a) If
tensions is normal to +1, do sclerectomy without iridectomy, the amount
of sclera excised being inversely proportionate to the degree of
hypertension. (b) If tension is +1 to +3, do sclerotomy-iridectomy, the
iridectomy being added to avoid entanglement of the iris. Lagrange does
not recommend his operation for acute glaucoma. It is especially adapted
for cases of chronic simple glaucoma."

During the past ten years or more I have been doing a modification of
the Lagrange operation, the details of which (The Operative Treatment of
Glaucoma with Special Reference to the Lagrange Method, _The Canadian
Medical Association Journal_, November, 1911) I have elsewhere
published.

As stated in this paper I have modified the procedure to the extent of
removing _all_ the conjunctiva attached to the borders of the operative
wound. I admit that this intervention exposes the root of the iris and
the ciliary body, but I have never yet had the slightest infection of
the wound. I attribute this freedom from sepsis to careful cleansing of
the conjunctival sac and to other pre-operative precautions, but
especially to the use, before and after the operation, of White's
ointment--a preparation of 1-3000 mercuric chloride in sterile vaseline.
One cannot use sublimate in such a strong _watery_ solution, but the
vaseline seems to modify it and to allow of such slow absorption that it
is not only a non-irritant but a most excellent antiseptic application
in operations on the eye.

In any event the result of the Lagrange operation proper, as well as my
modification of it, is to produce a drainage-oedema about the incisional
wound which persists almost indefinitely. In many cases this swelling
amounts to a bleb which may be increased by massage of or pressure upon
the eyeball. The efficacy of the operation in lowering intra-ocular
tension is to some extent measured by the degree and the constancy of
this epibulbar oedema; indeed, I suspect that the most successful
examples are those in which sclera fistulae, minute or otherwise, form
as a sequel of the operation.

My object in excising the conjunctiva about the sclero-corneal flap, is
to delay union of the wound edges, to widen the bridge of loose
cicatricial tissue between them, to prevent such a complete growth of
the endothelium as would cover the wound and block the exit of fluids,
and to insure intra-ocular rest.

In cases of _chronic_ increase of intra-ocular tension associated