CAUSES-Especially apt to occur in children and may be found in the perfectly healthy child as well as the weak and delicate ones. It is, however, most frequently seen in children of a scrofulous diathesis. Any irritating influence may cause it, such as errors in refraction, etc. It is again frequently observed associated with or following the exanthematous diseases. Bissell The Homoeopathic Eye, Ear and Throat Journal, Vol. II, p. 10, 1896. calls attention
DIFFERENTIAL DIAGNOSIS.
Conjunctivitis Phlyctenularis.
One or more small nodules usually at the corneal border. The phlyctenule forms the apex of a triangular shaped congestion, the vessels running to the nodule.The vessels are more superficial and movable on pressure. No discharge. Runs a rapid course and heals
by ulceration. Conjunctivitis Catarrhalis
Has no localized elevations. The inflammation is general and of the conjunctival vessels alone. Discharge is more or less profuse. Intra-nasal conditions as playing a very important factor in the causation of this trouble.
Episcleritis. The elevation has a very much larger base, its color is darker and shows no tendency to ulcerate. The congestion is much deeper, more of a bluish tint, and overlying the scleral vessels are seen the conjunctival vessels, which by pressure are made to move over the swelling. Little or no discharge. Course very chronic.
TREATMENT-It has been thought best to include under this head the various forms of phlyctenular inflammation of the eye, whether affecting the cornea or conjunctiva, as the aetiology, symptomatology, course and treatment vary little in either case; in fact, those remedies which have been found useful when the cornea is invaded are also our chief reliance in this form of inflammation of the conjunctiva.
The first points to be attended to are cleanliness and careful regulation of the diet. It is our rule to always prohibit all sweets and fats from the diet and confining the child mainly to milk, eggs, beef. mutton, etc. The eyes should be bathed often in lukewarm water, and any little scabs which may have formed on the lids immediately removed, as they only prove a source of irritation. If there is considerable photophobia, and the child is rubbing the eyes constantly, a compress bandage will prevent this, and at the same time, by keeping the lids closed, will relieve the irritation to the eyeball occasioned by their constant opening and closing; it also excludes the light, relieving the photophobia, soaks up the tears and so prevents their running over the cheek, making it sore and excoriated. The bandage is very seldom required, but when it is, should be removed every four or five hours and the eyes cleansed. External applications should not, as a rule, be employed, as we can usually cure better and quicker with internal remedies alone, if we are careful in the selection of our drugs. Occasionally, however, a case will be found which has proved very obstinate to treatment, where the ciliary injection is great, photophobia intense, and pupil a little sluggish in which a weak solution of Atropine dropped into the eye once or twice a day will be of great benefit. In some slow, indolent cases, the use of the following to stimulate into a more active condition is of value.
R/ Hydrarg. oxid. flay vaseline.
Misce.
Of this, a very small piece, not larger than the head of a pin, may be placed within the eye once or twice a day.
The most frequently indicated remedies are Pulsat., Sulphur, Hepar, Ipecac., Graphites, Calcarea, carb., Calcarea iod., Chamomilla, Conium, Mercurius, Arsen., Rhus tox., Euphras., Antimon. crud., Aurum, Kali bich., Nux vomica, Sepia, Apis, Baryta, Natrum mur., Psorinum. See Remedies in Conjunctivitis.
Remedies in Conjunctivitis.
Acetic acid-A remedy of the first importance in croupous conjunctivitis in which the false membrane is dense, yellow-white tough, and so closely adherent that removal is almost impossible. The lids are oedematously swollen and red. Although the membrane is closely adherent, it is not in the tissue, and so does not correspond to diphtheritic conjunctivitis.
Aconite-Is especially indicated in the first stage of any inflammation of the conjunctiva when the eyes are red, burning, very painful and with great dryness. The conjunctiva is intensely hyperaemic, may be oedematous and even chemosed. The eyes are usually dry, but may be useful when there is a moderate lachrymation and a muco-purulent discharge. The pain is generally described as smarting, burning with sensitiveness to the air, but their is often an aching or bruised pain, with the feeling as it the eyeball was enlarged and protruding, making the lids tense. Especially useful in an inflammation from a foreign body, in acute catarrhal or an acute aggravation of granular lids and pannus, particularly when induced by overheating, violent exercise, or by exposure to dry, cold air. It is in the Aconite cases that ice is especially serviceable.
