Several methods have been used in the past to correct the defective closure of the lids incident to the exophthalmos in exophthalmic goiter. Such methods are applicable as a measure of protection to the cornea not only preceding thyroidectomy but after operation as well when the exophthalmos persists.
In general, three methods of approach have been used. The first attacks the lids directly; the second attempts to modify the sympathetic nervous supply of the orbital contents, and the third aims to decompress the orbit. The external tarsorrhaphy advocated by E. Fuchs and the modifications of this operation employed by others correct the deformity to a satisfactory degree. Axenfeld1 used a looped silk suture. The upper end of a white silk suture was passed along through the upper lid parallel to the margin, and in the same manner the lower end was passed through the lower lid. At the outer