ANOMALIES OF THE PUNCTA LACRY AIALIA AND OF THE CANALICLILL—Con genital.—Complete obliteration or ab sence of the puncta as well as double puncta has been occasionally observed. At times tb e puncta and canaliculi may be wanting, the canals being represented by narrow grooves along the edges of the 1 i d.
Case of congenital epiphora of both eanaliculi in one eye and of inferior one in other in child complaining of cpiphora; hereditary origin. Lafite-Dupont. (Ann. d'Oeul., Apr., '95).
Acif. it-rd.—Such anomalies :11.0 usually filo I.( -tilt of chronic inflammations of the lid, and conjunctiva, which have dis tnrbtd the normal relationship existing bt mall the puneta and the bulbar eon junetka. They are frequently induced by old ago, due to a senile relaxation in the orbieularis palpebrarum, and are con stantly present in paralysis of the seventh nerve.
o cases of daeryorrlura caused by atresia of the puncta in consequence of si :1st le contracture of the sphincter.
(Zeliender's klin. Mount. f.
!milk., Sept., '90).
Lacrymal gland supplied by the facial nerve. One-sided weeping is due to a paralysis of that nerve. The gland is enly broug,ht into activity in the act of weeping or in forced lacrymal secretion. Goldzieher (Revue G(..11. d'Oplital., Jan., '94).
::-ecret ion of tears due to the influence of a branch of the seventh pair. Tribou deau (Jour. de MM. de Bordeaux, Nov. 3, '95).
Eversion of the punctum is ahnost a constant consequence of ectropion, and is also present in those rare cases \vhen the eyeball is so deeply set that a triangu lar space intervenes between the lid and the globe.
Complete obliteration is a not infre quent result of burns and traumatisms which have involved the lids, and of granular conjunctivitis and blepharitis. Rarely, the canal may be blocked by a cilium or polyp, or by leptothrix.
Cylindrical grass-blade, one-half cen timetre long. extracted from the upper canaliculus of a man. Rodionoff (Russ kaia Meditzina, No. 8, '88).
Case in which abscess of the inferior lacrymal canal was found to be caused by a piece of lettuce-leaf 2 millimetres long and 1 millimetre in circumference.
The foreig-n body had been driven into the nos.e and thence into the nasal duct by repeated efforts of sneezing. Malgat (Recucil d'Ophtal., Apr., '90).
.Mass of netinionycoses removed from er eanalienhis of a healthy man. lluth (C'entralb. f. prakt. Angenh., Apr., '91).
Symploins.—The most common symp tom of all these anomalies is the constant overflow of tears. This is annoying in itself, but, more than that, it frequently causes such irritation of the skin about the lids, that an inflammation is set up which causes contraction of the parts, and still further interference with the proper canalization of the tears.
Ilypert-emia and catarrh of the con junctiva are constantly present, consecu tive to all forms of lacrymal obstructions.
l'reatment.—Usually the simple dila tation of the punctum, or the slitting. up of the eanaliculus, is sufficient to effect a cure, with the co-operation of an as tringent wash of zinc and boric acid.
In the treatment of lacrynial obstruc tion, the lower canaliculus is slit with a bistoury or scissors only to a distance of five millimetres from the puncta, and Bowman's sounds passed for eight days following. The triple-furrowed sound is introduced and allow ed to remain in place during the remainder of the treat ment, the instillation of a 1-per-cent. so lution of zinc chloride being made along its capillary furrows. Libbrecht (Recueil d'Ophtal., May, '91).
Lacrymal obstruction often success fully treated by slitting upper canalic Illus. Story (Ophthalmic Review, June '95).
Hypnotism successfully used in a num ber of cases to pass lacryinal probes.. and eN-en for slitting up the canaliculus without pain. A. E. Davis (Post-gradu ate, Nov., '96).
If the condition has been brought about, however, by a high deg,ree of ectropion, or is the result of an extensive burn, relief will be frequently difficult to attain, and extensive plastic operations may be necessitated before the lid is restored to its normal position.