A BRIEF REPORT OF CASES OF SYMPATHETIC 
OPHTHALMIA AND SYMPATHETIC 
IRRITATION:/ 
]3y p. pi. JIosEBPyUGHj yVL. JD., 
Surgeon to the Toronto Eye Infirmary. 
(.Reprinted from the Canada Lancet, June 16th, /87j.) A BRIEF REPORT OF CASES OF SYMPATHETIC OPH- 
THALMIA AND SYMPATHETIC IRRITATION. 
A. M. ROSEBRUGH, M.D., SURGEON TO TORONTO EYE INFIRMARY. 
(Read before the Medical Section of the Canadia?i Institute, May 
16th, iBts- Reprinted from the Canada Lancet for June.) 
About two years ago I had the privilege of reading a paper 
before this Society on Sympathetic Ophthalmia, in which I endea- 
voured to point out: 
ist. That Sympathetic Ophthalmia is a peculiarly destructive 
form of inflammation of the eye, arising solely from irritation in the 
opposite eye, and that, as a rule, it runs its course unchecked, and 
the patient is left hopelessly blind. 
2nd. That the most common cause of Sympathetic Ophthalmia, 
or Sympathetic Irritation, is injury to the opposite eye, particularly 
wounds in the region of the ciliary body; and 
3rd. That the only possible means of arresting the progress of 
the disease is the early removal of the injured eye, and that in all 
cases when the injured organ is enucleated before Sympathetic 
inflammation is actually established, even although it may be already 
very much weakened from Sympathetic Irritation, the uninjured eye 
never becomes affected with Sympathetic Ophthalmia. 
The following cases illustrate some of these points. They are 
arranged according to the length of time that intervened between 
the date of injury and the appearance of sympathetic trouble in the 
uninjured eye. Eight are cases of Sympathetic Ophthalmia, and 
three are cases of Sympathetic Irritation. 2 
I.—Sympathetic Ophthalmia. 
Case i.—Total blindness, in three weeks after injury of one eye, 
from Sympathetic Ophthalmia. 
Peter John H., of Listowell, aged 16. Four years ago last 
March he was hooked by an ox, the horn rupturing the eye-ball, and 
a portion of the vitreous humour escaping. The wound healed, but 
remained irritable, and two weeks after the accident the uninjured 
eye became sympathetically affected, and one week later he was 
perfectly blind. I saw the case about two years after the accident, 
and found both eyes destroyed as organs of vision. He is now in 
the Institution for the Blind at Brantford. 
Case 2.—Total blindness in five weeks, from wound in one eye. 
Mrs. A. W. 8., of Little Scotland, county of Brant, had an injury 
in one eye in February last. Some boys were exploding a percussion 
cap, while she was looking on from a distance of six or eight feet. A 
piece struck the eye in the ciliary region. The sight of that eye 
soon became impaired, and the eye painful. In five weeks she com- 
plained that the uninjured eye felt “weak,” and by the end of the 
sixth week she was blind in both eyes. I saw her three weeks later, 
and found a cicatrix in the sclerotic, just external to the margin of 
the cornea. The eye was irritable and the tension reduced. The 
pupil was closed and the perception of light reduced to a minimum. 
On examination of the uninjured eye, I found the pupil closed with 
plastic exudation, but the inflammation had subsided. The quanti- 
tative perception of light was good. I recommended the immediate 
removal of the injured eye, and subsequently an artificial pupil 
operation on the other eye ; but as the patient had a great dread of 
chloroform, she declined operative interference. 
Case 3.—Total blindness from Sympathetic Ophthalmia, six 
weeks after injury of right eye. 
Joseph H., aged 22, Delaware, Ont. The right eye was injured 
in September, 1870, from the recoil of a piece of spring wire. The 
steel caused a penetrating wound of the cornea and prolapse of the 
iris. The wound healed in about ten days and the sight recovered 
completely. In about two weeks after the accident he had an attack 
of what his physicians called conjunctivitis, supposed to be caused 3 
by exposure to the dust of a threshing machine. This congestion of 
the conjunctiva was probably symptomatic of ciliary irritation caused 
by dragging upon the ciliary processes on account of the prolapse of 
the iris. The eye recovered from this attack, but in about three 
weeks later the eye again became inflamed, the disease extending to 
the iris and closing the pupil. One week later, or six weeks after 
the injury to the left eye, sympathetic irido-choroiditis was set up in 
the left eye which resulted in total blindness. He is also at the 
Institution for the blind at Brantford. 
Case 4.—Total blindness from Sympathetic Ophthalmia eight 
weeks after wound of right eye. 
Samuel McC., aged 36, Mt. Pleasant. Right eye wounded in 
June, 1871, from splinter of wood while chopping. The wound was 
in the sclerotic, just external to the cornea, and extending into the 
ciliary region. About three weeks after the accident, he came to 
Toronto for advice. The surgeon whom he consulted did not 
recommend any interference, and he returned without anything being 
done for him. I saw the case in October; about four months after- 
wards, and found that the injured eye was quite destroyed, and that 
the pupil of the other eye was quite closed from, plastic exudation. 
