A treatise on the diseases of the eye / By W. Lawrence.

  • Sir William Lawrence, 1st Baronet
Date:
1847
Catalogue details

Licence: Public Domain Mark

Credit: A treatise on the diseases of the eye / By W. Lawrence. Source: Wellcome Collection.

Provider: This material has been provided by the Harvey Cushing/John Hay Whitney Medical Library at Yale University, through the Medical Heritage Library. The original may be consulted at the Harvey Cushing/John Hay Whitney Medical Library at Yale University.

    879/920 page 841
    [The operations described in the preceding pages for the re-establish- ment of the passage for the tears to the nose, are, we believe, not often required—-rarely, if ever, except in cases where the inflammation has been so violent as to cause effusion of lymph and adhesion of the sides of the nasal duct, thus completely obliterating this passage. When the obstruction, however complete, is the result merely of thickening of the mucous membrane lining the nasal canal, forming, as it were, a stricture, it may be cured by a recourse to proper methods of dilatation on the same principle that strictures elsewhere are treated. It is true that the mucous membrane in this case is confined in a bony canal, which does not admit of dilatation, still the principle is applicable, for pressure on the thickened mucous membrane by the sound, causes the removal by the absorbents of the lymph deposited in the mucous tissue. Mr. Travers' remarks on this subject are very judicious. It can hardly be required, he observes, that I should occupy the time of the reader in showing that the practice of restoring a passage partially closed, or even establishing an artificial passage, as nearly as possible in the same direction, when the natural channel is obliterated, commands a de- cided superiority over the practice of making an artificial opening. This applies to the treatment of the urethra, as well as of the ductus nasalis, and it is only in case of abscess, in which the distended and inflamed integument threatens to give way by ulceration, that in either case it be- comes necessary to deviate from it. A set of silver probes, of about five inches long, varying in size, flattened at one end, and slightly bulbous* at the point, are the instru- ments I use for the purpose of restoring the passage. The probe is introduced with perfect facility by one who is familiarly acquainted with the anatomy of the part from either of the puncta lachrymalia into the corresponding nostril, when no obstruction is offered to its passage. If the punctum be constricted, it is readily entered and dilated by a common pin; and upon withdrawing it, by one of the smaller probes ; the direc- tion and relative situation of the lachrymal ducts, the sac, and the nasal canal, point out the proper course of the instrument. It is confirmed by its advance without the employment of force, and the sensation conveyed by the free and unencumbered motion of its point: until the point is fairly within the sac, it is necessary to keep the eyelid gently stretched and slightly everted; the upper lid being drawn a little upward toward the zygoma. The point carried home to the sac and touching lightly its nasal side, the lids may be left at liberty, while a half circular motion is performed by the instrument; the surgeon neither suffering the point to recede, nor, on the other hand, allowing it to become entangled in the membrane. The probe now rests in a perpendicular direction upon the eyebrow towards its inner angle, and in this direction it is to be gently depressed until it strikes upon the floor of the nostril, where its presence is readily ascertained by a common probe, passed beneath the inferior turbinated bone. The probe of smallest dimensions is of sufficient firmness to pre- serve its figure in its passage through the healthy duct, but it is too flexible to oppose any considerable obstruction, without danger of a change of figure : for the stricture of the lachrymal ducts it is of suffi- cient strength. Very many cases of recent origin, and in which the stricture has no great degree of firmness, are completely cured by three or four introduc- tions of the probe into the nostril, at intervals of one or two days. [• We prefer a probe well rounded at the point without a bulb.]
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