1094 



SURGICAL AXD TOPOORAPHICAL AXArOMY 



this vascularity we owe the eheinosis, or hot, red, tense swelling of ]>urulent 

 ophthalmia. The exquisite suffering of the same disease, or that caused hy a 

 foreign l)ody, is explained by the numerous nerve-i»ai)illa'. To the thickness and 

 abundance of the connective tissue are due the contraction and permanent thicken- 

 ing which may occur in granular lids. The so-called granulations, met with in this 

 disease on the palpebral conjunctiva, are really little nodules of hypertrophied 

 lymphoid follicles, or mucous glands, which abound here. 



The position of the lachrymal puncta should be noted; owing to their back- 

 ward direction, the lids must be previcnisly everted. The puncta are kept open by 

 a minute fil^rous ring. 



Each is situated on a minute i)apilla at the junction of the inner and straight 

 third of the lid with the outer curved two-thirds. Close to the inner canthus, in 

 addition to the puncta and papilla?, should be noted the caruncula lachrymalis," with 



Fig. 669. — The Lachkymal Appaeatus and Nasal Duct. (Bellamy.) 

 (Bristles are introdnced into the pniicta lachrymalia.) 



INNER WALL OF ANTRUM 



, LACHRYMAL SAC 



. Tendo oculi 



Valvular folds in nasal duet 



LOWER TURBINATED BONE Orifice of nasal duct 



its delicate hairs, and the plica semilunaris, which corresponds to the third eyelid 

 of certain birds. 



The lachrymal sac is the most important of the lachrymal apparatus, from its 

 disfiguring diseases; it lies in a bony groove, between the nasal process of the 

 maxilla and the lachrymal bone. The tendo oculi crosses it a little above its 

 centre (fig. 669). Thus two-thirds of the sac are below the tendon, and in sujipuration 

 the opening is made Ijelow it also. The angular artery ascends on the nasal side of 

 the sac. The manipulation of a probe along the lachrymal passages should 

 thus be practised: — The loAver lid l)eing drawn outwards and downwards by the 

 thumb, the probe is passed vertically into the punctum, then turned horizontally 

 and passed on till it reaches the inner wall of the sac. It is then raised vertically, 

 and pushed steadily along the duct downwards, and a little outwards and back- 

 wards, till the floor of the nose is reached. 



If the eyes are opened naturally, the greater part of the cornea, behind it tlie 

 iris, with the i)upil in the centre, on either side of the cornea some of the sclerotic, 

 the semilunar fold and caruncle can be seen. 



