Treatment. This may be attempted by bougies. In the horse a small sound, metallic or whalebone bougie, thoroughly sterilized and smeared with aseptic vaseline, or oil, is inserted from the nasal opening and carefully passed on into the sac. In the dog the nasal opening cannot be reached and the bougie must be passed by the puncta and lachrymal sac. To secure the requisite dilation, it is usually necessary to probe the passage daily, using a larger probe when the first passes easily, until the canal has been sufficiently dilated.
A second resort is to distend the canal by a liquid injection thrown into the nasal opening. This will succeed when the obstruction is only caused by concretions in the canal.
A somewhat similar resort is the insufflation of the duct by means of a finely pointed tube inserted from below into the nasal orifice of the duct.
Still another method is to make a new opening for the escape of the tears into the nose. When the stenosis is at or near the nasal opening of the duct, an artificial opening is easily made and usually satisfactory. Under anæsthesia, a sterilized silver probe is passed through the upper punctum, the sac and canal. When it meets definite obstruction its position is ascertained inside the nose, and an incision is made so as to allow its escape. The constant escape of tears tends to prevent it from closing up again, but it is well to examine into this until it has thoroughly healed. A silk thread worn in the duct and held in place by a copper or aluminum ring on each end may be resorted to.
Attempts have been made to establish a new outlet by boring through the lachrymal bone into the nose, but without a permanent success. It has also been advised to obliterate the lachrymal ducts and sac, on the one hand and to excise the lachrymal gland on the other, but the proposed cure is worse than the disease.
DISEASE OF THE LACHRYMAL CARUNCLE.
The caruncle is inflamed in conjunctivitis. When this inflammation leads to hypertrophy it is known as encanthis. This is a common condition in dogs and the caruncle may increase to the size of a pea or acorn, and by compressing the canaliculi it leads to a profuse overflow of tears on the cheek. At first there is the acute congestion of conjunctivitis, but later there may be induration and pallor.
The treatment of this condition consists in astringent and sedative collyria in the early inflammatory stages, and later in the ablation of the hypertrophied mass. The caruncle is seized with a pair of rat-tooth forceps and snipped off with curved scissors, the free bleeding being afterward checked by cold water.
In cases that seem, by reason of excessive vascularity ill adapted to this method, the hypertrophied mass may be tied at its base with a stout silk thread so as to cut off the supply of blood, and cause it to slough off. A collyria of boric acid (4 per cent.) or mercuric chloride (0.02 per cent.) may be used to prevent infection.
Tumors of the Caruncle are met with, such as fibroma (Wörz), Sarcoma and Melanosarcoma. For all alike the complete extirpation of the neoplasm is demanded.