Mrs. B. S., aged thirty-six, has had pain in and around the right eye
for two months, and examination showed vision in this eye reduced to
light perception; tension + 3, and the pupil widely dilated. The
anterior chamber was shallow, the cornea cloudy and slightly anæsthetic,
the media slightly cloudy, still allowing the fundus to be seen. The
episcleral vessels were enlarged. Circumcorneal injection was present
and the optic nerve cupped. A diagnosis of chronic irritative glaucoma
was made. The left eye presents immature cataract, and vision in this
eye is 20/70.
Knowing of the flattering results obtained by Jonnesco and others, by
excision of the superior cervical ganglion in absolute glaucoma, I
explained the operation to the patient, and obtained permission to
operate. On May 15, 1899, the patient was anæsthetized, chloroform being
employed. An incision four inches in length was made on the right side
downward from the mastoid process, extending along the posterior border
of the sterno-cleido-mastoid muscle. The external jugular vein was cut
and tied. The sterno-cleido-mastoid was then separated from the
trapezius muscle, and the spinal accessory nerve was cut. A deep
dissection was then made, exposing the carotid sheath. This was opened
to enable us to locate the pneumogastric nerve beyond question. The
carotid, internal jugular vein, and pneumogastric nerve were then pulled
forward, enabling us to see the rectus capitis anticus major muscle, on
which the superior cervical ganglion rests. Tearing through the fascia,
the ganglion was found and stripped. The ganglion was then cut high up
with curved scissors and all its branches severed. About one inch of the
trunk of the sympathetic below the ganglion was removed. The wound was
closed with interrupted sutures and the neck placed in a plaster cast.
The time required for operation was fifteen minutes, and immediately
after it was noticed that the right eye was suffused with tears, the
right conjunctiva much injected, and the right nostril moist. The
intra-ocular tension was + 2. The patient slept well all night, without
medicine, being free from pain for the first time in over two months.
Tension had steadily decreased to + 1.
On May 16, slight ptosis was noticed on the right side. This symptom is
yet present. On May 19 the circumcorneal injection was much less; the
conjunctival hyperæmia and lachrymation were still present, while the
ptosis was slightly increased and tension was + 1.
At the present date—July 23, 1899—this patient has no pain. The retinal
arteries are increased in size. Tension is + 1. Vision has increased
from light perception to ability to count fingers at three feet. The
conjunctival injection which followed the operation has disappeared; the
optic nerve has a color more approaching the normal. The ptosis is less.
This was the first sympathectomy made in America for glaucoma.