Fig. 41 A. The mucous membrane of the nose can be sutured to that of the lacrimal sac with interrupted 4–0 absorbable sutures, or as an alternative, they can be cauterized together. B. An alternative method of creating flaps can be used, particularly if the nasal mucosa is opened too high. In this instance, the entire mucosal lining of the nose can be used as a posterior flap, and the entire lacrimal sac used as an anterior flap.24 The anterior flap of the lacrimal sac can be sutured to the periosteum at the anterior bony opening.