The lachrymal passages begin with the puncta lacrimalia. These little points lie on the free border of the upper and lower lid, and at the inner extremity of the lids at a point where the tarsus terminates. They are situated on small prominences, the lachrymal papillæ, and form the orifices of the lachrymal canals. The canal in the upper lid runs upward slightly, and in the lower lid slightly downwards; then they bend at right angles to enter the lachrymal sac. Into this they enter separately or from a short common trunk. At the inner canthus of the eye the lachrymal sac is situated. The lachrymal bone bounds the sac on the inner side, while to the front and end side it is inclosed by the middle palpebral ligament. This relation of the lachrymal to the internal palpebral ligament enables us to determine the position of the sac-a matter of importance when operations are concerned -at a spot where the cleft of the lachrymal bone merges into the bony canal. This is the narrowest part of the canal and is especially liable to stricture. From this point the canal passes downwards, and enters into the nose just below the inferior turbinated body. The mucous membrane of the sac and duct forms a continuous whole. The posterior wall of the lachrymal sac, being bony, makes this part easily distended by the presence of fluids. The structures comprising the front of the sac, being soft and yielding, are easily distended, and this is shown by the swelling at this point. The duct proper is unyielding, hence, congestions, resulting from colds, produce strictures within the tear-duct, and they become manifest by the overflow of tears primar

Delivered at the Utah State Medical Association, Ogden, Utah, May 10 and 11, 1904.

No. 1

ily, and as a secondary condition we have the swelling and phlegmonous conditions that characterize the interference with the drainage of the eye. The physiological action of the tears. is to lubricate the eye. Most of the tears are supplied by the lachrymal glands, but the conjunctival surface furnishes a considerable quantity of these. In the act of winking the tears are carried, by gentle compression of the lids, into the puncta, a valve-like action is also produced on the tear sacs by the compression of the lids in the act of winking, and if no obstruction exists in the tear channels the eyes are properly drained. The remote effects of stricture of the tear-ducts are shown in ulcers of the cornea and ectropion. The immediate effects are manifest in the annoyance from constantly wiping the eyes, and from the nose a serious phlegmonous type of inflammation arises, which attacks the tear-sac.

The frequency with which these strictures are met with makes it important that the causative factors should be early understood, and, as far as may be, thoroughly removed. Diseases of the nasal mucosa, in perhaps the majority of instances, are accountable for these strictures. In the treatment of a large number of these-in fact, in more than two-thirds of the cases-I found mucous hypertrophies, hypertrophy of the turbinated bodies, or deviations of the nasal septa, as causative of the epiphora or stricture which resulted. I know of no class of cases which will give a physician more annoyance than these when the stricture is located in the bony portion of the tear-duct; for in this class of cases you are so apt to find a chronic inflammation of the tear-sac and all its accompanying disagree