CHAPTER VII 

 THE LACRYMAL APPARATUS 



Dacryocystitis. 



THOUGH the mucous membrane of the lacrymal sac is in immediate 

 continuation with that of the conjunctiva, still it does not react in the 

 same way to the causes which produce disease. 



The majority of the infectious diseases of the conjunctiva pass the 

 lacrymal sac by without affecting it, although the organisms which 

 produce them pass through the sac in large numbers. We can only 

 presume that, on account of frequent downward evacuation by the lid 

 movements, the material which enters it cannot gain a footing. The 

 importance of this is shown by the fact that, when there is a stenosis 

 of the nasal duct and the flow of the secretion is prevented, a catarrhal 

 inflammation soon occurs. This, however, does not explain all the 

 facts, for during the course of a gonorrhoea of the conjunctiva the sac 

 is filled for weeks with infectious material ; we must rather assume 

 that the mucous membrane of the lacrymal sac possesses quite different 

 ' affinities ' or receptors. It is more nearly related to the mucous 

 membrane of the nose than to that of the conjunctiva, and is relatively 

 immune to the Gonococcus and the Koch-Weeks bacillus. An inflamma- 

 tion of the lacrymal sac in the course of these affections is well known 

 to be extremely rare, and in the exceptional cases in which it does 

 occur, an examination should be made to see whether there is not 

 a mixed infection with some other bacteria, or some special condition 

 present. An inflammation of the lacrymal sac with Diplobadlli is 

 also very rare ; I have exceptionally found Diplobadlli to be the only 

 bacteria present in the lacrymal sac. 



If we consider the facts and the results of bacteriological examina- 

 tions, we find that Pncumococci, either pure or mixed with other 

 organisms, are the most common organisms present in a simple 

 catarrhal dacryocystitis ; next in the order of frequency are the 

 Staphylococci then perhaps the Gram-negative bacilli of the influenza 



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