278 BACTEBIOLOGY OF THE EYE 



inflammations of the accessory sinuses Pneumococci, Staphylococci and 



Streptococci are by far the most important. 1 A direct passage and 

 communication between a sinus and the lacrymal sac only occurs 

 rarely in phlegmonous dacryocystitis, due to its spreading beyond 

 bounds and forming a fistula. 



When the duct is closed, the overflow of infectious secretion must 

 find its way upwards into the conjunctiva ; hence the great liability of 

 wounds of the globe to infection. The statement by Hauenschild that 

 such an overflow does not take place unless some special pressure 

 is applied cannot be confirmed, although it is true that an ascending 

 infection of the nasal duct does not generally occur. 



If the sac be completely cut off, its contents will gradually become 

 sterile, as is the case in similar conditions of other closed mucous 

 cavities, particularly the accessory sinuses of the nose, which form 

 mucoceles with sterile contents. The bacteria (Pneumococci) will 

 finally die out, unless the retention causes a spread to the surrounding 

 tissues, and an acute inflammation with a fistula results. 



The results of occluding the canaliculi by cauterization in cases 

 where there is total stenosis of the nasal duct shows that this acute 

 spread is not very common ; it is more common to have a retention 

 cyst with sterile contents. The recommendation of Brandenburg 

 that, instead of extirpation, the canaliculi should be cauterized to cut 

 off the sac, is based on sound principles. Complete occlusion, how- 

 ever, does not always follow this method of treatment. 



Bacteriological Finding's. 



In cases of dacryocystitis the extraordinary richness in bacteria 

 of the pus from the sac was long ago the cause of investigations 

 by Leber, Widmark, Sattler, and Schmidt-Eimpler. Purulent infec- 

 tions of the cornea could be obtained experimentally both by the 

 inoculation of the pus and the pure cultures obtained from it ; results 

 thus obtained agreed with the clinical evidence in man. Schmidt- 

 Rimpler compared the effect of inoculating with the pus and with the 

 pure cultures, and showed that the lacrymal secretion varies very 

 much in its infectiousness. 



Attention was at first directed to the Staphylococci and the Strepto- 

 cocci. Later, however, from the researches of Gasparrini, Cu6nod, 

 Mazet, Uhthoff, and Axenfeld, the most important organism present 

 was shown to be the Pneumococcus, which in the majority of cases 



1 See section on 'The Orbit,' and Hoffmann, Z. f. A., 1906, xvi., 'Festschrift f. Kuhnt.' 



