Atlas and epitome of operative ophthalmology / by O. Haab ; edited by G. E. de Schweinitz.

  • Otto Haab
Date:
1905
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Licence: In copyright

Credit: Atlas and epitome of operative ophthalmology / by O. Haab ; edited by G. E. de Schweinitz. Source: Wellcome Collection.

Provider: This material has been provided by UCL Library Services. The original may be consulted at UCL (University College London)

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    if there is much secretion. If the catarrh is slight, it is not absolutely necessary to extirpate the sac, a procedure to which patients are very apt to refuse their consent. It may be treated for from three to live days with injections of protargol [or argyrol—Ed.], and finally with a 1 :1000 bichlorid solution, after which the canaliculi are tem- porarily closed. This procedure, which I have practised for the past fifteen years, and recommended in 1891, I have so far found uniformly successful; it is also employed by Snellen, who speaks of it in his recently published Operationslehre. The galvanocautery is compressed to form a point and introduced a few millimeters into the upper and lower canaliculus, and the current closed. The latter need be strong enough only to produce a faint red heat. The effect of this cauterization is to cause tem- porary adhesion of the canaliculi, which prevents any secretion that may be present in the lachrymal sac from entering the conjunctiva. If any subsequent treatment is to be employed, the canaliculus can be reopened with a conical probe. When one of the canaliculi has already been slit, I nevertheless cauterize it as well as possible and introduce one of my iodoform pencils. I may say in support of this procedure that I have so far never seen any case, in which an operation for cataract had to be performed in the presence of an existing dacryostenosis, give trouble during its subsequent course. It is true that I always make it a practice in these cases to fill the inner canthus with iodoform. In 1890 Eversbusch advised ligation of the canaliculi with catgut to render them impervious. [Ligation of the canaliculi is also advised by Buller, and represents an excellent practice in suitable cases.—Ed.] The edges of the eyelids, in my estimation, may be as great a source of danger as the lachrymal sac, especially when they are inflamed. It is true that they do not come in direct contact with cataract wounds nor with the iri- dectomy wound in glaucoma, if the customary upper in- cision is employed, and the surgeon avoids using the lower