When syringing and probing have failed to relieve the lachrymal obstruction, one of the following operations for the obliteration of the lachrymal passages may be employed.
OBLITERATION OF THE CANALICULI
Indications. In cases of lachrymal obstruction in which an immediate operation upon the globe is required.
Operation. Under cocaine. Fine sutures armed with a small curved needle are passed beneath both the upper and lower can[al]iculus and tied so as to include them in the ligature. Permanent obliteration may be caused by the destruction of the lining membrane with the actual cautery.
EXCISION OF THE LACHRYMAL SAC
Indications. (i) For mucocele in cases of lachrymal obstruction which have failed to yield to other treatment.
(ii) In all cases of tuberculous disease of the sac.
(iii) For a recurrent lachrymal abscess after subsidence of the acute inflammation.
(iv) For hypopyon ulcer associated with lachrymal obstruction.
(v) Before operation on the globe in cases of lachrymal obstruction.