Anomalies of the Lacrymal Sac and Nasal Duct.
DAcnvocYsTrris or inflammation of the lacrymal sac may be eitber acute or chronic.
Symptonzs.—The disease is rarely acute, but begins generally as a chronic inflammation, which manifests itself by a slight swelling and redness at the inner canthus, and by persistent and trouble some lacrymation, or by the discharge of a rnuco-purulent secretion from the inner eanthus of the eye. Pressure on the sac will express a secretion which is either mucoid or muco-purulent, either into the conjunctival or into the nose. This condition of affairs may persist and the sac may become chronically dis turbed, and give rise to a tumor of con siderable size (lacrymal tumor, or mueo cele). Frequently the inflammation as sumes an acute form, and the region of the sac becomes swelled and reddened and a thick creamy pus forms in the sac, which is only expressed after some diffi culty. The pain is intense, and there are marked constitutional symptoms, such as fever and loss of appetite. If the parts are undisturbed, the skin ulcerates and is perforated usually beneath the ten don of the orbicularis muscle, and a per manent fistula is formed. More rarely, the opening in the sac heals, and the for mation of the fistula is avoided. As a re sult of the fistulous formation, pus fre quently burrows into the deeper tissue, and necrosis of the neighboring bones is not rarely occasioned.
Etiology.—In the great majority of cases dacryocystitis is secondary to dis eases of the lacrymo-nasal duct, primary inflammation of the lacrymal sac being an extremely rare affection. It is a dis ease of adults, being rare in children, when it occurs under 10 years of age being usually significant of inherited syphilis.
Acute dacryocystitis is a suppurative osteoperiostitis of the orbital process of the superior maxilla, and only seconda rily implicates the sac. Fano (Journal d'Oculist. et de Chit, Apr., '91).
Dacryocystitis occurs upon the left side more frequently than upon the right, and affects women oftener than men, ap pearing 011 the average toward the thirty third year of age, and about six years after the beginning of epiphora. The
predisposing cause is a depraved consti tutional state. Variola has been found to have occurred previously in 41 per cent. Nasal affections —laypertrophic and atrophic thinitis, deviation of the septum, and especially fcetid atrophic rlainitis—seem intimately associated with daeryocystitis. The bad condition of the teeth in many cases renders possible the propagation of periosteal inflammation from the jaw to the lactymal mucous membrane. Purulent ophthalmia, as well as hereditary; direct traumatism, and osseous lesions contribute to the causes of dacryocystitis. Foucher (L'Union AIM. du Canada, Sept, '91).
Seven cases of so-called blennorrlicea of the lacryrnal sac in newborn infants. This condition can usually be accounted for by an atresia of the nasal opening of the lacrynial canal, caused by a failure of absorption of the embryonic tissues in this position. Avoidance of sounds is recommended; sliglit digital pressure over the sac, combined with frequent cleaning of the eye, will work a cure in a short tirne. Peters (Zehender's klin. Monats. f. Augenh., Nov., '91).
Fifty cases of dacryocystitis. In 24 the affection NN as bilateral, and there was usually an interval of several months after the time of infection. Chauvel (Recueil Alay, '92).
Fatal case of dacryocystitis caused by injection of 3-per-cent. solution of alum acetate into the canal. Leplat (Recueil d'Oplital., NOV., '94).
Case of dacryocystitis following slit ting and probing of canaliculi; total blindness. Valli& (Ann. &Omit., Afar., '95).
Nasal condition examined in 94 cases of dm. slim) ing that S9 had some nas.11 affection, whereas in only 5 11 as the nose healthy. E. Waggett (Ther. Monats., Dee., '96).
Examinations of the, secretion from in flamed tear sacs slim% s no eme organism is found constantly in ordinary mueocele. Eyre (Oplith. Record, Nov., '97).