From a study of the cases of sympathectomy made by Jonnesco and others,
and from the observation of my own cases, I offer these conclusions:
1. Excision of the superior cervical ganglion is a most valuable
procedure in glaucoma.
2. It is of more value in glaucoma simplex than in inflammatory
glaucoma.
3. In inflammatory glaucoma, on which iridectomy has been done without
benefit, excision of the superior cervical ganglion should certainly be
tried.
4. In cases of absolute glaucoma with pain, sympathectomy is to be tried
before resorting to any operation on the eyeball.
5. In cases of simple optic-nerve atrophy, sympathectomy may possibly be
beneficial if done before vision is entirely lost.
6. In cases of exophthalmic goiter, which do not improve under hygienic
medicinal and electric treatment, excision of the cervical sympathetic
on both sides is to be advised.
7. In unilateral glaucoma excision of the sympathetic ganglion is to be
done only on the corresponding side.
8. In the hands of a careful operator, excision of the superior and
middle ganglia is a safe operation, but removal of the inferior ganglion
can be done safely only by the most skillful surgeons.
9. The postmastoid route is to be preferred in excision of any part, or
all of the cervical sympathetic.
10. The fact that glaucoma is improved by sympathectomy and the finding
of pathologic changes in the excised ganglia suggest the conclusion that
this affection is due either to a permanent irritation of the cervical
sympathetic, or to an irritation located elsewhere and transmitted by
means of the cervical sympathetic.
I wish to extend my thanks to Drs. E. C. Renaud and Willard Bartlett for
valuable assistance in the preparation of this paper; to Dr. Carl Fisch
for the pathologic report.