A post-graduate lecture on traumatic enophthalmos : delivered at the West London Post-Graduate College / H. Percy Dunn.

  • Dunn, H. Percy.
Date:
[1908]
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Credit: A post-graduate lecture on traumatic enophthalmos : delivered at the West London Post-Graduate College / H. Percy Dunn. Source: Wellcome Collection.

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    proved. Van Duyse holds an almost similar view to that of Beer. He affirms that the shrinkage of the globe may be due to post-traumatic tropho-neiirotiu alfections causing a gradual resorption of the orbital fat. Of course, this theory is impossible in view of the ca.ses in which enophthalmos (liiickly follows the receipt of the traiuiiatisni. Schapringer, 1)11 tlie other hand, claims that the .symptoms are due to paralysis of the sympathetic, and that as the result of the injury the sympathetic has been bruised or li;eniorrhagically compressed. He cites in support of tliis view one of his ciisus in which the .symptoms only persisted for three days. It is, however, noticeable that apart from the paralysis of Miiller's muscle no theory is advanced to explain how lesion of the sympathetic could etiuse enophthalmos. Thus from these expressions of opinion it will be gathered that the belief obtains to the effect that enophthalmos follows some disturbance of the ocular innervation, some faiUu'e of the nerve-supply to the eye and orbit, some arrest of nutrition of the orbital, if not ocular, structures. And here it may be conceived, in the ab.sence of any post- mortem evidence verifying or otherwise the theories advanced, that further discussion upon the subject would l)ecome profitably impossible. With this assumption up to a short time ago I would have felt bound to agree. While in the course of preparing this lecture, however, I happened to recall the series of cases published by Mr. Jonathan Hutchin- son, jun., recording his results of the treatment of facial neuralgia by partial or complete removal of the Gasserian tranglion. Before, however, proceeding to discuss in detail the facts which his cases disclose, let me briefly revert to a description of the som'ces of innervation of the eye and orbit. There are, of course, the ojotic nerve and the ophthalmic division of the fifth nerve which is altogether sensory in function ; then there are the motor nerves—namely, the third, fourth, and .sixth ; and lastly the .sympathetic branches which are derived partly from the carotid but mostly from the cavernous plexus. With the recollection of the whole innervation of the eye and orbit before us, it is easier to ^peculate respecting the particular nerve-supply which is presuniaVily involved in the oases i-n which enophthalmos occurs. But while neither pathology nor physiology has enabled light to be thrown upon this question it so happens that surgery has come to our aid. I will now refer to the scries of cases, those of Mr. Jonatlian Hutchinson, jun., in which by the removal, wholly or [jartially, of the Gasserian ganglion for facial neuralgia the