Calcarea carb.-Especially indicated in pterygium caused from exposure to wet and cold.
Chimaphila.-This drug has been used with some success in many cases in which no marked indications have been present, though it has also often failed to improve.
Argent. nit., Arsen., Cannabis., Psorinum, Ratan., Spigelia, and Sulph. have also been used.
Sub-conjunctiva Ecchymosis, or an effusion of blood beneath the conjunctiva, may come from a blow, operations, or anything causing cranial congestions-the lifting of weights, coughing, vomiting, etc. It is quite common in old people with atheromata, and occurs in children with whooping cough, from vomiting, etc. Appears as a patch or deep red ring around the cornea. Looks alarming, but is generally of no importance, gradually disappearing of its own accord and presenting various shades during the process of absorption.
TREATMENT.-Applications of cold water, ice compresses, or a solution of one of the following remedies are advised, unless due to some chemical injury.
Arnica.-An important remedy for traumatic conjunctivitis or keratitis, following blows and various injuries of the eye. It is particularly called for immediately after the injury, before the inflammatory symptoms have really set in, though it is also useful in the later stages. Both spontaneous and traumatic haemorrhages into the conjunctiva have been promptly absorbed under the use of Arnica. The relaxation of the blood-vessels and too fluid conditions of the blood, which predispose to these haemorrhages in whooping cough have seemed to be corrected by this drug.
Ledum pal.-Is more commonly called for in both traumatic and spontaneous ecchymoses of the conjunctiva than any other remedy. It also often seems to correct the tendency to haemorrhage in these cases. Of value in inflammation of the conjunctiva in which extravasations of blood predominate.
Hamamelis virg.-Has proved very beneficial in traumatic conjunctivitis and keratitis consequent upon burns or other injuries. It also seems to hasten the absorption of conjunctival haemorrhages. “Pond’s Extract” may be used locally.
Aconite.-There is no remedy more frequently useful than this in inflammatory conditions of the eye resulting from the irritant action of foreign bodies, as cinders, chips of steel, stone or coal, which produce a variable amount of redness and pain, with a sensation of dryness, heat and burning in the eye.
Calendula.-Useful in traumatic, inflammation of the conjunctiva or cornea following any operation or resulting from a cut wound of any description.
Cantharis.-Ophthalmia traumatica caused from any burn, as from the flame of a candle, explosion of fireworks, etc., especially if characterized by much burning pain in the eye.
Any of the above remedies, with perhaps the exception of Cantharis, should always be used locally as well as internally in proportion of from ten to twenty drops of the tincture to the ounce of water. Compresses wet in this should be laid upon the eye.
Euphrasia, Hepar, Ignatia, Nux., Rhus., Silicea and other remedies may prove serviceable when special indications point to their use.
Sub-conjunctival Emphysema.-This is a puffy condition of the conjunctiva in which there is a sensation of crepitus to the touch, the swelling disappearing on pressure. It is of diagnostic value in other diseases, as it may be due to fracture of the orbital wall, opening a communication between the sub- conjunctival tissue and the nasal fossa, the frontal sinus or the ethmoidal cells. It also may occur from rupture of the lachrymal sac or tear passage, which allows the air to enter the tissues on blowing the nose.
Tuberculosis Conjunctivae.-This disease is of rare occurrence, but that it does occur has been demonstrated by microscopical investigation. Knapp Archiv. Ophthal., vol. xix., I, 1890. produced tuberculous disease in the eyes of rabbits by inoculation from a case of tuberculosis of the conjunctiva. The lymphatic glands of the neck on the same side as the affected eye are apt to be involved. The disease usually commences in the conjunctiva of the upper lid, occurs in young subjects and is apt to affect but one eye. There is a thickening of the eyelids, the swelling is somewhat reddened and of a soft, elastic feeling. On everting the lid the conjunctiva appears covered with exuberant granulations of grayish red color which are somewhat flattened and of a nodular appearance. There may also be one or more ulcerations in the palpebral conjunctiva. These granulations seem to spring especially from the retro-tarsal fold and are accompanied by a profuse purulent secretion. The cornea may become affected with pannus. Arlt plus Klinische Darstellung der Krankheiten des Auges, S. 98, 1881. says a positive diagnosis can only be made after a microscopical examination. Swan M Burnett (++) Archiv. Ophthal, vol. xix., 2, 1890. reports a case that was undoubtedly of primary origin, and argues that the condition is more often primary than secondary.
