. The principles and practice of modern surgery . events the patient may go on pretty comfortably. Treatment by the style.—But if the re-tention of the tears in the sac causes a con- =■■ • stant irritability of the eye, or if there is afistulous orifice between the sac and thecheek, measures should be adopted to re-store the obstructed duct. Supposing thatthere is a fistulous aperture, the fungousgranulations, or thickening of the skinabout it, should be first removed by nitrateof silver and poultices. If there is noaperture, the sac should be opened by anarrow knife ; introducing it just belo
. The principles and practice of modern surgery . events the patient may go on pretty comfortably. Treatment by the style.—But if the re-tention of the tears in the sac causes a con- =■■ • stant irritability of the eye, or if there is afistulous orifice between the sac and thecheek, measures should be adopted to re-store the obstructed duct. Supposing thatthere is a fistulous aperture, the fungousgranulations, or thickening of the skinabout it, should be first removed by nitrateof silver and poultices. If there is noaperture, the sac should be opened by anarrow knife ; introducing it just below thetendo oculi, and carrying it downwards andoutwards for one-fifth of an inch. Theplace of the tendo oculi may easily befound by gently drawing the eyelids out-wards, when it is seen as a small rounded cord, passing inwards from theinner canthus of the eye. The escape of tears and mucus shows w^henthe sac is opened. Then a common probe should be pushed through theduct into the nose. In order to make sure of getting it into the sac, it. 340 INFLAMMATION OF THE EYE. may as well be introduced by the side of the bistoury before that is with-drawn. It should be pushed downwards, but a little backwards and in-wards. When in the right direction, its upper part lies in the situation ofFig. 102. tlie supra-orbital notch. It will be known to have reached thenose by the escape of a little blood. When inflammation hassubsided, a style should be introduced, i. e. a silver-gilt probeabout an inch or an inch and a quarter long, solid or hollow, witha head like a nail, which lies on the cheek, where it passes unno-ticed like a black patch. The constant presence of this instru-ment causes the duct to dilate, so that the tears flow by its should be occasionally cleaned, and then be replaced; and itcauses so much comfort, and the duct is so likely to close if it beleft off, that it generally is worn for life. The above is the planof treatment which the author has generally seen
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