Syphilinum.-Chronic recurrent phlyctenular inflammation in scrofulous, delicate children, especially if there is any taint of hereditary syphilis. The photophobia will be intense and lachrymation profuse.
Terebinth.-In catarrhal conjunctivitis with great redness, usually dark in color, with severe pain in the eye and corresponding side of the head. Some pain in the back, and urine dark in color.
Thuja occid.-Favorable results have been gained by the use of this remedy in conjunctivitis trachomatosa, when the granulations have been large, like warts or blisters, with burning in the lids or eyes, worse at night; photophobia and suffusion of the eyes with tears.
Zincum.- In conjunctivitis, especially when confined to the inner half of the eye, with much discharge; worse toward evening and in the cool air. Generally there is itching, and perhaps pain, in the internal canthus.
Conjunctivitis Vernalis.-This condition is sometimes called spring catarrh, but the name catarrh seems to us wrong, because there is no discharge in this disease. It is characterized by a phlyctenoid eruption on the conjunctival limbus, which becomes a swollen ring, more or less large, encircling the cornea, the growths are hard, uneven, and of a brownish, gelatinous appearance. The swelling and redness are greater at the outer and inner sections of the conjunctiva. These nodules are unlike phlyctenules, in that they never ulcerate, and may remain with slight variations in size for years. The papillae of the tarsus are broad and flattened, and over the surface of the conjunctiva appears a bluish white film. It affects children especially from the seventh to the twentieth year, and almost always attacks both eyes. The great characteristic of this disease is that the annoyance-redness, photophobia and itching-comes on every spring, lasting through the warm weather, and goes off with the cool days of autumn and is entirely absent during the winter months. There is usually but slight photophobia, with occasionally some pain. The disease is rare, but is usually controlled after one or two seasons, without leaving any affection of the cornea behind.
TREATMENT.-See that given for Conjunctivitis Phlyctenularis. Sepia and Nux vom, have proven of special value in this disease.
Amyloid Degeneration of the Conjunctiva.-This is a very rare disease which is occasionally confounded with granulations. It consists of a hypertrophy of the mucous membrane, especially of the upper cul-de-sacs and semi-lunar folds, which become of so great a thickness as to often protrude between the lids. The conjunctiva appears like a yellow gelatinous looking mass, in the substance of which are semi-transparent granules, which are usually larger and more transparent than the granules of trachoma. On everting the lid the tarsus appears as though covered with wax. The tarsus is itself thickened and metamorphosed.
TREATMENT.-Excision of the mass.
Pemphigus Conjunctivae.-This is an extremely rare disease that is generally found in conjunction with eruptions of pemphigus vulgaris upon the skin. It is manifested by raw spots upon the conjunctiva, which become covered with a gray coating, and undergo cicatricial contraction. By the formation of other spots which gradually pass through the same process of cicatrization, the whole conjunctiva in the course of months or years becomes involved. The cornea becomes cloudy and dry, and in the bad cases the lids become completely adherent to the eyeball (symplepharon) and the eye is incurably blind. A very interesting case of this disease has been described by MacLachlan.The Homoeopathic Eye, Ear and Throat Journal, VOl. II., p. 35, 1896. Treatment of this disease has so far proven of no avail.
Xerosis Conjunctivae is a dryness of the conjunctiva from atrophy. Where the whole stroma of the conjunctiva is affected it is called parenchymatous, and where the atrophy is superficial it may be called partial or epithelial. When confined to only a part of the mucous membrane it is called xerosis glabra, and when it occupies the entire structure, xerosis squamosa, and in the latter the cornea is usually affected, when it is termed xerophthalmia. This condition is usually caused by inflammations that leave cicatrices, as in diphtheritic and granular conjunctivitis and burns of the conjunctiva. Idiopathic parenchymatous xerosis is extremely rare, but may occur as a sequelae of the desquamative skin diseases, especially psoriasis and pemphigus.
Epithelial xerosis is more common, and is usually a sequela of conjunctivitis vernalis, although it may be idiopathic. In this form we may find grayish-white patches of a satin-like lustre on the conjunctiva and most often on that part of the ocular conjunctiva left uncovered when the lids are opened.
In complete xerosis the conjunctiva is pale and dry, with small scales; the cul-de-sac and semi lunar folds are obliterated and the palpebral conjunctiva is directly continuous with that of the eyeball. The cornea is opaque, atrophied and diminished in all of its diameters. The Meibomian glands are atrophied, the ducts of the lachrymal gland and the puncta lachrymalis are obliterated. The absence of secretion causes dryness of the eye and the movements are limited by the retraction of the mucous membrane and the adhesions.
TREATMENT.-Can only be palliative, that is, ameliorate the excessive dryness which gives rise to so much heat and pain. Milk answers the purpose very well, or a weak solution of glycerine and water, to which one percent. of salt should be added. Artificial serum is perhaps better still. “Cold expressed castor oil has also proved effectual.”–Thomas.
Pterygium.-Is a vascular triangular thickening of a portion of the conjunctiva. Its apex rests on the edge of the cornea. It may be movable or adherent to the globe, and its width varies. The most frequent location of a pterygium is over the internal rectus muscle, less frequently over the external rectus. It is called membranous when thin and not inflamed, and sarcomatous when thick and accompanied by more or less conjunctival catarrh. Pterygium grows very slowly and has a tendency to spread over the cornea, though rarely seen to grow beyond the centre of the pupil.
CAUSES.-Arlt says they are due to small ulcers at the corneal margin which, in cicatrization, draws the epithelium of the conjunctiva forward, which then folds upon itself and becomes inflamed and vascular. Horner says that it is the result of a pinguecula, forming a cavity between it and the corneal margin in which secretions and small foreign bodies become lodged; that these then cause ulcerations at the corneal border, which in cicatrization, draws the pinguecula upon the cornea. It occurs mostly in individuals who are exposed to constant irritation of the conjunctiva, from dust, etc., and is only found in adults.
PROGNOSIS.-Depends on the extent of the cornea involved and the tendency to progress as it only affects the vision when it has extended over the pupil. The cornea remains opaque after its removal and the growth may recur.
TREATMENT.-As a rule operative measures will have to be resorted to, both to prevent loss of vision and for cosmetic purposes. Numerous methods have been advocated, chief among which are excision, ligation and transplantation.
Excision is perhaps the best and most frequently performed. The pterygium is raised with the forceps, a narrow knife is passed under the growth and a cut made to the corneal border; then, with a strabismus hook, pull it off from the cornea and with the scissors cut off at the base with converging incisions and unite the edges of the membrane with sutures-usually three.
Ligation is performed with a thread having a needle at each end. Raise the growth with the forceps and pass one needle from above downward under the growth near the cornea and the other at the base of the pterygium; now cut off your needles and tie the sutures; one takes in the base, the second the apex and the third detaches it from its posterior surface.
Transplantation is by detaching from the cornea and sclera so that it adheres only by the base, then make an incision in the conjunctiva below and parallel to the cornea and fasten the apex of the growth in this incision with sutures. When large it may be divided and inserted half above and half below the cornea.
Zincum.-Zinc has been more frequently employed and with greater satisfaction than any other remedy, especially in that form of pterygium which extends from the inner canthus (as it usually does), for the majority of the eye symptoms are found at the inner angle, as will be noticed by examination of the provings. The lachrymation is usually profuse and photophobia marked, especially by artificial light. The pains are pricking with itching and soreness in the inner angle worse at night; also itching and heat in the eyes, worse in the cold air and better in a warm room; external canthi cracked; green halo around the evening light. There may also be present great pressure across the root of the nose and supra-orbital region.
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.