Increased intraocular pressure secondary to mediastinal syndrome

F. N., a white man aged 66, was admitted to the Graduate Hospital of the University of Pennsylvania on July 11, 1950, because of swelling of the entire head, face, and neck. The patient stated that two months prior to admission he first noted that his lower eyelids were swollen in the morning. The swelling became progressively worse, so that his eyes were swollen shut in the morning, his neck veins became prominent, like cords, and his arms were swollen. He also began to notice distended veins on his chest and a sensation of being choked when he "stooped" over. All these symptoms were less severe after he was up and about. Physical examination revealed distended neck veins and numerous varices on the anterior chest wall, but no dependent edema. The rest of the examination revealed nothing significant. Laboratory studies showed a venous pressure of 310 mm. of water, a