Thirty out of thirty-five cases in which there was found, in chronic alteration of the lacrymal apparatus, an impairment of the nasal mucous membrane or a de flection of the nasal septum. Kruch (Annali di Ottalmol., 1\To. 3, 'SS).
Ozmia is a frequent cause of disease of the lacrymal passages. Van Alilligen (Archives d'Ophtal., Nov., Dec., '89).
Epiphora may result from an obstruc tion of the lacrymo-nasal duct from swelling of the mucous membrane, hav ing its primary origin in chronic or sub acute post-nasal catarrh, while the same symptoms may arise from atrophic changes with contraction, a part of similar process in the intranasal passages. Lacrymal abscess may be traced to chronic pharyngitis, with involvement of the mucous membrane of the lacrymal duct, producing true stricture, interfer ence with drainage, and development of pathogenic organisms. De Schweinitz (Cincinnati Lancet-Clinic, May 14, '92).
Four methods by which nasal dis orders may lead to eye-symptoms and eye-lesions: I. By processes of growth, causing, extension of tumors through the sinuses into the orbit or into the cranial cavity, and hypertrophies involving me chanically the nasal end of the duct. 2. By extension of infection through lymph-vessels and foramina or deficien cies in the bony walls, or by continuity of surface; spread of inflammatory proc esses into the lacrymal sac and into the orbit, thus affecting the intracranial portion of the optic nerve. 3. By cir culatory disturbances, which occur in the form of venous congestion whenever me chanical conditions exist in the nose which impede the cireulation. 4. By nervous disturbances. Cradle (Jour. Amer. Med. Assoc., Sept. 10, '92).
Infection of the conjunctival sac by bacteria from the nose is impossible by way of the lacryrnal canal. Bach (Ar chly f. Ophthalmologie, B. 40, II. 3, '94).
Pneumococcus, a normal occupant of respiratory tract, may cause ocular trouble by infection through lacrymal passages or endogenetically. CuCmod (Ann. d'Ocul., May. '95).
Two cases of lacrymation caused by the presence in the mouth of decayed stumps of teeth, through induction of the chronic inflammation of the antrum and the nasal fossa, thence extending up ward into the nasal duct. Puech (Rec.
d'Ophtal., Nov.. '95).
In scrofulous persons exostosis of the nasal duct is a cause of stenosis. Cale zowski (Rec. d'Opht., No. 2, p. 166, '96).
Some cases of apparent closure of the nasal duct, w ith all the symptoms of dacryocystitis, are really due to the pres ence of groups of actinomycosis. Evctsky (Arch. d'Ophtal., Apr., '96).
Obstinate unilateral lacrymation in a new born child usually signifies obstruc tion of the tear-duct. Landoll (Annales de Gyn. et d'Obst., Jam, '07).
Among the predisposing causes of dis eases of the lacrymal passages are such defects of structure as flattening of the b, lay canal or other irregularities, and ilefect4 of refrai Syphilis, gout. plithisis, scrofilla, or any of the infectious diseases may cause lacryinal disorder.
Among the local causes are conjuticti x kis at tlie upper end of the lacrytnal passage, and nasal dis-ease at the other end. iIP morbid process in either instance :Treading to the nearest canal. Con ner i„lour. Amer. Med. Assoc., July 2, '9S).
Trealment.—While an absolute and a complete eure of lacryinal obstruction may be frequently attained, more often relief is only partial. If the obstruction in the duct be due to swelling of the mucous membrane merely, the prognosis is good: but if the stricture be of bony origin it may be regarded as incurable.
Treatment may be either palliative or curative. The former consists in re peatedly pressing the contents of the lacryinal sac into the nose by the finger, and by the employment of antiseptic and astringent eye-washes, or by throwing a stream of boric-acid solution into the sac by means of an Anel syringe. Attention must be directed toward the nasal mucous membrane, and any local irrita tion existing about the nasal opening of the duct must be controlled with local applications.
In washing out the lacrymal passages, a hollow, conical eannula, which has its lower °purling upon the side and it short distance above the terminal point, em ployed. Vignes 1Recueil d'Ophtal., Mar., '91).