TREATMENT.-Fontan Rec. d’ophth., No. 10, 1886. advises scraping out the nodules and dusting iodoform upon them. The use of the galvano-cautery, as well as the knife to destroy the local products, is recommended by Knapp (loc.cit.). Internal medication, such as is used in tuberculous conditions elsewhere, should be followed.
Lesions of the Conjunctiva.-Foreign bodies penetrate the conjunctiva and may cause irritation if not removed early. They are mostly found on the inner surface of the upper lid, 2 to 3 mm. from the posterior border; the shallow border between cornea and sclera; the upper fornix. If allowed to remain, they set up hyperaemia and catarrhal conjunctivitis. They should be removed.
Wounds from sharp instruments, so long as they do not involve other structures, are not important and readily heal. When extensive, clean the wound carefully, unite the edge with sutures and apply cold compresses.
From burns and cauterisms by chemical reagents there is caused thick, whitish patches that project above the mucous surface and may result in severe pain and inflammation. Danger depends on the size, their influence on the cornea and the amount of cicatrization causing symblepharon.
TREATMENT.-If dependent upon some foreign body which has lodged on the conjunctiva, the first point to be attended to is its removal, which is generally easily effected. After which, directions should be given to bathe the eye in cold water or a weak solution of Aconite, Arnica or Calendula. This will usually suffice, though in severe cases it may be advisable to drop a little olive oil into the eye after removing the foreign body.
Chemical Injuries, especially from lime, are, unfortunately, of frequently occurrence and very dangerous in their nature on account of the formation of deep sloughs, which have a great tendency to result in symblepharon. If seen early, we should endeavor to remove as much as possible of the lime and then drop into the eye either a little olive oil, oil of sweet almonds, milk, weak solution of vinegar, or some substance which will unite with the lime and from an innocuous compound. Water should never be employed. Great care should be taken while the wound is healing that no adhesions between the lids and ball occur. If there is a tendency in this direction, the adhesions should be broken up once or twice a day by means of a probe.
When the injury is from strong acids, as sulphuric or nitric, the eye should be syringed out with a weak solution of carbonate of soda or potassa (Dj to z3vi aq. destil.) in order to neutralize the acid; afterwards olive oil should be dropped in. To relieve the severe pain a few drops of a 4 percen solution of cocaine may be instilled.
Tumors of the Conjunctiva.- Nearly all varieties of tumors, either benign or malignant may occur in the conjunctiva, and will be but briefly referred to.
Pinguecula is a yellowish-white swelling, the size varying from that of a pin-head to a pea, situated usually on the nasal side and near to the cornea. Fuchs says: It consists of a thickening of the conjunctiva with increase of its elastic fibres and an infiltration of hyaline into the tissue elements. It contains no fat as is usually considered from the appearance of the swelling. They are due to erosions from foreign bodies, are of no importance and need no treatment.
Dermoid Tumors are small, smooth and of a yellowish gray appearance, of a size varying from a pea to a hazel nut and are located at the margin of, and growing some upon the cornea. They are especially apt to be found at the lower and outer border of the cornea and hairs are sometimes seen growing from them. They consist, according to Fick, of a thick layer of stratified epidermis cells beneath which are connective tissue, fat cell smooth muscular fibres, glands and hairs, all being tissues of the external skin. They are congenital, have a tendency to increase in size and are apt to recur, if not all removed. They should be removed for cosmetic purposes and because they are liable to gradually encroach more and more upon the cornea. Remove with a cataract knife, first from the cornea and then from the sclerotic. They enter very deep into the substance of the cornea, but if suffices to remove on a level with the cornea.
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.