SULPHATE OF ESERINE IN THE TREAT- 
MENT OF ACUTE GLAUCOMA 
BY 
T. R. POOLEY, M. D. 
[reprinted from "archives OF MEDICINE," JUNE, 1879] 
NEW YORK 
G. P. PUTNAM'S SONS 
182 FIFTH AVENUE 
1879 SULPHATE OF ESERINE IN THE TREATMENT OF 
ACUTE GLAUCOMA.* 
By T . R. POOLEY, M. D. , 
OF NF.W YORK. 
ABOUT two years ago, Prof. Laquener, of Strassburg, 
published the results of his experience in the use of 
the sulphate of eserine in the treatment of acute glaucoma. 
To him belongs the merit of the discovery of its "anti- 
glaucomatous " effects. 
Since the publication of his paper, Wecker, Landesberg, 
Knapp and others have also written on the same subject. I 
have lately employed eserine in all the cases of glaucoma 
coming under my observation, and beg to offer the results 
of my experience, especially in acute glaucoma, to this So- 
ciety. The publications which have hitherto been made 
are mainly to be found in the special journals of ophthal- 
mology, and are therefore more or less inaccessible to the 
general practitioner. 
Within the last year I have employed eserine in four cases 
of acute glaucoma. In two of them it was too late to ex- 
pect any restoration to sight, as the disease had already 
progressed so far as to hopelessly compromise it - glau- 
coma absolutum-but as acute symptoms, circumcorneal in- 
* Read before the Medical Society of the State of New York, at its seventy- 
third annual meeting, February 4, 1879. 2 
T. R. POOLEY. 
jection and intense pain were still present, I classify them 
under this category. 
I will briefly enumerate the history of these cases, and 
then offer some remarks upon them, with special reference to 
the indication for the use of this most valuable remedy. 
Case i.-Mrs. G., of Saratoga, aged 71, came to consult me 
July roth, in the absence of Dr. Knapp from the city. Three 
years ago she had an attack of acute glaucoma in the left eye, 
which ran its painful course unrecognized. Since that time she 
was totally blind on this side, but the eye was not painful. Last 
April she was suddenly seized with a severe pain in the right eye, 
which was also very much inflamed. She had a great deal of con- 
stitutional disturbance, and was under treatment for bilious fever, 
remaining in bed for three weeks. On account of the pain in the 
eye and dimness of vision, her physician called in an oculist, who 
made the diagnosis of immature cataract, and advised her to have 
it removed when it became ripe. But at the expiration of three 
or four weeks she was blind, and as the pain in the eye continued, 
she came to New York for advice. The left eye presented the 
typical appearance of absolute glaucoma. The pupil was wide 
and immovable, the lens cataractous, the globe hard, + 7'. 2, and 
all perception of light was gone, but the eye was quite free from 
pain or inflammatory symptoms. In the right eye there was still 
circumcorneal injection, fulness of the scleral veins, a wide, im- 
movable pupil, -j- 7'. 3, deep excavation of the optic disc, the 
cornea anesthetic, and no perception of light. I ordered six 
leeches to the temple of right side, an aperient, a one per cent, 
solution of eserine, and advised an iridectomy for the relief of 
pain. About a week later, after the daily use of eserine in the 
meantime, she was admitted to the New York Ophthalmic and 
Aural Institute. The eserine had very materially diminished the 
pain, and the tension was lessened. The pupil was also now only 
middle-wide, but there was no restoration of sight. I made a 
broad iridectomy upwards. On cutting the iris the anterior cham- 
ber completely filled with blood. The blood absorbed in three 
days. Since the operation no pain ; Tn. Discharged July 20, 
1878. I heard from the patient once since her return home. The 
eye was again painful, but resort to the use of eserine soon freed 
her again from pain. 
Case 2.-John Connolly, aged 60, was admitted to the New ACUTE GLAUCOMA. 
3 
York Ophthalmic and Aural Institute June 27, 1878, He had 
several attacks of glaucoma in the right eye, which is perfectly 
blind. The eye was injected, pupil wide, immovable ; anterior 
chamber almost gone, + T. 2, and no perception of light. Scler- 
otomy was made the same day to relieve his pain, with Graefe's 
knife. A single drop of vitreous escaped by opening the zonula, 
on account of a sudden movement of the patient, The following 
night he slept well ; pain all gone, vitreous in wound. Eserine 
was used daily, and seemed to aid materially the closing of the 
wound. He was discharged July 1st. After leaving the hospital 
he had recurrences of pain in the eye, which was always relieved 
by the use ot eserine. At each period of pain the eye was hard, 
but always regained normal tension under the use of eserine. 
Case 3.-Mary Fuchs, aged 50, admitted to the Institute Dec. 
9, 1878. The right eye became affected only a day or two be- 
fore admission. Counts fingers at six inches, anterior chamber 
shallow, pupil moderately wide. Field contracted on the nasal 
side and below ; media hazy ; inability to see the back-ground of 
the eye, + 71 2. She was given a one-half per cent, solution of 
eserine to instill in the eye every two hours ; six leeches ordered to 
the temple, and a cathartic. The following day the anterior 
chamber was deeper, pupil somewhat contracted, tension reduced 
to+Tl 1, and fingers were counted at ten feet. An upward iri- 
dectomy was now made, without accident, under ether, nth.- 
No reaction ; wound closed ; eye free from pain. 12th.-Had 
pain in the left eye during the night; pupil dilated + 71 1 ; 
circumcorneal injection ; rainbow colors around the light, 
Fl Acute glaucoma diagnosed and eserine ordered, with 
leeches to temple. Eserine was instilled every two hours the 
following day, and on the 14th the eye was almost well; the 
pupil was contracted, Tn., and the eyeball only slightly red. 
