Blepharoptosis

BLEPHAROPTQSIS, see Ptosis. Blepharorrhaphy is the operation of shortening the palpebral fissure by suturing the eyelids. There are: V. medialis, when the eyelids are sutured at the internal raphé; V. lateralis, when the edges of the eyelids are joined at the external raphé; V. totalis, when the eyelids are sutured along the entire length of the palpebral fissure. V. lateralis is performed most often. Indications for it: involutional and paralytic type ectropion of the eyelids with flaccidity and stretching of the skin of the lower eyelid and elongation of the ciliary margin of the lower eyelid; at lagophthalmus (paralysis of the facial nerve), exophthalmus (in Graves' disease), when there is a threat to the cornea, which is insufficiently covered; at various plastic operations on the eyelids. V. medialis is applied, mainly, at involutional ectropion of the lower eyelid in its medial part. The combination of internal and external V. was proposed by Rudin as a means against xerosis of the cornea in trachoma; the aim of this operation is to increase the moisture of the conjunctival sac by sharply shortening the palpebral fissure from inside and outside. Finally, V. totalis is usually a temporary measure, when it is necessary to ensure an immobile closed position of the palpebral fissure and eyelids during blepharoplasty or when it is necessary to protect the cornea at high degrees of exophthalmos.

Blepharopexia-Blepha-rorrhaphia. In the intermarginal space the epithelium is excised and sutures are placed, which must be tightened and tied.

Blepharospasmus (from Greek blepha-ron-eyelid and spasmos-spasm), blepharospasm, tonic spasm of the circular muscle of the eyelids. Blepharospasmus may be, firstly, due to reflex irritation of the branches of the trigeminal nerve (diseases of the nasal cavity, mouth, and, especially often, the eye and its appendages); secondly, V. may develop at organic lesions of the facial nerve in its cortical centers, medulla oblongata, trunk, and peripheral branches; thirdly, V. may be so-called essential—a functional disorder from psychogenic causes and on the ground of age changes (hysterical V., V. at traumatic neurosis, senile V.). At reflex V. there is no direct correspondence with the severity of the disease of the eye; at light, relatively, changes in the eye there may be a severe V. The latter, in combination with photophobia, often greatly hinders the examination of the eyes and has a very unfavorable effect on the course of eye diseases, delaying tears and discharge under the eyelids, causing swelling of the eyelids, and sometimes even a spastic inversion or eversion of them. Very often the existence of V. is maintained by those cracks which are obtained at the outer angle of the eye and after the healing of which or after anesthesia (with cocaine ointment) V. quickly ceases. To eliminate reflex V. it is necessary to treat the corresponding diseases of the eye, nose, and mouth. At essential V. one often finds so-called pressure points, at the pressing of which V. immediately ceases. Mostly these points are located in the area of branching of the trigeminal nerve, but sometimes also in other places (on the ribs, vertebrae, limbs, etc.). They give grounds to bring part of the cases of essential V. with reflex V. closer together. In the treatment of essential V. the usual anti-nervous drugs are used first, as well as strengthening and narcotic drugs; at hysteria—suggestion. A good means is a constant current, at which the "pressure point", if such exists, is chosen as the place of application of the current. In severe cases, operative treatment is resorted to—injection of alcohol and traction of the trunk of the facial nerve and neurotomy of the supra- and infraorbital nerves. A. Pokrovskii.