Human anatomy; Medicine -- Study and teaching; Palpation
15. =Puncta lachrymalia.=--The puncta lachrymalia are distinctly
visible at the inner angles of the lids. The lower punctum is larger
and a little more external than the upper, so that they are not exactly
opposite. The direction, too, of the puncta deserves notice. Their open
mouths look a little backwards, ready to imbibe the tears. When their
proper bearing is lost, as in facial paralysis or by a cicatrix near
the lid, the tears overflow the cheek. The length of the lachrymal
canals is from three to four lines. The lower is a little shorter and
wider than the upper. As each makes a little angle in its course, about
a line from its orifice, the lid should be drawn outwards to straighten
the canal when we introduce a probe.
16. =Lachrymal sac.=--To find the lachrymal sac, draw outwards the
eyelids to tighten the tendo oculi, which crosses the sac a little
above its middle. A knife introduced just below the tendon close to
the edge of the orbit would enter the sac. The angular artery and vein
would be on the inner side of the incision. A probe directed in a line
with the inner edge of the orbit, _i.e._ downwards, outwards, and
backwards, would pass down the nasal duct, and appear in the inferior
meatus of the nose.
The tendo oculi serves many purposes besides giving attachment to the
cartilages and muscles of the lids. One purpose is said to be to pump
the tears into the lachrymal sac. Place a finger on the tendon, and
feel that it tightens every time the lids are closed. The tendon, being
intimately connected to the sac, draws, as it tightens, the sac wall
outwards and forwards, and in this way it may pump along the lachrymal
canals any fluid collected at the angle of the eye.
17. =Nasal duct.=--The nasal duct is from six to eight lines long, and
narrowest in the middle of its course. Its termination in the inferior
meatus lies under the inferior spongy bone, about a quarter of an inch
behind the bony edge of the nostril. The appearance of the orifice in
the dry bone conveys no idea of its size and shape in life; for it is
diminished by a valve-like fold of mucous membrane, so that it becomes,
in most cases, a mere slit, not exceeding a line in diameter.
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