115. – Iritis.
DEFINITION.-Inflammation of the iris. The iris is the coloured membrane which lies in the space between the cornea and crystalline lens. In its centre is the circular aperture called the pupil. By the contractile power of the iris the size of the pupil is varied, and thereby the amount of light admitted into the eye through the pupil is regulated. When children are born they have blue eyes, but as pigment is developed in the substance of the iris they may become brown.
Inflammation of the iris is acute or chronic; again, Iritis may be primary in the iris, or secondary, from extension of the inflammation from a neighbouring diseased structure.
By far the most common cause of acute primary Iritis is Syphilis, probably fifty per cent. of all cases being due to it. Other causes are gonorrhoea, tuberculosis, rheumatism, gout, diabetes, enteric fever, pneumonia, influenza, etc.
SYMPTOMS. – There are burning pains of a neuralgic character in the eye and severe aching in the forehead which come on in paroxysms and are aggravated at night. The iris changes its colour and becomes blurred. The pupil is sluggish in action, small and irregular in shape, and if the disease be neglected or mistreated closed or obstructed-the rays of light being thus intercepted in their passage to the retina, sight is prevented. Marked congestion of the eye, and especially a radiating zone of vascular redness surround the cornea. No matter forms.
A grave mistake into which the uninitiated often fail is to take a case of iritis to be one of conjunctivitis scleritis. The appearance of the iris itself is the most valuable guide.
TREATMENT. – Atropine (g. iv…i) instilled into the eye every two hours for the first day or two, less frequently afterwards. Dry heat applied over the eye. Dark glasses.
In the gonorrhoeal rheumatic forms, the attacks are very liable to recur even after an interval of years.
EPITOME OF TREATMENT.- 1. Traumatic Iritis. – Arnica (both internally and externally); Aconite (febrile symptoms); Belladonna
2. Rheumatic.-Aconite, Mercurius, Belladonna, Cocc., Coloc., Spigelia, Sulphur
3. Syphilitic. – Mercurius-S., Cinnabar, Clem., Merc-Iodium, Belladonna, Aurum
See Leading Indications for Ophthalmic Medicines.
116. Eyestrain.
DEFINITION. – A convenient expression which may be taken as meaning that the eyes cannot be used as they should be in a state of health, without entailing a strain upon the muscles of the eye, which in its turn betrays its presence by local or general discomfort.
CAUSES. – Some often unsuspected, error of refraction, or deficiency in the focusing system (accommodation), or in muscular action, of the eye. Slight degrees of hypermetropia (longsight), with or without astigmatism, is the commonest cause of eyestrain. Other things being equal, it is the small error of refraction and not the large which is usually responsible for the symptoms.
Eyestrain is more likely to show itself among the cultivated than among the uncultivated members of society-the small error of refraction that would pass unnoticed in a labourer might produce marked discomfort in hard-worked literary man.
An error of refraction is naturally more likely to cause headache if the patient is debilitated. It is far from uncommon for the discomfort to make its appearance for the first time under such circumstances, even although the underlying ocular defect may have existed from childhood.
SYMPTOMS. – It is most important to bear in mind that the suffers from eyestrain rarely complain of any defect of vision. Indeed, they not infrequently warmly repudiate any suggestion that the eyes are at fault by asserting that they have a very good sight – and so they often have; but how do they obtain it? At the expense of a strain upon the eyes, or otherwise?
Headache is the commonest manifestation of eye-strain. It has been estimated that from eighty to ninety per cent. of all headaches are of this origin. Whenever headache, neuralgia, giddiness or other symptom is induced or made worse by use of the eyes and relieved by rest, it may be assumed to be due to eyestrain. That supposition is strengthened if the patient possesses sight which when estimated by test types is found to be normal or better than normal.
It is a suspicious circumstances if headache is complained of after a visit to a theatre or a picture gallery, or a journey by train, tram or car. There is nothing peculiarly characteristic about the headache except that the sufferer rarely suspects that his eyes are at fault.
The local evidences of eyestrain, which are sometimes present, assume the form of aching, tenderness, fatigue, throbbing, watering, and redness of the eyes. A frequent complaint is that lines of print becomes misty, and cannot be read again until the eyes have been closed for a few seconds. An outbreak of small styes is often a sign; so is frequent blinking.
