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To the Editor.
—The interesting article by Spaeth in the March issue of the Archives (77:355) deserves attention also in the way the lacrimal ducts were—and should be—irrigated. The diagnosis of the melaninladen casts was made because of the proper way the rinsing was done: the patient seated, head tilted forward, and holding a pan under his chin. In some places the tear sac is now rinsed on the recumbent patient. This implies that the rinsing fluid plus blood, pus, or whatever the lacrimal sac contained, will be washed into the throat of the patient, possibly eliciting the cough reflex, instead of becoming visible for inspection when leaving the nostrils. On the recumbent patient, Dr. Spaeth would have missed his interesting and new diagnosis of melanin casts of the canaliculi.
Ascher KW. HOW TO RINSE THE TEAR DUCT. Arch Ophthalmol. 1967;78(5):691. doi:10.1001/archopht.1967.00980030693022