I then learned that the inflammation had set up in the then sound 
eye almost exactly six weeks from the date of injury of the other 
eye. The injured eye was enucleated and an iridectomy performed 
upon the opposite eye. Vision was somewhat improved by the arti- 
ficial pupil. He returned in February, 1872, for a second operation. 
Unfortunately suppurative inflammation followed the operation, 
and he is now hopelessly blind. I learned subsequently that at this 
particular time erysipelas and puerperal fever were unusually preva- 
lent in Toronto and vicinity. The suppurative inflammation follow- 
ing the operation upon the iris may have arisen from the same pre- 
disposing atmospheric cause. 
Case 5.—Blindness in one eye and Sympathetic irido-choroiditis in 
the other seven weeks after injury. Good result. 
R. S. H., of Consecon, while driving a nail, Feb. 15, the nail 
broke and the end struck the left eye in the ciliary region. He was 
sent to me by his family physician four weeks after the accident. 
The eye was then filled with blood and quite useless; the sclerotic 4 
was ruptured in the ciliary region. He returned home with a 
note to his physician pointing out the danger to be apprehended, 
and recommending that both eyes be closely watched. He 
returned in three weeks, led by his brother. The injured eye was 
about the same as when I saw it last, with the exception that there 
was less hsemorrhage and he could see the light from the ophthal- 
moscopic mirror brighter than before. On examining the right 
eye, however, I found the pupil irregular and other symptoms of 
Sympathetic irido-choroiditis. The injured eye was enucleated the 
same day under chloroform. The right eye was placed under 
treatment and it commenced to improve immediately. In two weeks 
he returned to Consecon ; the inflammation relieved, vision restored 
and wearing an artificial eye. . 
Case 6.—Total blindness from Sympathetic Ophthalmia two 
months after wound of left eye. 
The following very brief memorandum is copied from my jour- 
nal for 1871. I cannot now recall the case. Hamilton P., Toronto, 
aged 21. When six years of age the left eye was wounded with a 
scythe. The eye remained full size after the accident, but the sight 
was destroyed. Pour weeks afterwards the sight of the right eye 
commenced to fail, and in about two months from the date of the 
accident he was quite blind. 
Case 7.—Total blindness from Sympathetic Ophthalmia in nine 
months after wound of left eye. 
Hester L., aged 21, County of Hastings, gives the following account 
of her case ;—At eight years of age, the left eye was wounded with a 
stick of wood. The “pupil” was cut. The accident occurred at Christ, 
mas time.The wound was healed in about a month, but that eye was 
quite blind. She went to school for eight months, when the right eye 
began to fail. At first she noticed that there was occasionally a 
blur over the letters in reading ; this increased, and both eyes 
became quite painful; the sight continued to fail until the month of 
October, when she found herself quite blind in both eyes. She has 
now been blind 13 years. Both eyes are atrophied. 5 
Case B.—Total blindness from Sympathetic Ophthalmia fifteen 
months after wound of right eye. 
George 8., aged 18, Toronto, has been blind for 4 years. 
When about 12 years of age, he had a wound of the right eye with 
a piece of glass, which resulted in the loss of sight in that eye. The 
sight in the other eye began to fail in about a year after the 
accident. Six months after he applied for relief at the then Toronto 
Eye Dispensary, when he was found to be quite blind. His right 
eye was slightly atrophied (tension reduced) and tender to the 
touch, the direct result of the wound eighteen months previously. 
The left eye was full and the tension normal, but the pupil was 
completely closed, and the iris adherent to the anterior capsule of 
the lens, (posterior synechia) the result, undoubtedly, of sympathetic 
irido-choroiditis. The right eye was enucleated, and subsequently 
an artificial pupil operation was performed on the left, but without 
avail. The eye subsequently atrophied. He is also in the Brantford 
Blind Institute. 
ll.—Sympathetic Irritation. 
Case 9.—Sympathetic Irritation three months after wound of 
opposite eye. Good residt. 
Robert L., aged 45, Toronto. About March 15th, 1869, the eye 
was wounded by a piece of iron rivet, in using a hammer and chisel. 
The wound extended from the cornea into the ciliary region. The 
sight was destroyed, and the eye kept tender until June 15th, when 
he first came under observation. The wound had quite healed, but 
the eye was sensitive to the touch. The opposite eye to all appear* 
ance was healthy, but he complained of its being so weak, that he 
could neither read nor return to his work. In technical language, 
he had sympathetic irritation. A consultation with the family 
physician was suggested, but he was not seen again for two weeks, 
when the consultation was held, and the enucleation of the injured 
eye decided upon, to which he only gave a reluctant consent after 
the strongest representations were made to him by his clergyman 
and family physician. In a week’s time the eye was perfectly healed, 
and in less than two weeks he was at work again. 6 
Case io.—Sympathetic Irritatio7i from wound of the opposite eye 
twelve months previous. Good result. 
