---

PREOPERATIVE DIAGNOSES:
1. Entropion, left upper lid.
2. Entropion and some blepharon, right lower lid.

TITLE OF OPERATION:
1. Repair of entropion, left upper lid, with excision of anterior lamella and cryotherapy.
2. Repairs of blepharon, entropion, right lower lid with mucous membrane graft.

PROCEDURE IN DETAIL: The patient was brought to the operating room and prepped and draped in the usual fashion. The left upper lid and right lower lid were all infiltrated with 2% Xylocaine with Epinephrine.

The lid was then everted with special clips and the mucotome was then used to cut a large mucous membrane graft from the lower lid measuring 0.5 mm in thickness. The graft was placed in saline and a 4 x 4 was placed over the lower lid.

Attention was then drawn to the left upper lid and the operating microscope was found to place. An incision was made in the gray line nasally in the area of trichiasis and entropion, and the dissection was carried anterior to the tarsal plate and an elliptical piece of the anterior lamella was excised. Bleeding was controlled with the wet-field cautery and the cryoprobe was then used with a temperature of -8 degree centigrade in the freeze-thaw-refreeze technique to treat the bed of the excised area.

Attention was then drawn to the right lower lid with the operating microscope and a large elliptical area of the internal aspect of the lid margin was excised with a super blade. Some of the blepharon were dissected from the globe and bleeding was controlled with the wet-field cautery. An elliptical piece of mucous membrane was then fashioned and placed into the defect in the lower lid and sutured with a running 6-0 chromic catgut suture anteriorly and posteriorly.

The graft was in good position and everything was satisfactory at the end of procedure. Some antibiotic steroidal ointment was instilled in the right eye and a light pressure dressing was applied. No patch was applied to the left eye. The patient tolerated the procedure well and was sent to recovery room in good condition.

---