Chronic suppurative dacryocystitis and its radical treatment : read before the British Medical Association, Toronto, Canada, Thursday, August 23rd, 1906 / by Fred T. Tooke.

  • Tooke, Fred T.
Date:
1906
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Credit: Chronic suppurative dacryocystitis and its radical treatment : read before the British Medical Association, Toronto, Canada, Thursday, August 23rd, 1906 / by Fred T. Tooke. Source: Wellcome Collection.

Provider: This material has been provided by UCL Library Services. The original may be consulted at UCL (University College London)

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    ing of the lumen of the sac, as one might suppose, but by an engorgement of the subperiosteal veins in the neigh- bourhood of the nasal duct. Probing the sac in such cases can easily be seen to be useless aH well as irrational. Further, in poor people, and still more in people living at a distance from medical attendance, it is actually im- possible to have treatment of a conservative character satisfactorily carried out for any length of time. The palliative treatment in cases of chronic suppurative dacryocystitis, dilatation of the sac, fistulae, recurrent erysipelas and perilachrymal abscess with dacryocystitis we must admit as unsatisfactory. In actual hypopyon ulcer of the cornea, or keratitis with any of the above- mentioned conditions an excision of the sac is not only in- dicated but imperatively called for; one must, however, in such cases take additional precautions in avoiding any undue pressure upon the globe. Serumtherapy is unsati.-factory. Boucheron7 has re- commended the us^ of antistreptococeus serum in ct-rtain cas^s, huh it is questionable if s=ueh a form of treatment is either rational or satisfactory; in cases of perilachrymal trouble the condition appears to be due rather to an acute inflammatory condition accountable to a different micro- organism than the Streptococcus pyogenes, but in a way attributable to a prpvious diseased condition in the sac wall itself. Komera has recommended the employment of antipneumococcus serum which can be used in cases of invasion of the cornea by the pneumococcus. Its us^, however, is suggested rather as a prophylactic than as a cure. As the first evidence of the presence of tne pneumococcus is frequently a corneal inflamma- tion, patients are gentrally too late to hope for any benefit from the u^e of serum. I saw one such case when a pneumococcus infection set in immediately after a cataract extraction ; the pneumococci were demonstrated to be present and theantipneumococcic serum immediately employed, but without benefit. That there are numerous cases of stenosis of the nasal duct and many of actual dacryocystitis where no rational treatment has bpen attempted or requested is a fact brought home to us every day by many of the unfortunate conditions of permanent blindness due to corneal ulcera- tion complicating tear sac trouble. We cannot close our eyes to the fact that there are numbers who cannot or will not wpar protecting glasses, and yet who are, on account of their respective callings, daily exposed to injuries of the cornea. The mechanic, the foundryman, the farmer, the lumberman, are amongst those who are frequently, unknown to themselves, afflicted with dacryocystitis, at the same time to whom superficial injuries of the cornea are of frequent occurrence. Country people, particularly, are subject to tremendous risks; such people suffering from dacryocystitis in a land of such enormous expanse as Canada are frequently practically isolated from any one with a definite knowledge of the special diseases of the eye, and disastrous results may follow an insignificant