In 1836, Montain1 first described the use of a perforating trephine in the treatment of lacrimal fistula. He dilated the fistula and, introducing a trephine into the lacrimal fossa, perforated the bone with the trephine. He then packed the newly created opening with a gut suture and irrigated this twice daily. After ten to fifteen days, when the patient was discharged, the skin was healed. In 1897, Kyle2 described a procedure for chronic dacryocystitis. The lower canaliculus was slit and dissected to the opening of the nasolacrimal duct. A trocar was then placed through the newly created fistula. The cannula was allowed to remain in place until the fistulous opening had epithelized, after which it was removed.
This type of procedure was replaced by the type of external dacryocystorhinostomy first described by Toti3 in 1904. An external skin incision was made over the anterior lacrimal crest. The
KINOSIAN HJ. A New Technique for Dacryocystorhinostomy. Arch Ophthalmol. 1963;70(1):33–37. doi:10.1001/archopht.1963.00960050035008
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