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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    There may he some ecchymosis or even swelling of the lower lid, but this soon disappears. The nose frequently bleeds for a few minutes owing to a slight scratch of the nasal mucosa by the point of the dilator as it emerges beneath the inferior turbinate. Patients should be warned not to blow the nose for twenty-four hours, as a very slight rupture in the lining of the canal will permit a palpebral emphysema that might prove alarming and unsightly, although it will disappear spontaneously in a few days. Irrigation should not be attempted for at least one ' week, as part of the fluid might escape through some minute laceration of the lining membrane and thus cause infiltration of the tissues. In a few cases 1 have noted a crackling sound that indicated slight fracture of the bony walls of the duct, but I can only agree with Theobald in saving that nothing more serious than ecchymosis has followed. I have often been asked as to the danger of making a false passage. I have never seen such an accident, but an ignorant, careless or unskilful operator may spoil any operation. I have encountered a few cases of caries in which the usual pressure might have caused the dilator to perforate the lacrimal bone and to enter the nose over the middle turbinate. One must always “have an eve in the point of the dilator.” POST-OPERATIVE TREATMENT The after-treatment is usually very simple, consisting of a soothing eyewash, to which epinephrin may be added in the proportion of 1 to 16. If the eyelids are glued together for a few days following the operation an astringent application will promptly check the conjunc- tival discharge. If there should be any puffing of the lids ice-pads may be applied. If there is ecchymosis hot stupes are indicated. If emphysema occurs no treat- ment is necessary, as it will promptly and spontaneously disappear. INDICATIONS FOR RAPID DILATATION Rapid dilatation of the lacrimonasal duct is indicated whenever a permeable canal is desired. It is particu- larly effective in those cases of epiphora and obstruction arising from atresia, localized stricture and general stenosis with interstitial thickening of the mucosa.