US2154968A - Process and apparatus for treatment of diseased obstruction of the lacrymal ducts - Google Patents

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April 18, 1939. v. v. ALKIQ 2,154,968

PROCESS AND APPARATUS FOR TREATMENT OF DISEASED DESTRUCTION OF THE LACRYMAL DUCTS Filed Oct. 1. 1936 2 Sheets-Shet 1 Fig.1 Fi 2 Fi .3 Fi Q 6 12 5 I: E 5'. I s n' z I l 1' F:- IIH I 2 Pi: E 4:" f 2/ j 2 Ii" '1! E. w: g "'1 I E l'fig H E E *f" 2 ll I I F "F "I: I0 g P 8* 5 V/LJO M AZ/f/O April 18, 1939. v. v. ALKl O 2,154,968

PROCESS AND APPARATUS FOR TREATMENT OF DISEASED DESTRUCTION OF THE LACRYMAL DUCTS Filed Oct. 1, 1936 2 Sheets-Sheet 2 Patented Apr. 18, 1939 UNITED STATES PATENT QFFECE MENT OF DISEASED OBSTRUCTION THE LACRYMAL DUCTS Viljo Verner Alkio, Helsinki, Finland Application October 1, 1936, Serial No. 103,598 In Finland December 23, 1935 3 Claims.

Obstruction of the lacrymal duct is a disease which is very diflicult to treat and remedy. In many cases an operation would be necessary, but many patients object to this procedure. For this reason, I have made extensive experiments for the purpose of enlarging, without having recourse to an operation, the lacrymal duct by inserting' into the same an element adapted to enlarge the same. To enable free flow of the tear secretion during the treatment, which may last for several weeks or months, the enlarging element is constructed in the form of a metal spiral.

The accompanying drawings illustrate the spiral element used for the above mentioned treatment, together with the means for introducing the same into the lacrymal duct.

Fig. 1 illustrates the spiral canula.

Fig. 2 illustrates a tube and wire used in connection with the spiral canula.

Fig. 3 illustrates a view of a hook employed to manipulate the wire.

Fig. 4 illustrates a sleeve used in connection with the spiral canula and wire.

Fig. 5 illustrates the manner in which the hook is used in connection with the wire and tube.

Fig. 6 is a diagrammatic view illustrating the first step in carrying out the improved method.

Fig. 7 is a similar view illustrating the wire and tube shown in Fig. 6 lifted slightly from the bottom of the nose.

Fig. 8 is a similar view illustrating the means employed to pull out the lower end of the wire from the nasal cavity.

Fig. 9 is a similar view illustrating a spiral canula and a sleeve threaded on the wire and the application of artery forceps at the opposite ends of the wire to position the canula in the duct.

Fig. 10 is a similar view illustrating the spiral canula drawn into position in the duct, and the tube removed.

The spiral canula is formed of thin metal wire. preferably of some precious metal. The external 0 diameter of the same may vary up to about 5/32 such as the Eustachian tube, the urethra, et cetera.

4 indicates a tube having a blade or knob 5 at its upper end. 6 is a thin metal wire which when in use is drawn through the tube i, the Wire being from 8 to 1.6 inches long. The lower end of the Wire 6 is provided with a knob and extension 8 of such size that it can not pass through the tube l. Another instrument 9 is provided, same being formed with a hook ill, the eye formed by the hook being of such diameter as to embrace the wire 6 but too narrow for the passage of the knob l, as shown in Fig. 5. In the position shown at 9a, the hook rests upon the tube 4, while in the position shown at 91), the hook engages the wire 6. Fig. 4 illustrates a sleeve H for the purpose of supporting the spiral canula on forcing the same into the lacrymal duct. The ends 52 of the sleeve ii are flared for the purpose of better engaging the end of the spiral canula.

