In 1912 he earned his medical doctorate, and later worked as an assistant at ophthalmology clinics in Graz and Vienna.

Afterwards, he worked as an assistant for his cousin, Alexander Pagenstecher (1828-1879), at the latter's ophthalmology clinic in Wiesbaden.

From 1862 he maintained a popular ophthalmology clinic in Paris.

In 1894 he founded an ophthalmology clinic at the "Greek hospital" in Constantinople, serving as director of this institute until 1922.

For many years the sweep technique has been used in paediatric ophthalmology (electrodiagnosis) clinics Worldwide.

At the University of Rostock he was initially an honorary professor (1866), and from 1869 a regular professor and chair of the ophthalmology clinic.

There he became chief of the new ophthalmology clinic that he helped establish.

In 1914 he became an assistant at the ophthalmology clinic in Halle, and in 1918 received his habilitation.

Rural patients tend to be referred later and the risks of this can be amplified if there are problems in the 'referral chain' to the ophthalmology clinic.

He turned one of the wings of the castle into an ophthalmology clinic were he treated poor patients for free.