The remote effects are ptosis, which appears on the third or fourth day, improvement of vision, and in some instances a tardy contraction of the pupil and a tardy reduction of the intra-ocular tension. To these there must also be added a slight sinking of the eyeball into the orbit, and a feeling of heaviness in the head. What I have just written applies particularly to cases of glaucoma.
In exophthalmic goiter, after the excision of the ganglia, the exophthalmus and tachycardia are said to improve almost immediately and a reduction of the goiter soon follows.
Although Jonnesco speaks of the immediate reduction of the intra-ocular tension, yet this does not always occur. In my second case, at the end of eight days the tension was + 2. On the sixteenth day the tension was normal. In my first case reduction of the tension was immediate. The relief from pain in the first case was immediate and lasting. This patient had not been free from pain for two months previously. The slight ptosis following sympathectomy is to be attributed to paralysis of Müller’s muscle. Sinking of the eyeball is no doubt due to paralysis of the unstriped peribulbar fibers found in Tenon’s capsule. Contraction of the pupil is usually an immediate result; it may, however, appear tardily. Thus in my first case the pupil was unchanged until the fourth day after the operation; and it did not become at any time as markedly contracted as in the other two patients. In the third case—that of optic-nerve atrophy—the pupil was markedly contracted within five minutes after the excision.
The lachrymation, conjunctival injection, and nasal moisture are transient symptoms which are usually absent after the first day.
In this connection it is interesting to note that Mr. Jonathan Hutchinson, as early as 1866, recognized many of the ocular symptoms of paralysis of the cervical sympathetic, and wrote a paper thereon.
HOW DOES EXCISION OF THE CERVICAL SYMPATHETIC REDUCE INTRA-OCULAR TENSION?
This is a question difficult to answer—difficult for the reason that we are not sufficiently acquainted with the physiology of the production of aqueous humor under normal surroundings. Panas and Duvigneaud have assumed rightfully that “If the nervous mechanism of intra-ocular secretion or, to speak without hypothesis, the action of the nervous system on intra-ocular tension can be known, the pathology of glaucoma will be cleared up, iridectomy will be explained, and perhaps a new and scientific basis for the treatment of glaucoma will be established.” Many observers have sought to solve the problem. Donders attributed the hypertension to a neuro-secretory cause and believed the trigeminus to be the agent of excessive secretion. He held that section of the trigeminus should relieve intra-ocular tension, while section of the cervical sympathetic could have no particular influence.
