Use of large probes urged in the treat ment of chronic cases of stricture of the lacrymal duct. G. M. Black (Phila. Med. Jour., July 16, '98).
One hundred and thirty cases of lacry mal stricture treated with the large probes until pronounced cured; 40 of these were kept under observation for periods varyiug from 1 to 8 years and re lapse had occurred in only 2 cases. H. O. Reik (Phila. Med. Jour., July 16, '98).
Conservatism advisable in the treat ment of epiphora. and lacrymal obstruc tion; cutting operations are followed by only temporary relief, and subsequent contractions make strictures worse than before. Lacrymal retention will often disappear with the cure of intra-ocular conditions. S. D. Risley (Jour. Amer. Med. Assoc., Oct. 24, '98).
In tear-duct obstruction repeated prob. ings have been almost entirely aban doned personally, the use of solid metal styles made of electrical-fuse wire being preferred. After dividing the lower canaliculus and the stenosed portion of the tear-duet by means of a specially constructed knife, a No. 6 Couper bulb ous probe is inserted, and then the style. When the style is properly inserted, the bent upper portion should lie in the di vided canalieulus without causing in convenience, and without being seen ex cept on eversion of the eyelid. The style need not be removed for two or three months, by which time the cure is gen erally complete. The only further treat ment necessary is the use of an alum and-borie lotion for bathing the eye, and the emptying of the sae by pressure over it with the finger. The treatment has been tested in about two hundred cases with gratifying results. McGillivray (Glasgow Med. Jour., Dec., '99).
In lacrymal obstruetion and suppura tiNe conditions of the laorytno•nasal pa--.ige•. the iiroceilitre lot to probing: A long sir\ er probe with an ejelet is threaded With coarse silk and passed into the canal until it emerge., front the nose, whereupon the two ends of the thread are tied. It is preferable to tie a large knot s-o that by pulling the string through the canal, hiell is done two or three tiliteg a day, a larger opening is produced. The string is removed in one week. The operation eau generally be performed under e0 cajun, ancesthesia. Pond Died. Record,
Feb. 2, 19011.
In infants operative procedure should be postponed until palliative measures have been thoroughly tried, although in obstinate cases this may be successfully accomplished under a general ant:esthetic.
To prevent closure of the duct after it has been made patulous, a number of operators insert a leaden style, leaving this in position for several weeks or months. This is of especial value when the patients live at a distance, and cannot submit to the frequent and continued probing which is necessary to attain the best results.
The use of the style made of pure sil ver, not larger than the No. 6 Bowman probe, and having the upper end bent so as to lie on the side of the nose close to the carunele, recommended. This is warn from four to twelve weeks, according to the pathological character of the strict ure. After this mild irrigation of the passages with the aid of a dental syringe completc-s the recovery. A large probe may be introduced once in two weeks, until it is evident that all tendency to relapse has disappeared. H. 1). Noyes (N. Y. Eye and Ear Infirmary Reports, Jan., '99).
There are many which require more radical measures than those usually re sorted to. Rapid and sure relief is ob tainable by extirpation of the lacrymal sac and gland. This takes away the source of irritation, and not only does away with the disease of the sac and its danger.s, but diminishes the flow of tears materially. Removal of the larger lac ryttial gland causes surprisingly little diminution in the apparent moisture of the conjunctival sae. It is only when the eye is exposed to stimulus that thc difference is usually apparent, and then the dimi llll tion is relative. History of five eases is given. W. 11. Lancaster (Boston Med. and Surg. Jour., Jan. 10, 1901).
Extirpation of the sac most satisfac tory in cases of long duration with more or less profuse muco-purulent secretion, in all cases with fistula, in those with changes in the periostemn and with caries of the bone, and in those result ing from the action of caustics or from trauma, in eases with prolonged conjun tivitis, ulcerations of the lids, and in trachom a. Al brand ( Deutsche med. Woch., Apr. 4, 1901).