Alumina Cepa.-Of use in acute catarrhal conjunctivitis associated with a similar condition of the air passage, as in hay fever; the lachrymation is scalding, profuse and not excoriating, though the nasal discharge is so (reverse of Euphrasia).
Alumina-In chronic granular lids where there is much marked dryness of the lids and eyes, especially in the evening, with burning, itching and pressure always aggravated from overuse of the eyes, and accompanied by a sensation of dryness, with a moderate discharge and a heavy feeling in the lids.
Antimonium crud-In phlyctenular or pustular conjunctivitis, especially in cross children who are afflicted with pustules on the face and moist eruptions behind the ears. The lids are red, swollen and excoriated by the profuse mucous discharges and lachrymation. Excoriation of the nostrils and swollen upper lip. (Similar to Graphites)
Apis mel.-May be indicated in any form of conjunctivitis if there is great swelling (oedematous) of the lids and adjacent cellular tissue. The conjunctiva is congested and of a dark, red, puffy condition. The discharge is moderate, while the lachrymation is profuse, hot and burning, with photophobia (Rhus). The tears while hot and burning do not excoriate the lids, as in cases in which Arsenicum is indicated. The character of the pains, which are stinging and shooting, is an important indication, and serve to distinguish between Apis and Rhus cases which objectively are very similar. The symptoms are aggravated in the evening and often concomitant symptoms, such as drowsiness, absence of thirst, and dropsy, are present.
Argentum nit-This is the most serviceable remedy in the whole materia medica for any form of purulent inflammation of the conjunctiva. The most intense chemosis with strangulated vessels, profuse purulent discharge and commencing haziness of the cornea, with a tendency to slough, have been seen to subside rapidly under this remedy. The absence of subjective symptoms, with the profuse purulent discharge, and the swollen lids, swollen from being distended by a collection of pus in the eye, or from swelling connective tissues of the lids themselves (as in Rhus or Apis), indicates the drug. In the blenorrhoeal stages of conjunctivitis when the discharge becomes profuse and assumes a purulent character. In some chronic forms of conjunctivitis when the conjunctiva is scarlet-red and the papillae hypertrophied. The inflammatory symptoms usually subside in the open air and are aggravated in a warm room. In the early stages of acute granular conjunctivitis, if the conjunctiva is intensely pink or scarlet- red and the discharge is profuse. The use of a solution of five or ten grains of the first decimal trituration to two drachms of water, as a local application, after the very profuse discharge has subsided, is often of very great value.
Arsenicum.-Especially of service in phlyctenular conjunctivitis after the pustules have broken leaving a superficial ulceration. Also in acute catarrhal conjunctivitis with chemosis, much hot, scalding lachrymation, burning pains, especially at night, and an oedematous condition of the lids, particularly the lower. Indicated in chronic granular lids, when the palpebral conjunctiva only is inflamed; the lids are painful, dry, and rub against the ball; they burn and can scarcely be opened. In chronic forms if the lachrymation and discharges are thin and acrid excoriating the lids and cheek. The photophobia is usually intense, and often relieved in the open air. The lids may be oedematous and spasmodically closed, or else inflamed and excoriated by the acrid discharges. The nostrils and upper lip ate usually excoriated by the acrid coryza. It is especially indicated in low, cachectic conditions, and the ill-nourished, scrofulous children of the poor. Great restlessness and thirst for small quantities of water are commonly noticed. Warm applications generally relieve. The attacks of inflammation are frequently periodic and often alternate from one eye to the other.
Aurum met-Scrofulous ophthalmia, with ulceration and vascularity of the cornea. Useful in trachoma, either with or without pannus (especially when pannus is present); there is probably no other remedy given internally along that has cured more cases. Photophobia severe, lachrymation profuse and scalding; eyes very sensitive to touch. The pains are from without inward, and worse upon touch (reverse of Asafoetida). The cervical glands are usually swollen; patient very irritable and sensitive to noise.
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.