T. J., aged forty-six, an inmate of the St. Louis City Hospital, a
laborer, was admitted on account of blindness. There was no history of
syphilis, rheumatism, nor any systemic disease. The patient was of
limited mentality. No history of his family could be obtained. He
claimed to have had good health all his life, with the exception of an
attack of malarial fever several years ago. The patient had been a
moderate drinker of alcoholic beverages. In appearance he was robust,
and he complained only of loss of vision which, in the left eye, had
been failing for eleven months, in the right for seventeen weeks,
according to his statement. Until seventeen weeks before this he could
see enough with the right eye to get around. Since then vision had
steadily declined until he had light perception only—and this only
apparent when light was concentrated on the eye by the ophthalmoscopic
mirror. Vision of the left eye = 0.
The pupils were widely dilated. The ophthalmoscope showed, in the right
eye, a white disk, particularly on the temporal side; the arteries
slightly reduced in caliber, veins normal. There was shallow, atrophic
cupping of the nerve head. The retina and choroid were normal, the
vitreous and lens clear. The left eye showed a disk of a dead white
color throughout the whole area, arteries very small, atrophic
excavation pronounced, veins reduced in caliber, and choroid normal. The
macula was not visible in this eye, owing to the much-reduced
blood-supply. The vitreous and lens were clear. Vision was as follows:
R. E. = perception of concentrated light. L. E. = 0.
_Diagnosis._—R. E. = optic-nerve atrophy. L. E. = complete atrophy of
optic nerve and retina.
_Treatment_: Resection of the right superior cervical ganglion of the
sympathetic was done. The operation was followed by conjunctival
congestion, lachrymation and contraction of the pupil, slight ptosis and
hypotonia.
No appreciable change in the patient’s vision followed, and
ophthalmoscopic examination made two weeks after operation showed no
change in the appearance of the fundus, except that a cilioretinal
artery in the upper part of the disk had doubled in caliber.
So far as I know, Case III. is the first instance in the history of
medicine of an excision of the superior cervical ganglion, or of any
part of the sympathetic system, for the relief of optic-nerve atrophy.
Although the operation was not of benefit in this particular instance,
yet I am not willing to concede that it will prove valueless in cases of
non-inflammatory atrophy in which vision is not entirely lost. In truth,
I expect it to prove beneficial in such cases, sufficiently often to
justify the procedure.
I was led to make this experimental operation for several reasons: 1.
The use of glonoin is often followed by an improvement in vision in
cases of simple atrophy of the optic nerve. 2. Glonoin enlarges the
retinal vessels, as has been proved by ophthalmoscopic examination. 3.
There is no question that in glaucoma simplex—a disease in which there
is an atrophy of the optic nerve—improvement in vision follows
sympathectomy. 4. Excision of the cervical sympathetic is followed by an
increase in the blood-supply of the orbital contents.