal fold of slda ])arallel to the edge of the lid, with a suture of the wound. I have never known failure from this. If, however, the desire is only temporarily to prevent a bandage from causing entro- pium, I have always been satisfied with the following suture: I enter the needle about I cm. inward from the external canthus, and push it, as may seem best, 2, j, or even 4 cm. beneath the skin outward, or outward and downward. After bringing it out I tie the ends of the threads. The skin thus caught up is formed into a sort of tumor, the lid being actively stretched and drawn away from the eye. Of course, the thread gradually cuts into the skin and its efficacy is consequently lost, but as soon as the bandage is un- necessary, the thread should be removed. A successful treatment of cicatricial entropium demands a more radical interference. As the edge of the lid, in this case, will not yield to moderate traction, it must first be made movable. This can be done by Flarer's incision, which is made a few millimeters deep at the intermarginal part, and splits the lid into an anterior and a posterior layer,—the anterior carrying all the lashes with their hair bulbs and glands, and the posterior consisting of tarsus and conjunctiva, while the length of the incision is proportionate to the length of the entropianized part of the lid. The excision of a fold in the skin parallel to the edge of the lid is made after this. The edge of the lid is thus made movable. If the wound parallel to the edge of the lid is now closed by perpendicular sutures, this mov- able edge will yield to traction on it, and there will remain a nar- row wound beneath the edge of the lid (if the upper lid has been operated on). This linear wound surface was formerly left to itself,