CAUSES.-Choroiditis of all forms, in a very large proportion of cases, is due to syphilis, and in those cases not resulting from that disease there seems to be a decided hereditary trait. Scrofula, chlorosis, anaemia and similar general disorders of nutrition may cause choroiditis. Other cases are connected with, or extend from, a progressive posterior staphyloma. The disseminate and central forms of choroiditis may occur spontaneously, so far as any direct cause can be determined, while the areolar form seems to occur frequently in tutors, governesses and others of whom it may be said their occupation requires what may be called an intelligent use of the eyes. Gould Archiv. Ophthal., vol. xix., I, 1890. reports cases of central choroido-retinitis, which he attributes to ametropia, believing that chronic uncorrected ametropia may result in permanent lesion in the region of the macula, with pigmentary changes, which he thinks may result from straining of the retina in an effort to secure a clear image.
TREATMENT.-Under this heading we shall consider the treatment of the several forms of choroiditis already described.
Rest in a darkened room for a long period has been recommended for inflammation of the choroid. This, together with bandaging of the eye, will answer in some cases of acute serous inflammation, but its tendency to impair the general health usually renders it unsafe, especially in chronic cases and in the disseminate form of inflammation, in which it is far wiser to allow moderate exercise in the open air, with the eyes protected from the bright light by smoked or blue glasses. Complete rest of the eyes from all work should always be required. Atropine may be useful in some cases, as it paralyzes the tensor choroidea, thus preventing any movement of the inflamed tissue upon change of light. In the serous variety, if the intra-ocular tension becomes increased, frequent paracentesis may be performed, or if this does not suffice an iridectomy must be made. Abstinence from all stimulants proper hygienic measures are necessary.
Aurum.- Choroiditis, with or without retinal complication, especially if there is exudation into the choroid and retina or into the vitreous, causing haziness of the vitreous. We may have sensitiveness to light and touch, ciliary injection and some pressive pain in the eye from above downward or form without inward, aggravated on touch, or pain in the bones around the eye. A general feeling of malaise and depression of spirits is often present.
Kali iod.-It is the remedy for syphilitic choroido-retinitis characterized by great haziness and exudation into the vitreous, which may vary from day to day; also for syphilitic disseminate choroiditis, with little or no haziness of vitreous. Much benefit has been derived from its use in simple disseminate choroiditis even when the atrophic changes in the choroid are far advanced or when the whole uveal tract has become involved.
Mercurius.-The various preparations are used, according to special indications, though the corrosivus or solubis is more often needed. Mercury is of great value in choroiditis, especially disseminate, and when the iris is also involved (irido-choroditis.). The syphilitic dyscrasia would particularly point to its use, though it is indicated in non-syphilitic cases. The pains are usually intense both in and around the eye, varying to a great extent in character. The nocturnal aggravation of all symptoms is of importance in the selection of this remedy, as well as the general condition of the patient.
Phosphorus.-Both serous and disseminate choroiditis have been benefited, especially when accompanied by photopsies and chromopsies of various shapes and colors (red predominating). We find in the proving of Phosphorus, that it has produced hyperaemia of the choroid, and experience shows that it is often adapted to this condition. When sexual excesses seem to be the cause of the trouble this remedy is indicated. The optic nerve and even retina may show decided hyperaemia. Black spots pass before the vision. There may be some dread of light. The eyes seem better in the twilight. Particularly suitable to lean, slender persons, and especially if complicated with cough, etc.
Bryonia.-Serous choroiditis, or inflammation of the uveal tract, following rheumatic iritis. From serous infiltration into the vitreous the haziness is often so great as to seriously interfere with our view of the fundus. The vessels of the fundus are congested; the pupils may be somewhat dilated and the tension increased. The eyeball feels sore to touch and motion, while darting pains through the eye into the head are usually present.
Gelsemium.-It may be of service in the plastic forms of choroiditis, but its grand sphere of action is in serous inflammation of the uveal tract, especially if anterior to the equator, with great haziness of the humors. The impairment of vision will be great; may be slow and gradual or subject to sudden changes. The haziness of the vitreous is usually fine; the tension may be increased and pupil dilated. The iris may be involved with tendency to posterior synechiae. The pain is dull, aching, pressing, in and over the eyes; may extend to occiput and be relieved by hot applications. Eyeball sore to touch. Heaviness of the lids. Headache, general depression, loss of muscular tone, fever and thirstlessness.
