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The Abuse of Canalicotomy in Simple Epiphora
American Journal of Ophthalmology Series 3, Vol. 2, No. 7 PUBLISHED MONTHLY
July, 1919 BY T H E O P H T H A L M I C P U B L I S H I N G
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EDITORIAL STAFF CASEY A. WOOD, ADOLF ALT, 7 W. Madison St., Chicago, 111. Metropolitan Bldg., St. Louis, Mo. HARRY V. WURDEMANN, M. URIBE-TRONCOSO, Cobb Bldg., Seattle, Washington. 143 W. 92nd St., New.York City. EDWARD JACKSON, Editor, MEYER WIENER, 318 Majestic Bldg., Denver, Colo. Carleton Bldg., St. Louis, Mo. CLARENCE LOEB, Associate Editor, 25 E. Washington St., Chicago, 111. Original papers and" books for review may be sent to any member of the _ editorial staff. Reports of society proceedings, correspondence, and other scientific communications should be addressed to the Editor. Proof should be corrected and returned within forty-eight hours to the printer. Reprints may be obtained from the printers, Tucker-Kenworthy Co., 501 S. La Salle St., Chicago, 111., if ordered at the time proofs are returned. Subscriptions, applications for single copies, communications with reference to advertising or other business, should be addressed to H. A. FOX, Manager, 7 West Madison St., Chicago, 111.
T H E A B U S E OF CANALICOTOMY IN SIMPLE EPIPHORA. Is there or is there not a tendency among the rank and file of Ophthalmic Surgeons toward sane and safe treatment of lacrimal diseases, especially the simple forms of lacrimal obstruction? The conservatism of the Philadelphia Surgeons, the radicalism of Baltimore and of some Surgeons in the Middle West, are the extremes. Is there no safe middle ground? Yes:— The treatment is drainage, first, last and all the time, but anatomic drainage and not artificial drainage. W h y is canalicotomy for epiphora so often performed in these more enlightened days, when the cause, be it conjunctivitis with excess of tears and thickened secretions, punctal obstruction, lacrimal sac catarrh, closure of the saccal or nasal ends likely due to hypertrophied turbinals or deflected septum leading to obstruction, may and should be first removed before radical procedures are performed upon the tear passages? Certainly if probing is to be resorted to, dilatation of the punctum is the
first step, to be followed by syringing with mild solutions. If cocain with • adrenalin then be injected into the sac, large sized probes, even No. 8 Bowman, 6 Fox or 4 Theobald may be passed without pain and without resort to the unwarranted slitting of the canaliculus. These sounds are as large as the normal bony canals will contain. Then after removal of the ocular or nasal cause a practical cure will ensue. The lacrimal puncta are not only the beginning of the sewer system for the drainage of the tears and mucous secretions, but the canaliculi form with these entrances a very perfect capillary, gravity and suction pump apparatus, the latter acting both by the ring muscle around its lumen and by the pressure massage of the movements of the lids. All but the open sewer gravity functions of the lacrimal passages are destroyed by the transformation of this tube into a slot by slitting the canaliculus by the Weber, Bowman or Stilling knives. Canalicotomy should not be done except in the presence of pus in the sac, and for that not very often. H. V. W.
July, 1919 BY T H E O P H T H A L M I C P U B L I S H I N G
COMPANY
EDITORIAL STAFF CASEY A. WOOD, ADOLF ALT, 7 W. Madison St., Chicago, 111. Metropolitan Bldg., St. Louis, Mo. HARRY V. WURDEMANN, M. URIBE-TRONCOSO, Cobb Bldg., Seattle, Washington. 143 W. 92nd St., New.York City. EDWARD JACKSON, Editor, MEYER WIENER, 318 Majestic Bldg., Denver, Colo. Carleton Bldg., St. Louis, Mo. CLARENCE LOEB, Associate Editor, 25 E. Washington St., Chicago, 111. Original papers and" books for review may be sent to any member of the _ editorial staff. Reports of society proceedings, correspondence, and other scientific communications should be addressed to the Editor. Proof should be corrected and returned within forty-eight hours to the printer. Reprints may be obtained from the printers, Tucker-Kenworthy Co., 501 S. La Salle St., Chicago, 111., if ordered at the time proofs are returned. Subscriptions, applications for single copies, communications with reference to advertising or other business, should be addressed to H. A. FOX, Manager, 7 West Madison St., Chicago, 111.
T H E A B U S E OF CANALICOTOMY IN SIMPLE EPIPHORA. Is there or is there not a tendency among the rank and file of Ophthalmic Surgeons toward sane and safe treatment of lacrimal diseases, especially the simple forms of lacrimal obstruction? The conservatism of the Philadelphia Surgeons, the radicalism of Baltimore and of some Surgeons in the Middle West, are the extremes. Is there no safe middle ground? Yes:— The treatment is drainage, first, last and all the time, but anatomic drainage and not artificial drainage. W h y is canalicotomy for epiphora so often performed in these more enlightened days, when the cause, be it conjunctivitis with excess of tears and thickened secretions, punctal obstruction, lacrimal sac catarrh, closure of the saccal or nasal ends likely due to hypertrophied turbinals or deflected septum leading to obstruction, may and should be first removed before radical procedures are performed upon the tear passages? Certainly if probing is to be resorted to, dilatation of the punctum is the
first step, to be followed by syringing with mild solutions. If cocain with • adrenalin then be injected into the sac, large sized probes, even No. 8 Bowman, 6 Fox or 4 Theobald may be passed without pain and without resort to the unwarranted slitting of the canaliculus. These sounds are as large as the normal bony canals will contain. Then after removal of the ocular or nasal cause a practical cure will ensue. The lacrimal puncta are not only the beginning of the sewer system for the drainage of the tears and mucous secretions, but the canaliculi form with these entrances a very perfect capillary, gravity and suction pump apparatus, the latter acting both by the ring muscle around its lumen and by the pressure massage of the movements of the lids. All but the open sewer gravity functions of the lacrimal passages are destroyed by the transformation of this tube into a slot by slitting the canaliculus by the Weber, Bowman or Stilling knives. Canalicotomy should not be done except in the presence of pus in the sac, and for that not very often. H. V. W.