After the usual probing of the lacrymal duct, the tube 4 is inserted through the punctum, as shown in Fig. 6, with the lower end in the nasal cavity between the concha nasalis inferior and the external wall of the nasal cavity, so that the knob l of the wire 6 will contact with the bottom of the nasal cavity. The tube 4 is then raised about one-half inch as shown in Fig. 7, and the wire 6 is pressed downwardly in the tube so that its knob remains in contact with the bottom of the nasal cavity. Then the hook 9 is inserted through the nostril, with its eye it! downwardly directed to the external wall of the concha nasalis inferior. When the eye Iii has passed the wire, the same is turned outwards and the hook 9 is pulled outwards to engage the wire 6. On pulling out the wire, the knob 7 will be engaged in the eye I0 and the wire can thus be pulled out through the nostril as shown in Fig. 8. When 40 the wire 6 has thus been pulled out sufficiently, the spiral canula l is threaded on the wire with its tapered end turned upwards. Then the sup porting sleeve it is placed upon the wire 6, as shown in Fig. 9. The canula l is thus held on the wire 6 by attaching artery forceps l3 above the tube 4 and below the sleeve II. By pulling the top forceps and supporting the lower forceps, the canula is drawn up into the lacrymal duct. When the top end of the canula is in the lacrymal sac, the top forceps are disengaged and the wire 6 together with the sleeve H is pulled out through the nose. The wire 3 at the lower end of the canula is bent and pushed against the interior front wall of the nostril as shown in Fig. 10.

To better understand the method of treatment, attention is directed to the series of diagrams shown in Figs, 6 to 10. The metal tube 4 with the wire 6 are first forced through the punctum and the lacrymal duct to the bottom of the nasal cavity, as shown in Fig. 6. The tube 4 and wire 6 are then elevated by pulling up on the upper end of the tube, as shown in Fig. '7, the

wire then being forced down until the enlarged end 1 contacts with the bottom of the nasal cavity. Then the instrument 9 is inserted into the nose and the hook 10 engages the wire 6 below the tube 4, as shown in Fig. 8, and the wire is withdrawn through the nose. The spiral canula I and the sleeve H are threaded on the wire, as shown in Fig. 9.

At this time, it will be noted that the canula is confined between the end of the tube 4 and the sleeve II, and because of the flexibility of both wire and canula, the inner end of the canula is perpendicular to and in line with the lacrymal duct, and therefore in position to be drawn up into the duct, as best shown in Fig. 9.

By gripping the wire adjacent the end of the sleeve H, and further gripping the wire above the tube 4, and simultaneously pulling on the upper end and forcing the lower end in, the canula is inserted in the duct. In this operation, the sleeve H, canula I, tube 4 and wire 6 are bodily moved until the canula reaches the punctum, shown in Fig. 10. Then the forceps are released, the sleeve H removed, and the wire 6 and tube 4 removed, leaving the spiral canula in the duct with its lower end supported on the bottom of the nasal cavity, and the extension 3 curled up in the nose, as shown in Fig. 10.

The introduction. of the canula into the laorymal duct is quite painless and the patient will soon forget the existence of the canula which may be left for several days or months in the duct. By pulling at the extension of the canula, the

, patient or the physician may remove the canula which, however, very often falls out by itself after some time when the lacrymal duct has become suflioiently enlarged.

I claim:

1. The method of enlarging and draining the lacrymal duct, consisting in inserting a tube in said duct to preliminarily enlarge the same, thereafter inserting a spiral canula in said duct through the nose and behind the tube, drawing the tube and canula upwardly in the duct, and removing the tube, the canula remaining in the duct for drain of secretion between the spirals of the canula.

2. The method of enlarging and draining the lacrymal duct, consisting in inserting a tube with a wire therein through the top of the duct to the bottom of the nasal cavity, threading a canula on the lower end of the wire and against the tube, drawing the wire, tube and canula' upwardly through the duct, and removing the wire and tube, the canula remaining in the duct to permit draining of secretion through the spaces between the spirals of the canula.

3. The method of enlarging and draining the lacrymal duct, consisting in inserting a tube'with a wire therein through the top of the duct to the bottom of the nasal cavity, threading a canula on the lower end of the wire and against the tube, placing a sleeve on the lower end of the wire and against the end of the spiral canula and holding same, drawing the wire, tube, canula and sleeve inwardly and upwardly through the'duct, removing the wire, tube, and sleeve the canula ref maining in the duct to permit draining of secretion through the spaces between the spirals of the canula. I I v VILJO VERNER. ALKIO.

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