The radical treatment of lacrimonasal disease by rapid dilatation and allied measures / S. Lewis Ziegler.

  • Ziegler, S. Lewis (Samuel Lewis), 1861-1926.
Date:
1910
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Licence: In copyright

Credit: The radical treatment of lacrimonasal disease by rapid dilatation and allied measures / S. Lewis Ziegler. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

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    the infection may penetrate the deeper structures, result- ing in periostitis, caries or even in the formation of abscess. We must always bear in mind, therefore, the possibility of two active factors in the etiology of ocular disease, first, the pus-laden nasal fluids which the tear- duct may suck up and transmit directly to the eye, and second, the perverted secretions which the obstructed tear-duct may develop within itself. I have elsewhere3 referred to this as follows: If now we concede an infectious cystitis of the antrum, we can comprehend how it is possible for an unlimited stream of pathogenic micro-organisms to be poured out onto the cup-like door of the nasal chamber, and by capillary attraction drawn up into the lacrimonasal duct, and thence to the ocular cul- de-sac. The lacrimonasal duct itself is, moreover, a most fer- tile nidus for this bacterial development. The presence of strictures, viscid secretions, ulceration of the lining membrane, or interstitial thickening of the same, all tend to interfere with its siphonic action in the downward drainage of the tears. The bacterial growth is greatly facilitated by the consequent stag- nation. Not only are the tears prevented from passing into the nose, but microbic infection is carried upward to the eye by the regurgitation of these septic secretions. The ocular tissues that are most vulnerable to these septic and irritating fluids are the cornea, the conjunc- tiva and the palpebrum. Ulcerative keratitis, especially when recurrent, phlyctenular keratitis, vascular kerati- tis, sloughing of the cornea and wound infection may originate in this manner. Chronic conjunctivitis, eczema of the lid, and blepharitis marginalis may rise from the same cause, while the influence of persistent lacrimal irritation in causing ectropion and entropion is well known. The absence of epiphora or blennorrhea does not con- traindicate lacrimonasal disease. On the contrary, we should always remember these two important facts, first, that Ave may have obstructi ve lacrimal disease with- out epiphora, and second, that we may have ocular infection without visible blennorrhea. DILATATION OF THE DUCT While many authorities have advocated probing of the tear-duct, Bowman probably did most to popularize this procedure. Ilis probes, however, were very small, the 3. Corneal Ulceration due 10 Nasal Infection, Am. Med., April 9, 1904, p. 599.