Ocular manifestations after upper dorsal sympathectomy

Area of Science:

• Ophthalmology
• Neurosurgery
• Surgical Anatomy

Background:

• Palmar hyperhidrosis is a common condition.
• Bilateral upper dorsal sympathectomy is a surgical treatment for hyperhidrosis.
• Ophthalmologic side effects of this procedure are not fully understood.

Purpose of the Study:

• To evaluate the short- and long-term ophthalmologic complications of bilateral upper dorsal sympathectomy.
• To assess the incidence and severity of ptosis, miosis, and other ocular symptoms post-surgery.
• To investigate potential modifications to the classical explanation of Horner's syndrome based on observed outcomes.

Main Methods:

• Prospective study of 50 patients undergoing bilateral upper dorsal sympathectomy for palmar hyperhidrosis.
• Ophthalmologic examinations conducted pre-operatively and at multiple post-operative intervals (1 week, 3-4 weeks, 6-12 months).
• Assessment of key signs including ptosis, miosis, lacrimation, and conjunctival congestion.

Main Results:

• Immediately post-surgery, 18 patients experienced ptosis and 23 experienced miosis.
• 19 patients reported excessive lacrimation, and nearly all had conjunctival congestion.
• Most symptoms significantly decreased over time, with only 3 severe ptosis and 4 severe miosis cases remaining at 1 year.

Conclusions:

• Bilateral upper dorsal sympathectomy frequently causes transient Horner's syndrome-like symptoms.
• The observed ocular manifestations suggest a need to refine the understanding of sympathetic nerve pathways involved in the procedure.
• Long-term follow-up is crucial for assessing the full impact of sympathectomy on ocular structures.