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244 the position and direction of its follicle may be in this way permanently changed. This method was described by Celsus as "illaqueatio."

Occasionally, in patients who are annoyed by a sensation as of a foreign body in the eye, there may be found, either with the naked eye or by the help of a lens, a number of very fine cilia (strongly developed lanugo), which, with their points, touch the caruncula lacrymalis. Epilation is the only remedy.

Distichiasis congenita is very rare. In this condition the cilia at the outer edge of the lid are normally developed, but from the intermarginal part, near the mouths of the tarsal glands, there springs a second row of cilia which lean against the eyeball. In many cases there exist still other congenital anomalies; for instance, in one case which I observed there was epicanthus and bilateral ptosis congenita; in another case I found a cleft in the soft palate.

Ammon has given the name epicanthus to that condition in which there is a redundancy of skin upon the bridge of the nose, and as a consequence the inner canthus is covered by a vertical fold. It occurs only when the bridge of the nose is very flat, and in its highest grades is generally associated with congenital ptosis. If it seem desirable to relieve the condition by operation, it may be done by the excision of an elliptical piece from the superfluous skin on the bridge of the nose.

Congenital cleft (coloboma) of the upper lid has been observed generally associated with other congenital anomalies. If the cleft be so deep that it requires to be closed by an operation, its edges are to be freshened and then united with sutures.

SYMBLEPHARON.

Symblepharon is the union of the inner surface of the lid with the eyeball, following destruction of the conjunctiva. Burns with hot metal, concentrated mineral acids, lime, and unskilful cauterizations with nitrate of silver are the usual causes. It very seldom follows wounds made with sharp instruments.

Since it is almost always due to an accidental spurting of the caustic in'to the eye, the scleral and palpebral conjunctiva are generally simultaneously destroyed and the cornea involved in the injury.