Frequently epiphora is a troublesome symptom from the physician's as well as the patient's point of view. Quite naturally a person suffering from tearing seeks the advice of an ophthalmologist, but in many cases it is also necessary to consult a rhinologist.It is true that in the majority of cases the tearing results from local stenosis of the lacrimal duct, but not infrequently the cause is to be found in the nose. In these cases treatment with mild anesthetics or astringents or dilation by means of probes is not sufficient.From the rhinologic standpoint, swelling or polypoidal thickening just under the anterior end of the inferior turbinate is liable to produce tearing. In other words, any mechanical obstruction at the nasal end of the lacrimal duct is of particular interest to the rhinologist.To summarize the anatomy : A normal nasolacrimal passageway presents the following:(1) The two lacrimal canaliculi, running from the free margin of the upper and lower lid. These run at first vertically for a short distance, and then turn at an angle to run a medial course converging toward the lacrimal sac. They then unite either in a common trunk to empty into the sac, or they empty separately.(2) The lacrimal sac is the upper dilated end of the nasolacrimal duct and is lodged in a deep groove formed by the lacrimal bone and frontal process of the maxilla. It is oval in form and measures about 12 mm. in length. Its upper end is closed and rounded, while the lower end continues as the nasolacrimal duct.(3) The nasolacrimal duct extends from the lower part of the lacrimal sac to the inferior meatus of the nose, being slightly narrowed at its lower extremity.1The inferior or nasal opening of the duct is variable in shape and position and is often difficult to find on inspection.... In the foetus up to eight months, often up to birth, and sometimes even in the new born child, the duct is closed below by a thin partition formed by the approximation of the lining membrane of the nose to that of the duct, the ostium being subsequently formed by its dehiscence. The resulting opening, which is rarely as large as the lumen of the duct, may be round or linear, vertical or transverse, punctiform or even duplicate. Holmes found it nearly always slit-like and very fine; it may be guarded by a valve, a flap or a diaphragm.2 From the point of view of local treatment it is important to know the probable site of the nasal ostium.
Swerschewsky3 described three positions :The first is in the roof of the inferior meatus of the nose, coinciding with the aperture of the bony nasolacrimal canal, and is found in 45 per cent. There is a fold guarding the opening in 27 per cent of these, a diaphragm in 12 per cent and a circular orifice in 6 per cent. The second is below this point on the side wall of the in¬ ferior meatus in 49 per cent, the generally de¬ scribed position. The aperture is a wide one in 18 per cent, a half-open canal in 16 per cent and a small groove in 15 per cent. The last is the condition considered by him to be most favorable...
