Physiological Considerations in the Treatment of Pulsating Exophthalmos

Abstract

The authors agree that this term should rightly be restricted to that type which is due to vascular lesions of vessels closely associated with the orbital supply of blood; it is most often due to an arterio-venous communication between the internal carotid artery and the cavernous sinus. The physiological and pathological considerations involved in the management of pulsating exophthalmos include the mechanism of the carotid sinus, the role of the sympathetics, the factors of thrombosis and of embolism, and the anatomical details of collateral circulation. Treatment by ligation of the common carotid artery, subsequently by ligation of the external carotid, reduces the flow in the internal carotid by SO percent and 75 percent, respectively. When the pressures within the internal carotid are not reduced too greatly there is no tendency to reversal of blood flow from the distal portion of the carotid backward through the fistula. The reduction of the blood flow is followed by contraction of the lumen of the vessel and favors the reduction in the size of the fistula. Drainage of operative wounds in the neck is specially considered for the avoidance of operative complications. Read before the Association for Research in Ophthalmology, in Cleveland, June 12, 1934.