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Show EXTIRPATION or THE EYE. EXTIRPATION OF THE EYE. iii riated cheek, something must be done to make the duct perOPERATIONS FOR. THE FISTULA LACRRYMALIS» Tun FISTULA LACHRYMALIS is a disease of the laehrymal canal.--In what may be called its complete state, there is an obstruction of the duct which carries the tears into the nose, and a fistulous sore discharging the tears and pus near the inner angle of the eye; the patient only complains of a weakness of sight, the eye is watery, and on every little excitement the tears fall over the check, which is sometimes excoriated, v.i ‘3 the nostril of that side is dry. i ran mom i g l' . am»:- five 1*me «tr-u- '5‘ on. ‘9‘ . obstruction in the nasal duct, the disease is general, and all importance, because if an operation is to be done, the entire operation is not more severe, or troublesome, than a more partial attempt to cut into the sac and make it contract and fill up. If it should be found that a more general disease of the membrane prevails, or even if the general affection be proved to be_ the original cause, this only teaches us to be careful to correct the slight and chronic inflammation of the surface, after the course of the tears is established, and dur- the continuous surface of the eyelids, puncta, sac, and duct, are unusually vascular and spongy. The natural resource against such symptoms is to endeavour to subdue and counteract this general tendency to a chronic inflammation in the whole mucous membrane and ducts. By astringent injections or collyria, the general r8laxation may be removed, and the soreness and swelling of the eyelids relieved by the citrine and tutty ointments ; then the sac and ducts must be kept also clear, pressing out the ing the progress of the cure. A great part of this disease consists in the constant excitement which the suppurating sac gives to the eye; and that again is a consequence of the absorption still continuing by accumulated mucus, and injecting into the ducts until the has no longer the irritation of the acrid tears. Accordingly it is one kind of operation, attended with much relief of symptoms, to obliterate and fill up the sac altogether. t fluid passes into the nose. 2. When there is not only a watery eye, and humid eyC- (I ,M'F‘T} ~‘wmana-rf-ww," "any But this complaint will not admit of a description in the form of a definition; in common discourse we call all the various degrees of the disease of these passages, which might in a latter stage form an open weeping sore, fistula lachrymalis. I. The first state of disease I shall describe is this: the eye is considerably inflamed and irritable; the edges of the eyelids are tumid, and the glands secrete profusely ; the intern nal membrane of the eyelid is very red, and flakes of mucus are seen upon turning down the eyelid; the integuments over the lachrymal sac are full and pufl'y, and on pressing these, mucus and pus escape from the puncta. To account for this appearance, there is no occasion to suppose that there is an vious. In this state of the disease, it seems to be ill-judged practice to endeavour to give firmness and resistance to the sac, to make it contract, by cutting open and stuffing it with dressing. This is the same as if a surgeon would continue to scarify and dress a fistulous sore in the perineum, after he knew urine was discharged from it, and that there was an obstruction in the urethra. The only questions to be determined on previous to the operation are these: 1. Is this a disease owing to a general sponginess and thickening of the mucous membrane? 2. Has this general diseased state terminated in a particular stricture, or obliteration of the latch- rymal duct? 3. Is there a stricture, or obliteration of the passage which has been the primary cause of the symptoms, and still keeps up the disorder .9 But even the answers to these questions are of no great the puncta, after the duct is obstructed-for if the sac be closed up and obliterated, and there be no disease originally in the coats of the eye, a great deal of the irritation and even the watering of the eye will subside-and if the puncta be. closed, so will the inflammation of the sac subside, because it vc'r. IL lid, but a distinct tumour of the lachrymal sac and an 6X00" L |
