3. Pressure symptoms.
The impairment of venous flow in those radicles which drain into the cavernous sinus is evidenced by the marked engorgement of palpebral, conjunctival, episcleral, and retinal veins. Obstruction to lymph flow is shown by a hazy cornea, chemosis, and œdema of the parts surrounding the orbit. The danger thus incurred by the cornea is rendered more serious by the inability on the part of the patient to close the eyelids over the protruded globe. Keratitis and sloughing of the globe are to be feared. From muscular involvement, squints and diplopia are frequently observed. The pupil may be fully dilated through paralysis of the third nerve.
4. Subjective symptoms.
Defect in vision is experienced at an early date, but perhaps the most prominent subjective symptom lies in ‘noises in the head’, compared by the patient to the thud of a steam-hammer, the whirring of wheels, the buzzing of bees, &c. These noises are more or less constant, most annoying to the patient, and increased on bending down, straining, &c.
All these symptoms tend to become more severe as time lapses, though cases have been recorded in which the symptoms remained in statu quo. In the event of failure at relief or cure, the patient runs considerable risk of losing his sight from corneal ulceration, whilst repeated hæmorrhages and secondary infection may place the patient in imminent danger of his life.
Treatment.
In the consideration of the treatment of this condition, the results obtained in the 26 cases investigated will afford a valuable guide.
In 4 cases an expectant attitude was adopted, the patient being kept quiet, restricted in diet, and dosed with potassium iodide. One case improved, two experienced no material benefit, and the fourth, dissatisfied, discharged himself from the hospital.
In 10 cases compression was applied to the common carotid artery, with the result that in 3 cases the conditions remained stationary whilst in the remainder, either on account of the pain produced or from complete failure to bring about any improvement, this mode of treatment was abandoned in favour of ligature of the common carotid. In some cases the carotid compression was carried out by means of tourniquets, in others intermittent digital pressure was utilized by means of relays of assistants.
In 18 cases the common carotid was ligatured, in 12 cases as a primary measure, in 6 after failure of other methods. The immediate and remote results were in all cases as satisfactory as could be anticipated. Proptosis at once diminished, the globe receding in some cases to the normal position, and the distressing subjective symptoms were almost entirely relieved. In many cases the patients were enabled to return to work.