Nevertheless, it was thought to be safest to make an iridectomy, 
which was easily done, and resulted favorably. A few days later, 
the patient was discharged. A week later she came to the Dis- 
pensary, and her vision was found to be in the right and 
in the left eye. There was a large coloboma in both, normal 
tension, and ophthalmoscopy showed no excavation of the optic 
disc in either eye. In short a complete cure. 
Case 4.-Mrs. H., aged 65, a lady of wealth, and who had, with 
the exception of her eye trouble, always enjoyed good health, con- 
sulted me Dec. 26th, on account of an attack of acute glaucoma 
of the right eye. For the past few months, but especially since 4 
T. R. POOLEY. 
last July, she had suffered from prodromic symptoms of glaucoma ; 
temporary obscuration of sight, rainbow colors around the light, 
and supraorbital neuralgia. She consulted an oculist last July, 
who found that she had incipient cataract in both eyes. The 
Sunday before coming to me she was awakened early in the morn- 
ing with intense pain in and around the eye, which was found to 
be very much inflamed. When she came to my office I found the 
lids swollen, oedematous, chemosis of the ocular conjunctiva, cir- 
cumcorneal injection, veins tortuous, cornea hazy, with central 
opacity, and insensible to the touch, pupil ad maximum dilated. 
Field of vision wanting above and to the inner side ; fingers could 
with difficulty be seen in the outer part of the field at six inches, 
+ T. 2. No view of the interior could be obtained with the oph- 
thalmoscope. The eye was very painful. The left eye had H. -fa, 
V. jj-J, and showed no signs of glaucoma. I advised the use of 
eserine until the afternoon of the next day, and then iridectomy. 
A one per cent, solution of eserine was instilled every two hours, 
six leeches applied to the temple, and an aperient ordered. The 
following day, when I went to her residence to perform the opera- 
tion, I was amazed at the change which had been made by the eserine. 
The eye was much less swollen and injected, the field of vision 
almost normal, fingers very readily seen at ten feet, and the pupil 
only middle wide. The anterior chamber was not very shallow. 
Iridectomy was made under ether without any accident ; but 
when the point of the knife had but slightly entered the anterior 
chamber, I was struck by the resistance which the sclerotic afforded 
to its further progress ; it was almost like cutting through cartilage. 
Dec. 28th, the morning after the operation, there was some slight 
discharge on the lint and considerable serous chemosis, the lids 
were a little swollen, but there was not the slightest pain. The 
patient had enjoyed the best night's sleep for months. There was 
a good-sized coloboma, and no incarceration of the iris in the 
wound, which was closed, and the anterior chamber fully restored ; 
some blood in the pupil. From this time forward there was a 
favorable healing, although the eye remained hard for some time. 
At the end of two weeks the patient could go down stairs, and by 
the third week after the operation she drove out. 
Jan. 27, 1879, just one month after the operation, I examined 
the eye at my office, and found V. with +16, while with -(-9 
she reads Sn. 1% quite fluently. The ophthalmoscope shows in- 
cipient cataract, and true excavation of the optic disc. The field 
of vision and tension normal. ACUTE GLAUCOMA. 
5 
I may mention here that at the time of operating upon the right 
eye, I made use of eserine in the healthy one as a prophylatic 
against the occurrence of glaucoma in it, as recommended by 
Wecker ; and I regret that this was not done also in the third case. 
These four cases, but especially the last two,-the one af- 
fected with acute glaucoma in both eyes, the other in one,- 
illustrate the remarkable effect, which has already been pub- 
lished by others, of eserine in reducing intra-ocular pressure. 
Indeed, the immediate good results obtained by the use 
of this drug at once raise the question, whether we might 
not depend upon it to the exclusion of iridectomy. But I 
only know of one case reported by Knapp, in which a cure 
of acute glaucoma was produced by eserine. It is not my 
purpose to discuss this question here. So far as we know at 
present, eserine cures acute glaucoma permanently in ex- 
ceptional cases only. But its great value is that it produces 
a temporary improvement, by which the patient is benefici- 
ally prepared for an operation. It is for this reason that its 
actions should be more widely known. And my reason for 
bringing the attention of those present to this point is obvious. 
The cases of blindness from unrecognized glaucoma,- 
thanks to the increased facilities for acquiring a knowledge 
of eye diseases, is steadily diminishing. But there are a 
number of practitioners who, although they are quite com- 
petent to make the diagnosis of acute glaucoma, do not care 
to assume the responsibility of making iridectomy for its 
cure. The operation is certainly difficult, and should be 
done by skilled hands. 
In eserine, we have a remedy which can be used until the 
patient is able to reach an oculist, which not only prevents 
the destruction of the eye, that would otherwise ensue, but 
also, makes the conditions for performing the operation 
more favorable. It is with the hope of introducing the 
sulphate of eserine into practice under such circumstances, 
that this paper is presented.