Daniel M., of Lindsay, aged 33. In March, 1870, while 
cutting hot iron with a chisel, a piece hit the eye and rup- 
tured the sclerotic. His physician sent him to Toronto, and 
three sutures were introduced. The wound was healed in three 
weeks. He returned to his home and his business as a blacksmith. 
The sight in that eye was destroyed, and the eye was occasionally a 
little sore, but he kept at his work for x 2 months, when he returned 
to Toronto, no longer able to continue his business on account of 
Sympathetic Irritation. The injured eye was enucleated, and in a 
week’s time the other eye was quite strong again. A week later he 
left Toronto wearing an artificial eye. 
Case ii.—Sympathetic Irritation. Piece of steel in the eye 
eighteen years. Good result. 
A. R. H., Toronto. Right eye blinded 18 years from a piece 
of steel entering and remaining in the eye. No irritation in 
left eye until 12 weeks before he applied for relief. Left eye was 
then (Dec., 1869) so “weak” that he could neither read nor work. 
The injured eye was atrophied and a little tender. It was removed, 
x6th Dec. Four weeks afterwards his report is that his eye is all 
right. When last seen, 12 months ago, he was at work and wearing 
an artificial eye. 
General Conclusions.—From these and other cases of sym- 
pathetic diseases of the eye that have come under my observation, I 
have been led to draw the following conclusions, which are in full 
accord with the conclusions of others ; and which I take the liberty 
of expressing in language similar to that of Mr. Lawson in his admir- 
able treatise on “Injuries of the Eye.” 
xst.—That Sympathetic Ophthalmia is a peculiar inflammation 
of one eye, originating solely from an irritation in the other. 
2nd.—That the most frequent causes of Sympathetic Ophthalmia 
are penetrating wounds of the eye, and especially those which involve 
the ciliary region ] and foreign bodies within the eye. 3rd.—That Sympathetic Ophthalmia usually takes the character 
of a malignant form of irido-choroiditis, with a tendency to a rapid 
effusion of lymph, capable of speedy organization. 
4th.—That the disease once started is very difficult to arrest; 
that it is recurrent in its nature, and that when once fully established 
it often runs its course unchecked, to the complete destruction of the 
eye as an organ of vision. 
sth.—That the removal of the injured eye affords the best 
chance of arresting the disease; and that, as seen in Case 5, if this 
operation is resorted to in its early stages, there is a good prospect 
of its doing so. Hence the importance of diagnosing in what cases 
of injury, Sympathetic Ophthalmia is likely to follow, and the neces- 
sity of at once removing such injured eyes which are prone to pro- 
duce it, and especially if they are already lost for all visual purposes. 
Before proceeding to a description of the operation of enuclea- 
tion, with which I will bring this paper to a close, I would add that 
in my opinion every surgeon might be qualified to perform this oper- 
ation. It is not nearly so formidable as generally supposed, and the 
haemorrhage is usually very slight. The wound is generally perfectly 
healed in six days, and an artificial eye may be worn in less than three 
weeks. The eyeball alone being removed, the conjunctiva and 
muscles form a cushion upon which the shell of the artificial eye 
rests, and which enables it to move in concert with the other eye. 
The patient is placed on his back and brought under the influ- 
ence of chloroform. The eyelids are widely separated by means of 
the spring (self-retained) speculum. The conjunctiva is seized near 
the cornea with a pair of fixation forceps; the raised portion is 
snipped with a pair of strabismus scissors; the points of the scissors 
are introduced through the wound, and the conjunctiva is dissected 
up for some distance on each side of the wound, and following the 
circumference of the cornea. This loosened portion of conjunctiva 
is detached close to the cornea by several snips of the scissors. A 
portion of conjunctiva on the opposite side of the cornea is seized, 
dissected from the sclerotic, and detached from, the cornea in the 
same manner. When this part of the operation is complete, there 
should be a circular incision through the conjunctiva close to and 8 
surrounding the cornea. This opening is sufficiently large for the 
passage of the bulb. The recti muscles are successively picked up 
with a strabismus hook, and divided with the scissors. It is an 
advantage to use two hooks, the one being introduced before the 
other is withdrawn. The optic nerve is usually severed with a pair 
of scissors, but I consider it an improvement to divide the nerve 
with a blunt-pointed bistory. The eye-ball is made to advance 
through the conjunctival opening, and seized with the thumb and 
finger; the blunt-pointed knife is introduced on the nasal side, 
far back into the orbit. The nerve can be readily felt, it being 
slightly on the stretch. It is divided, and as the eye is being 
brought forward, the oblique muscles are divided.' As a rule, but 
little after-treatment is required. One fold of wet lint should be 
kept over the eyelids fora few days, and the bloody discharges from 
time to time removed.