Belladonna.-An important remedy in hyperaemia or acute inflammatory conditions of the choroid, particularly of the disseminate variety and accompanied by congestive headaches. The optic disc is of a deep red color and the retinal vessels enlarged, especially the veins. The pupil is slightly dilated, ciliary injection usually marked and the eyes sensitive to light, with full feeling usually marked and the eyes sensitive to light, with full feeling as if pressed out of the head. Disturbances of the vision are often present, as halo around the light and various flashes of light and sparks. The headache and constitutional symptoms decide our choice.
Kali mur.-The benefit derived from its use in the absorption of exudations has been demonstrated in exudative choroiditis.
Nux vomica-In disseminate choroiditis occurring in persons addicted to the use of stimulants, also when atrophic changes are even far advanced, Nux often seems to materially improve the degree of vision. The eyes are especially weak and sensitive to light in the morning. Gastric derangements and other constitutional symptoms are of great importance in selecting this drug.
Prunus spin.-Inflammation of the choroid, either with or without iritic or retinal complication. Haziness of the vitreous and other common symptoms of the disease are present, but the characteristic indication will be found in the pain, which is usually severe, as if the eyeball were being pressed asunder, or else sharp, shooting and cutting through the eye and corresponding side of the head, or crushing in character.
Pulsatilla.-Hyperaemia of the choroid or sub-acute cases of choroiditis occurring in women of a mild, tearful, yielding disposition and when accompanied by amenorrhoea; also in tea drinkers who are subject to neuralgic headaches. Eye symptoms not characteristic.
Sulphur.-Chronic cases of choroiditis, especially if occurring in a strumous subject. Sharp darting pains are usually present. Often assists in clearing the vitreous and completing a cure after other remedies have been used with advantage. The hemeralopia found in some cases may be relieved.
Veratrum vir.-Choroiditis, especially in women with much vaso-motor disturbance. Aching pains in the eyes, becoming sharp in the evening. Photopsies. Painful menstruation and aggravation of eye symptoms at that time.
In addition to the above, the following remedies have been employed with favorable results: Aconite, Arsen., Duboisin, Hepar, Jaborandi, Psorinum, Ruta, Silicea
Choroiditis Suppurativa (Choroiditis Metastatica. Panophthalmitis, Traumatic Purulent Choroiditis).-The characteristic feature of purulent choroiditis is an infiltration and new formation of cells in the parenchyma of the choroid, and as the disease advances, the whole structure of the choroid and uveal tract becomes filled with round cells, and the retina and vitreous are infiltrated with pus cells. The purulent inflammation may extend outward and thus may finally result in a purulent infiltration of all the membranes of the eye (panophthalmitis). Schobl Archiv. Ophthal. vol. xx., I, 1891. describes the pathological anatomy in twenty-seven cases of panophthalmitis, and concludes that, from whatever cause it occurs, it commences as a fulminating purulent retinitis or choroiditis, or both together, and from this rapidly extends to the other coats.
SYMPTOMS AND COURSE.-The lids are oedematously swollen, red and puffy, the conjunctiva chemosed, and, from the inflammation of the capsule of Tenon, there is exophthalmos, with limitations in the movement of the eye. The corneal is hazy, the aqueous cloudy and hypopyon rapidly forms. There are posterior synechiae, the anterior chamber shallow and the tension is liable to be increased. The white reflex from the fundus is present and indicates the formation of pus within the eye. In this form of choroiditis the pain in and around the eye is usually very severe and the eye is sensitive to touch. Tension of the eye is diminished. The rapid onset and course is apt to be accompanied with high fever, vomiting and other general manifestations. Destruction of vision takes place early and the suppurative process quickly results in perforation and atrophy of the eyeball.
Professor of Ophthalmology in the College of the New York Ophthalmic Hospital; Surgeon to the New York Ophthalmic Hospital. Visiting Oculist to the Laura Franklin Free Hospital for Children; Ex-President American Homoeopathic Ophthalmological, Otological and Laryngological Society. First Vice-President American Institute of Homoeopathy : President Homoeopathic Medical Society of the State of New York ; Editor Homoeopathic Eye. Ear and Throat Journal : Associate Editor. Department of Ophthalmology, North American Journal of Homoeopathy, etc.