PROGNOSIS.-In the prodromal stage, or that of sympathetic irritation, the prognosis may always be considered favorable; but if later, after exudation has taken place, it is unfavorable, as in the majority of cases the disease leads to blindness. the prognosis is always more favorable when the course of the disease is slow, rather than rapid, and more favorable in the serous than in the plastic form.
TREATMENT.-Our attention should first be directed to the exciting eye, and in all eyes where we find it at all irritable, sensitive to touch and the vision lost, an enucleation of that eye should at once be made. If the affected eye is only in the stage of prodromal irritation, the removal of the eye which is creating the sympathetic irritation will usually result in at once checking the disease and restoring the eye to its normal condition. It the exciting eye contains a foreign body which cannot be independently removed and is itself undergoing inflammatory changes, it should be removed, even though possessing more or less vision, as that eye will probably be lost, and, by its removal, the other may be saved. The advisability of removing an exciting eye when it has a certain amount of vision, in a plastic form of sympathetic ophthalmia, is a decidedly delicate question, because there is a very grave probability of losing the sympathetic eye, while the eye originally causing the irritation may come out with the best vision.
Enucleation should always be practiced in the irritative stage, if possible as often, if delayed until the sympathetic eye has become actively inflamed, its removal then will not serve to check the progress of the disease. In all cases where one eye has become lost, and especially when from injuries or wounds in the ciliary region, the patient should be thoroughly cautioned as to the possibility of its serving at any time to cause destruction of the other eye from sympathetic ophthalmia and its removal advised. If enucleation is not submitted to at this time, they should be warned of the importance of immediate attention upon the slightest sign of any pain or irritation.
Enucleation or Evisceration as described on page 271 is the best operative measure for sympathetic ophthalmia.
Optico Ciliary Neurectomy.-The operation of division of the optic and ciliary nerves behind the eyeball has been advised and practiced by some. Its only claimed value is in the retention of the eye. Schweigger and others recommend it as a preventive measure; but, as a remedy in the inflammatory type, it is untrust worthy, and even in the stage of irritation it ranks below enucleation. The operation is best performed by division of the internal rectus muscle, and dissecting back with the blunt scissors to the vicinity of the optic nerve. Then, by rotating the globe outward, insert a strabismus hook, with which you catch up the optic nerve and drag it out as far as possible. The scissors are now inserted over the hook and the nerve severed as near to the apex of the orbit as possible; the nerve is then drawn out, and, with the forceps and scissors, cut off all the nerve tissue possible close to the eye. The eye is then restored to its place and the muscle and conjunctival wound closed with sutures. Profuse haemorrhage and reaction are apt to follow from this operation.
In addition to the operative measures when an eye is sympathetically inflamed it should be given the same treatment as that for irido-choroiditis. The use of Atropine to dilate the pupil and relieve the pain may be tried, if there is not an exclusion of the pupil, when it had better not be used. The patient should be kept at rest in a darkened room. Hot fomentations or the cotton pad may be applied. Ice has been employed in some cases, though as a rule it is not advisable. Recently the sub-conjunctival injection of the bichloride of mercury has been greatly lauded by Darier and others in disease of the uveal tract. My own experience has given me no beneficial results from these injections. Iridectomy has been recommended, but sclerotomy is better, if the tension is increased and the eye painful, but it is far better to make no operation upon the affected eye during the inflammatory stage and not until long after it has become quiescent, as there is grave danger of lighting up another attack. The remedies most apt to be of value are Belladonna, Mercurius, Silicea, Kali-iod., Rhus tox., and Bryonia For special indications see Part II.
Professor of Ophthalmology in the College of the New York Ophthalmic Hospital; Surgeon to the New York Ophthalmic Hospital. Visiting Oculist to the Laura Franklin Free Hospital for Children; Ex-President American Homoeopathic Ophthalmological, Otological and Laryngological Society. First Vice-President American Institute of Homoeopathy : President Homoeopathic Medical Society of the State of New York ; Editor Homoeopathic Eye. Ear and Throat Journal : Associate Editor. Department of Ophthalmology, North American Journal of Homoeopathy, etc.