Accepted methods of treating lachrymal obstructions succeed in some cases but fail in others, for reasons not always apparent. Bearing on the sources of failure are the following suggestions, grouped under four heads: Constitutional disorder, eye strain, nasal disease and faulty technique.
First. It is evident that if lachrymal obstruction be caused by a chronic constitutional disease, the best planned and most skillfully executed operation will come to naught, for surgery never cured syphilis, gout nor rheumatism, and yet observation shows that this obvious truth is not infrequently overlooked. Spyhilitic infection may diplace the puncta, obstruct the canaliculi, induce a dacryocystitis, locate a mucous patch about the mouth of the duct, cause a periostitis, endostitis or subperiosteal gumma, adjacent to, or necrosis of the bony wall of, the duct; or hyperplastic processes of the bones themselves. These lesions may be found in any stage, from insignificant to gravest, singly or