THE INSERTION OF STYLES
A few surgeons still insert styles into the lachrymal duct with the idea of continuous dilatation. The hollow styles used by Bickerton are the ones most frequently employed.
Instruments for dilating, slitting the canaliculus, probing, and styles. Also Stilling’s knife.
Operation. A general anæsthetic is desirable.
First step. The canaliculus is dilated and slit up, the posterior lip being removed (see [p. 29]).
Second step. The duct is dilated by probing (vide supra) or enlarged by passing Stilling’s knife down it.
Third step. A style is passed down the dilated duct. The lower end of the style should rest upon the floor of the nose, otherwise there is a tendency for the style to slip into the duct and disappear. Care should be taken that the upper end does not rub on the globe. Styles should generally be left in position from three to six months. A style should at first be made of lead wire and moulded until a suitable pattern is obtained, from which a hollow gold style can be made subsequently.
Complications. 1. Dacrocystitis may follow the insertion of a style, which should then be removed until the inflammation has subsided.
2. The style may slip down the duct. If this should occur an attempt should be made to grasp it through the slit canaliculus. The lower end may present in the nose and the style can then be withdrawn with forceps. Occasionally styles lodge in the antrum of Highmore, in which case they must be removed after localization by the X-rays through an opening from the mouth above the canine tooth.