That those who suffer from ocular headache sometimes suffer also from disordered general health can scarcely be looked upon as extraordinary. Such complaints as sleeplessness, confusion of thought, inability to fix attention, irritability of temper, and gastric disturbance are not rare, and these symptoms, like the headache may often be relieved by suitable glasses.
Eyestrain should always be thought of as a possible cause in all patients with insomnia, who use the eyes much.
TREATMENT. – Appropriate glasses prescribed after testing with ophthalmoscope and retinoscope by a competent ophthalmic surgeon.
The effects of eyestrain can often be relieved for a time at all events by medicinal treatment, and the leading of an outdoor and active life.
Many highly organized people experience considerable difficulty in becoming used to glasses; while some, alas will not preserve long enough to obtain any sensible relief. If the glasses are correct-not always an easy thing to make a patient believe-the only remedy is time. The uncomfortable feelings gradually become less and less marked, until in the course of a few weeks they are no longer experienced.
117. – Foreign Bodies.
Foreign bodies lodged in the conjunctival sac, unless embedded, are usually found under the upper lid. If the lids be everted they are easily removed with a clean spud, needle, etc. If necessary a drop of four per cent. Cocaine solution may be first instilled into the eye, in which case the eye should be subsequently bandaged for a few hours until the effect of the Cocaine has passed off.
To evert the upper lid, make the patient look strongly down; seize the eyelashes of the upper lid with the thumb and forefinger of the left hand; push down with the thumb of the right hand the skin of the upper lid, three-eighths of an inch above the lid margin, then evert by pulling the lid upwards against the point of the thumb
Many foreign bodies are dislodged by simply using the eye-bath with warm water.,
Lime frequently gets into the conjunctival sac and produces a caustic effect. Water must never be applied to these cases, but a strong solution of sugar, which will form with the lime an insoluble lime salt; or a few drops of oil may be placed between the lids.
118. -Myopia-Nearsightedness.
Defect in distant vision is the commonest symptom, and if the short sight be more than a very moderate degree it will be found that the patient hold print nearer than normal to the eye.
Myopia is due to stretching of the globe of the eye, so that the eyeball is longer than normal. It may often be suspected by the prominence of the eye.
Myopia tends to increase, but the increase does not occur as a rule after twenty-five year of age. Any severe illness, and especially congestion of the eyes brought about by excessive strain in near vision, and stooping over books, etc., favours its progress.
City or town residence by the constant self-adaptation of the eyes to short distances, is a powerful predisposing cause. It cannot but make a vast difference in the condition of the eye in the course of years, whether it is daily employed in looking at walls a few feet distant, or as in the country, at mountains and forests, which often are in view miles distant.
TREATMENT. – In the majority of cases no medical treatment is required, but only the choice of suitable glasses. These should not be purchased at random, but under the guidance of a competent ophthalmic surgeon.
119.-Cataract.
DEFINITION. – Opacity of the crystalline lens, or its capsule, causing obscuration or total loss of vision.
Cataract may be present at birth (congenital cataract) or acquired. It may be partial or complete, and it may be stationary or progressive.
SYMPTOMS. – The symptoms produced depend on the density and position of the cataract or the defect of vision caused thereby. A very thin cataract may cause practically no defect of vision.
The opacity comes on in a gradual manner, first affecting one eye, afterwards both, and is often discovered by accident only. Objects appear to the patient as if seen through a mist or gauze, and a flame is observed surrounded by a halo. Vision is less affected in a weak light, such as twilight, or when the patient has his back to the window, under such circumstances the pupil dilates and the light enters at the circumference of the lens. For the same reason Atropine, which dilates the pupil, improves vision. The patient may also see better in an oblique than in a straight direction. The patient does not become so blind but that he can distinguish day from night, the position of the window, the shadow of passing objects, and is able to find his way about his own house with little difficulty.
LICENTIATE OF THE ROYAL COLLEGE OF PHYSICIANS; MEMBER OF THE ROYAL COLLEGE OF SURGEONS; LICENTIATE IN MIDWIFERY, LONDON AND EDINBURGH, ETC. PHYSICIAN TO THE READING AND BERKSHIRE HOMOEOPATHIC DISPENSARY.
Author of "The Stepping Stone to Homeopathy and Health,"
"Manual of Homoeopathic Treatment". Editor of "The Homoeopathic World."