In the treatment of the blenorrhoea, a free vent for the secretions through the opened or unopened canaliculus being present, the patient should be instructed to press out the matter several times a day.
Mild astringent injections of boracic acid, sulphate of zinc of a two to four per cent. solution or some similar preparation may sometimes prove very serviceable.
Recently I have been using with good results an injection of the blue pyoktanin, 1 to 1,000.
Pulsatilla.-One of the most important remedies for dacryocystitis, which may sometimes be cut short at its very beginning with it, and may be useful at any stage of the inflammation. It is also important in blenorrhoea of the sac, if the discharge is profuse and bland. Profuse thick and bland discharge from the nose; especially beneficial in children.
Stannum.- Very favorable results have frequently been obtained in controlling the yellow-white discharge from the lachrymal sac, itching or sharp pain in the inner canthus, especially at night.
Hepar sulph.-Inflammation of the lachrymal sac after pus has formed, or in blenorrhoea, with great sensitiveness to touch and cold, with profuse discharge. Throbbing pains.
Euphrasia.-Much thick, yellow, acrid discharge, making the lids sore and excoriated. Blurring of the vision relieved by winking. Thin, watery, bland discharge from the nose.
Argentum nit.-Discharge very profuse, caruncula lachrymalis swollen, looking like a lump of red flesh; conjunctiva usually congested.
Aconite.-In the first stage, when the lids are much swollen, with great heat, dryness, tenderness, sharp pains and general fever.
Apis.-Before the formation of pus. Lids oedematously swollen, with stinging, shooting pains. Patient drowsy, without thirst.
Arum triph.-Catarrh of the lachrymal sac, with desire to bore into that side of the nose; nose obstructed, compelling to breathe through the mouth; nostrils sore, the left discharges continually.
Mercurius.-In the later stages after the pus has become thin and excoriating; acrid coryza; nocturnal aggravation.
Petroleum.-Discharge from the lachrymal sac, with roughness of the cheek, occipital headache, and other marked concomitant symptoms. In the early stages, when there is considerable swelling of the lid, with burning pains.
Silicea.- Occasionally indicated in dacryocystitis characterized by the usual symptoms of pain, swelling, tenderness and lachrymation; even cases that have far advanced toward suppuration have been checked. Blennorrhoea of the lachrymal sac often calls for it. The patient is particularly sensitive to cold air and wishes to keep warmly covered.
Other remedies which have been recommended and proved useful are Belladonna, Calcarea, Cinnab., Hydrast., Kali iod., Mercurius prot., Nat. mur., Nux vomica, Sulphur and Zinc sulph.
Dacryocystitis Phlegmonosa.-Phlegmonous inflammation of the lachrymal sac may be considered as merely a higher stage or extension of the preceding disease. It consists in a purulent inflammation of the connective tissue surrounding the lachrymal sac, and results in as abscess that breaks externally.
SYMPTOMS.-In this the swelling is greatly increased and extremely sensitive to touch. The integument becomes very tense and assumes a dusky-red hue. There is usually an oedematous infiltration of the surrounding parts, viz.: eyelids, side of the nose and cheek. There is intense pain and heat, with sometimes general symptoms of chills, fever and vomiting. The conjunctiva may be inflamed and even chemosed.
Differential Diagnosis. The appearance at this time resembles an abscess of the cellular tissue overlying the lachrymal sac and must be carefully differentiated, but in the dacryocystitis phlegmonosa firm pressure over the swelling will usually empty the tumor either through the puncta or downward through the nose, while in abscess it will not. In dacryocystitis we also have the previous history of a long- continued lachrymation, which is, of course, absent in abscess. An abscess over the lachrymal sac is rare, and we may therefore generally assume the abscess to have originated within the sac.
COURSE.-If left to itself the swelling usually increases steadily, the skin over the sac becomes thinner and thinner, until it finally gives way, the abscess discharges leaving a fistula of the lachrymal sac, which is extremely difficult to heal.
CAUSE.-A catarrhal inflammation precedes a phlegmon. The decomposed secretions in the sac penetrate the mucous membrane and set up a purulent inflammation. The exciting cause is frequently a simple cold in the head.
TREATMENT.-At the commencement, before the formation of pus, cold compresses (even ice) are advisable, which, together with the indicated remedy, may cause the inflammation to abort before an abscess has formed.
As soon, however, as pus has begun to collect in the lachrymal sac, our treatment must undergo a decided change. The first and most important step to be taken to prevent its breaking externally, with the possible formation of a fistula, is the opening of the canaliculus into the sac and the evacuation of its contents, through the natural channel. But if the disease has so far advanced that perforation is inevitable, a free incision into the sac should be made externally, after which, and also in case the abscess has opened spontaneously, warm compresses may be employed for twenty-four or forty-eight hours, but must not be continued too long. The opening should be kept open by the insertion of a strip of iodoform gauze every day until the subsidence of the inflammation, when the opening will usually close without trouble, though it may be necessary to open the nasal duct and establish a free passage for the tears before it does so. Probing of the nasal duct should be avoided until the severity of the inflammation has subsided. Warm and moist applications should be substituted for the cold as soon as suppuration has commenced. Among the best of those in use is a solution of calendula. Internal medication during the whole course of the disease will form an important feature in the treatment. For indication see dacryocystitis catarrhalis, page 137.
Fistula Lachrymalis.- An opening externally of the lachrymal sac, when the result of an abscess breaking, is often very obstinate and difficult to heal; hence, when evidently about to break, it should be opened with bistoury.
TREATMENT.- The first point to be attended to is to see that the passage is free into the nose. We must therefore slit up the canaliculus and divide any stricture found in the nasal duct, providing it is sufficient to interfere with the flow of tears; after which the canal should be kept open.
The fistula must now be healed, and, if recent, this is best done by touching the edges with a stick of nitrate of silver, or the gentle application of the galvano-cautery. If the edges of the fistula are healed and covered with smooth skin, it will be necessary to pare the edges and unite with a suture.
The following remedies have been advised and may have been of service in recent cases, though we doubt if any effect can be obtained in old chronic fistulae; Bromium, Calcarea, Fluoric ac., Lachesis, Mercurius, mur., Petrol., Silicea and Sulph.
Professor of Ophthalmology in the College of the New York Ophthalmic Hospital; Surgeon to the New York Ophthalmic Hospital. Visiting Oculist to the Laura Franklin Free Hospital for Children; Ex-President American Homoeopathic Ophthalmological, Otological and Laryngological Society. First Vice-President American Institute of Homoeopathy : President Homoeopathic Medical Society of the State of New York ; Editor Homoeopathic Eye. Ear and Throat Journal : Associate Editor. Department of Ophthalmology, North American Journal of Homoeopathy, etc.