The curative plan of treatment re solves itself into some form of surgical procedure. These measures have been conveniently classed by Theobald under four heads: 1. Those which aim to re store the natural passages. 2. Those which have for their object the forma tion of a new passage into the nose for the tears. 3. Those which aim at the obliteration of the natural passages,—the laerytnal sac and duct. 4. The removal of the lacrynial gland for the purpose of arresting the secretion of tears.
The first step toward the restoration of the natural passages consists in the oper ation of Bowman, which consists in slit ting up the lower canaliculus throughout its entire length. This is accomplished by entering a fine canaliculus-knife into the inferior puncturn, and by slowly pushing it along the floor of the canalic Otis, until it abuts against the inner wall of the sac as it rests against the lacryinal bone. The handle of the knife should now be swept upward, while an upward and slightly backward inclina tion is given to the blade of the knife. A ready entrance into the sac being gained by the successful accomplishment of this act, attempts should be made to engage the stricture, and to dilate its caliber by means of probes. I generally first make the attempt with a very small Bowman probe, and then gradually increase the size by passing slig,htly-higher numbers every second or third day. I am satisfied after a No. 6 probe, with a caliber of 1.50 can be passed into the nose without difficulty. Larger probes are not employed, as they are apt to injure the mucous membrane and periosteum, and in some cases to lead to necrosis. Weber, Cooper, and Theobald, however, think sounds of the size of a Bowman No. 6 quite inadequate, and have devised probes of much larger caliber, employing instruments of a diameter of 4 milli metres in the treatment of the majority of their eases. As stated above, I am generally satisfied with a dilatation of 1.50 millimetres, and alternate the pas sage of probes by careful syringing of the duct with a weak solution of zinc and boric acid.
Routine slitting up of the eanalieuli in every ease demanding treatment of the laerymal sac or nasal duet deprecated.
Stenosis of the lower end of the nasal duct often can be relieved by the galvano cautery. Gillet de Grandmont (Recueil d'Ophtal., May, '90).
In stenosis of the nasal duct, method recommended by Benson, which consists in the use of removable styles, intro duced by the patient and worn during the night. Hasbrouck (Jour. of Ophthal., Otol., and Laryn., Apr., '90).
After first obtaining local anmsthesia by cocaine, electrolysis of the lacrymal duct may be effected by passing an ordi nary Bowman probe into position, and then connecting the negative electrode of a battery with the handle of the probe by a serre-fine, and effecting continuity of circuit by forcing a small platinum tracheotomy cannula, to which the posi tive electrode of the battery has been fastened into the corresponding nostril so as to meet the probe. After this has been done, a larger-sized probe can be readily introduced. Gorecki (Archives d'Ophtal., Sept., '90).
Summary of methods of treatment of affections of the lacrymal apparatus: 1. Epiphora: astringent and antiseptic collyria. 2. Catarrh, with and without stricture: in the first case, catheterism by Bowman's probes, followed by injec tions of sublimate, 1 to 3000; in the sec ond, the injections will suffice. Finally, extirpation of one or both parts of the lacrymal gland. 3. Suppuration of the sac: if acute, incision of the anterior wall, bichloride wash, and iodoform dressing; if chronic, treatment for blen norrhma; and, if this fails, incision of the sac and cauterization of the mucous membrane with actual cautery. 4. Lac rymal fistula and fungosities of sac: thorough destruction, by thermocautery, of the sac and its surrounding tissue. 5. Alterations of the bony walls: open ing, scraping, curetting, and cauteriza tion. Specific treatment, if required. Lagrange (Gaz. Hebdorn. des Sciences Med. de Bordeaux, Sept. 20, Nov. 1, '91).
Importance of examining the nasal passages after the passing of lacrymal probes, both in order to determine their position and to detect the presence of any abnormality which might tend to ob struct the lower end of the ducts. Cheat ham (Amer. Praet. and News, Apr. 27, '93).
Lacrymal duet kept open by passing small-sized cannula containing probe through canal; cannula removed and split pea of lead fastened to one end of thread pulled up until its progress is ar rested; second shot attached to upper end near punctum. Vilas (Med. Rec., June, '95).