Your patient complains of painful swelling beside his nose near his right inner canthus.To examine the patient's lacrimal sac for obstruction, you should press your index finger
a. gently near the inner canthus.
b. firmly over the lacrimal gland toward the outer canthus.
c. intermittently over the punctum to express any discharge.
d. over the lacrimal sac, applying steady and firm pressure.
A
The lacrimal apparatus consists of the lacrimal gland and the ducts. The lacrimal glands, located above and on the temporal side of each eye, produce tears. Tears drain into the puncta, visible on the upper and lower lids at the inner canthus. The tears then drain into the lacrimal sac through the nasolacrimal duct, and empty into the inferior turbinate in the nose. To examine the lacrimal sac for obstruction, don gloves and gently press the index finger near the inner canthus, just inside the rim of the bony orbit of the eye. Pressing over the lacrimal gland toward the outer canthus is incorrect anatomically because the lacrimal sac is near the inner canthus. Steady and firm pressure is not required to examine the lacrimal sac for obstruction.
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