The common causes of glaucoma must be avoided, particularly the use of a mydriatic, unless iritic adhesions (poste rior synechite) are present. If operation is not permitted, myotics—as physostig mine (eserine) and pilocarpine—may be instilled, combined with cocaine. Tak ing blood from the temple and bathing the eye with water as hot as can be borne lend to diminish pain.
Successful operation, and belief that visual acuity is improved in some cases. Be states that by using- a blunt dis sector it is not usually necessary to ligate the external jugular vein or to cut the spinal accessory nerve, and the oper ation is neither lengthy nor exception ally difficult. G. F. Suker (Ophthalmic Record, Aug. 16, '99).
Resection of the cervical sympathetic, performed seven times by donnesco iu 1898, has recently been resorted to with success by several clinicians. Its vari ous steps are as follow: An incision four inches in length is made on the right side downward from the mastoid process along the posterior border of the sterno mastoid muscle. The external jugular vein is cut and tied. The ste•no-inastoid is then separated from the trapezius and the spinal accessory nerve cut. A deep dissection must then be made, ex posing the carotid sheath. This is opened in order to locate the pneumo gastric nerve. The carotid, internal jugular, and pnenmogastric nerve are then pulled forward, exposing the rectus capitis anticns major muscle, on which the superior cervical ganglion rests. Tearing through the fascia, the ganglion is located and stripped, then cut high up with curved scissors and all its branches severed, about one inch of the trunk of the sympathetic below the ganglion being removed.
There is, as a rule, no change in the pulse or respiration. The wound is closed with interrupted sutures, and the neck placed in a plaster east, or some such reliable apparatus to avoid twist big of the neck. The time required for operation averages from fifteen to thirty minutes.
The results reported are: immediate cessation of pain, fall or tension, reduc tion in the size of the pupil, and im provement of sight when the optic nerve was not already totally destroyed. Jon nese° makes a premastoidal Abadie performed it successfully in a man who had already lost one eye by enucleation for glaucoma, and whose sufferings led him to beg the author for of the second eye. Instead, Abadie removed the superior cervical ganglion of the sympathetic of the same side and obtained cessation of all the symptoms slowly and progressively, even to clearing up of the media.
Successful operation in a case which presented a typical picture of unilateral chronic glaucoma; tension, + 3; vision reduced to light-perception in the af fected eye, with the usual fundus changes and much pain. Ball (Med. Re view, Aug. 26, '99).
Removal of the right upper cervical sympathetic ganglion is of no service in glaucoma simplex where vision has been reduced to zero, but may be of service in arresting the disease in the earlier stages and retain vision before atrophic changes have taken place in the nerve, retina, and choroid.
After mvotics and iridectomies have failed to relieve the disease, it is then when one is justified to advise sympa thetieectomy in hope of relief from per manent blindness. Even then there is no assurance that the glaucomatous at tacks will not return mouths afterward and destroy \ vhat has been gained.
The operation in skillful hands is not a dangerous one, nor has there been any deleterious effects upon the patient, ex cept the numbness of the lobe of the right ear and along the inferior maxil lary. D. H. Coover (Phila. Med. Jour., March 16, 1901).
Sympatheticectomy is indicated in glau coma simplex, inflammatory glaucoma where iridectomy has failed. licemo• rhagie glaucoma early in the disease: and it should be tried in absolute glau coma with pain, in preference to ennele ation. In unilateral trouble the gan glion of the corresponding side should be excised. While sympatheticectomy may not be curative in every case of glaucoma, the results thus far have been sufficiently satisfactory to make it a de sirable procedure in this much-dreaded disease. Williams (Medical News, Apr. 6, 1901).
Resection of the cervical sympathetic. Review of the cases in which operation has been done for the relief of glaucoma. S6 cases in all. Only about 13, however, had been followed sufficiently long to form any basis for deductions. None of these were made worse: 1 was mi 1 changed. and the remainder were im proved, 5 of the latter subsequently suf fering relapses. The operation is a safe procedure in the hands of a skillful sur geon and apparently never does any harm. The results have been so varied that one cannot yet be sure in what cases it can be advantageously employed. It does not replace iridectomy, but may pos sibly supplement the latter in case this is refused or has already resulted dis astrously to the other eye, or is contra indicated. W. B. Marple (Medical Rec ord. May 10, 190:2).