A considerable number of people seem to be subject to attacks of pain
in one or both eyes. These attacks of pain come at varying intervals;
in some cases several times a day, in others as far apart as one
or two weeks. The pain will suddenly start almost without warning
and with very little provocation, and last from one to twenty-four
hours. It is very severe and the patient frequently thinks something
terrible is wrong. Something terrible is wrong so far as his comfort
is concerned. But in these cases to which I am referring there is no
organic trouble with the eye. The patient does not need glasses. There
is no sign of inflammation. Vision is not disturbed. Local examination
of the eye with the ophthalmoscope reveals that the fundus of the eye
is normal. There is no symptom connected with the eye except pain,
occasionally accompanied by a slight redness. I have had several cases
in my own practice and my attention has been directed to cases of other
physicians.
These cases differ from _tic douloureux_ in that there is no muscular
spasm. In fact, motor nerves do not seem to be involved. The
involvement seems to be largely in the =fifth cranial nerve=, usually
the supraorbital, or other smaller branches of the ophthalmic division
of the fifth cranial. Sometimes we note slight dilatation of the pupil
with more or less congestion. This would indicate an involvement of the
sympathetic branch to the eye.
The lesions discovered in these cases have been a subluxation of the
occiput upon the atlas or an upper cervical lesion and frequently some
involvement at the second dorsal. There has been noted also trouble in
the nasopharynx such as contractures of the muscles of the soft palate
and adhesions in the fossa of Rosenmuller.
Misplacements of the uterus have also been found in some cases.