IMAGE EVALUATION TEST TARGET (MT-3) // is. {./ A,"^ 1.0 I.I 1*5 i^ IIIIM y£ liil^ m 126 us 1^ 12.0 1-25 1.4 1.6 •• 6" ► V] <^ /^ >^ ^^1 <$>! :"^.>:> 1/ ^^ y -(^ Photographic Sdences Corporation €3 i\ S ,v \\ ^9) .V \ 6^ 4^ <^ 23 WEST MAIN STREET WEBSTER, N.Y. 14580 (716) 872-4503 %^ ,. ^0 CIHM/ICMH Microfiche Series. CIHM/ICMH Collection de microfiches. Canadian Institute for Historical Microreproductions / Institut Canadian de microreproductions historiques Technical and Bibliographic Notes/Notes techniques at bibliographiques The Institute has attempted to obtain the best original copy available for filming. 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Whenever possible, these have been omitted from filming/ II se peut que certaines pages blanches ajout^es lors d'une restauration apparaissent dans le texte. mais, lorsque cela 6tait possible, ces pages n'ont pas it6 filmies. Additional comments:/ Commentaires suppldmentaires: L'Institut a microfilm^ le meilleur exempiaire qu'il lui a it6 possible de se procurer. Les details de cet exempiaire qui sont peut-Atre uniques du point de vue bibliographique, qui peuvent modifier une image reproduite, ou qui peuvent exiger une modification dans la mithode normale de filmage sont indiquAs ci-dessous. □ Coloured pages/ Pages de couleur □ Pages damaged/ Pages endommagies n i/ D D Pages restored and/or laminated/ Pages restaur^es et/ou pelliculdes r~~| Pages discoloured, stained or foxed/ Pages d6coloil »i By CASEY A. WOOD, CM., M.D., of Chicago. MANZ ' considers it at least dbiibtful whether there is such a thing as congenital fistula of the sac, but, admitting its possibility would regard it as an arrest of development, an imperfect closure of the groove which, in the embryo, runs from the eye to the olfactory pit. De Wecker," on the other hand, instances a number of cases from the writings of G. Beer, Scarpa, ct a/., and says of them that the openings were all of the capillary variety ; the laclirymal fluid did not discharge through the defect in its walls, except during crying, or when a gentle pres- sure was made over the region of the sac itself. An example of " double lachrymal fistula (probably con- genital) " is described by Hartridge,^ but few and imper- fect details of the case are furnished. Agnew,^ however, gives us a more perfect picture of a three-year-old girl, entirely healthy, who had no other congenital defect, and had never shown any sign of inflammation in or about the eyes. On either side, immediately under the central por- tion of the lig. pa/pel), int., there was a capillary opening in the skin, from which discharged, especially after crying ' Graefe-Saemisch, Handbiich der g. Atigenheilkunde, ii., 113. ' Traitc Complct d'Oplitalmologit\ iv., 1103. ■' Trans. Oph. Soc . United Kingdom, xii,, 172. ■• A case of double, extremely minute, and apparently congenital lachrymal fistula. Trans, .-t/n. Oph. Sdc, '874, 209, 210. Reprinted from the Archivks of OrHTliALMOi.OGY, Vol. xxiii., No. i, 1894. '^i^ b& 26 Casey A. Wood. (sometimes spontaneously, sometimes on pressure), a small drop of transparent fluid. I am able to add another case to the limited number described in literature. A short tiiiK' ago I was consulted by ('. H. S , a gentleman aged tliirty-fivc, wlu) complained of no ocular symptoms except some indicative of acconuiiodative astlK'no])ia. While examining him for glasses, he called my attention to a couple of minute and faintly UKirked jnickerings in the paljjebral skin, and furnished me with the following history : When eighteen years of age {1S76) he was studying law, and working very hard day and night. His eyes then became very weak, and, among other troubles, he noticed that tears remained in the inner ((irners of his eyes, especially of his left eye. He consulted Dr. Williams, of Cincinnati, who care- fully examined the eyes, and discovered an abnormal opening into either tear sac. Under treatment by syringing out the sacs, probing, the use of glasses, and better care of the eyes, the la( hrymation almost entirely ceased, returning only on driving in the wind, or on exposure during cold weather. This symj)tom has i)ersiste(l to the i)resent day, but is noticeable only when the patient overworks and does not get sufficient sleep. It is also liable to re< iir whilst driving against a cold wind. .\ careful examination of the ])atient's eyes revealed a minute cicatricial point at the inferior edge of either lachrymal sac. On the right side it is slightly lower than on the left, but is in both situated about the same distance from the nose. A line drawn from the caruncle on eac h side to the central jjoint of the corre- sponding upper lateral nasal cartilage, ])asses through this small mass of puckered scar tissue. The latter is distant from the < aruncle about five mm on the left side, and about six mm on the right. I was able to pass a No. i Bowman's probe through a minute opening in the centre of the small scar into either sac. All the puncta and their canaliculi are