Such is the method by which a permanent cure may often be obtained, and which, in my opinion, is preferable to the use of tubes. If these are to be employed, they should, as already mentioned, be nearly of equal calibre throughout; the external opening must not be allowed to close for a considerable time after the introduction of the instrument; and the tube must be kept pervious for some time by a style introduced through it. But by these means, which are essential for the success of the practice, the main advantage arising from the use of a tube, viz., little irritation being produced at first, and the parts being allowed to close soon over it, are completely done away with.
The practice of perforating the os unguis never can be required; it is cruel, unnecessary, and unsurgical.
Sometimes the lachrymal passages are entirely destroyed. In such cases, it has been found that no great inconvenience arises from their obliteration, as the lachrymal gland ceases, in a great measure, to secrete fluid, and the conjunctival secretion, after having performed its office, evaporates from the surface. In truth, the lachrymal gland always enjoys long periods of repose, and is only called into active exercise of its functions occasionally, as the eye in its ordinary condition is sufficiently lubricated by secretion from its conjunctival covering.
The treatment of fistula lachrymalis, as has been well remarked by an eminent author, must be varied and regulated according to circumstances;—by the degree of obstruction in the duct, by the state of the coverings of the sac, of the sac itself, and of the subjacent bone, and by the general state and habit of the patient.
Encanthis is a tumour situated in the corner of the eye. The caruncula lachrymalis appears to be the original seat of the disease, at least it is involved at an early period. The growth is at first
small, and appears to be simple enlargement of the caruncle: it is of a reddish colour, and its surface is studded with numerous granulations. It often attains a very considerable size; and, on account of its propinquity to the lachrymal passages, is accompanied with watering of the eye, the puncta being either involved in the growth, or compressed or displaced by it. Sometimes the whole inner corner of the eye, from the margin of the cornea to the inner junction of the eyelids, is occupied by the granulated swelling; and in such cases it is not uncommon for the tumour to extend itself outwards, in the form of a lunated appendage, on the under surface of each lid; thereby the motions and functions of the ball are much impeded, and a prominent deformity is occasioned. In most instances the growth seems to be a simple enlargement of structure, and is of a benign nature; but sometimes it is firm, hard, of rather a livid hue, with a smooth slimy surface, and is decidedly malignant,—enlarging, and gradually involving the surrounding parts.
Cancerous ulceration, attacking and destroying the eyelids, and the parts around the ball of the eye, often commences in the situation of the caruncle, or in a wart on the edge of the lid. Cancer, though a rare and uncommon disease of the eyeball, frequently seizes on the appendages of the eye, extending rapidly in all directions, and often completely detaching the ball by ulceration. Warty tumours also occur on the conjunctiva of the lids, or of the ball, and are inconvenient as a source of much irritation to the neighbouring parts, even though of a benign nature in themselves.
Extirpation, by means of a small pointed knife, or curved scissors, is the only means to be relied on for the cure of such warty tumours, and of encanthis. The growth must be fixed and pulled outwards with a small hook, and carefully dissected away; the eyelids, and, if necessary, the ball of the eye, being kept fixed with the fingers, or by means of a speculum: the fingers are generally sufficient, and more convenient than any instrument. If from the appearance of the parts, and from induration surrounding the tumour, malignant action has evidently taken place or is dreaded, then the incisions must be made wide of the base of the swelling. For malignant, open, and extensive ulcerations, nothing can be done farther than to allay the pain, and soothe the constitutional disturbance. On the whole, encanthis is a rare disease; however, I have seen, and operated on, several instances of it.
Encysted Tumours of the Eyelids.—These occur beneath the conjunctival lining of either the upper or under lid, but most frequently in the former. They form rapidly, but seldom attain any very considerable size; and may be found to contain, along with glairy fluid, a mixture of pus, or curdy matter. The contents, however, are generally glairy, rarely atheromatous. The cysts are very thin and adherent, and the tumour projects externally, forming a dusky red elevation of the integuments. They cause considerable deformity, watering of the eye, and stiffness and difficulty in moving the lids. On everting