Paracentesis, may also be resorted to in the above cases, though it has been nearly supplanted by Saemisch’s incision, which, in the majority of instances, is far preferable. The puncture should be made with a fine needle, through the deepest portion of the ulcer, the aqueous allowed to flow off as gently as possible and a compress bandage applied. It is not necessary to wait too long before making a paracentesis, as it aids repair by relieving the pressure from intra-ocular tension and may be repeated several times, if necessary. We have often found very good results from Felchenfeld’s Zehender’s klin. Monatsbl. f. Augenheilk., vol. xxviii., p. 502 method of scratching out superficial cornea ulcers with a gouge or needle and then applying an antiseptic dressing. All ulcers should be closely watched that we may detect any hernia of the cornea or prolapse of the iris as soon as they occur. If a prolapse has taken place and is of recent origin, we should endeavor to replace it, either by dilating or contracting the pupil according to its situation; if this proves inadequate, the protruding iris should be snipped off with a pair of scissors, Atropine instilled and a pressure bandage applied.
In some very indolent ulcers the application of a mild irritant, such as the powdered calomel, or the yellow oxide of mercury ointment, page 107, will materially aid the process of repair.
Hepar.-This is one of the most frequently indicated remedies for ulcers and abscesses of the cornea, especially for the deep, sloughing form and when hypopyon is present. Also useful in acute aggravation of pannus tending toward ulceration.
Some torpid forms of ulcers and abscesses have been benefited, though usually the symptoms are well pronounced when this drug is indicated. There is intense photophobia, profuse lachrymation and great redness of the cornea and conjunctiva, even chemosis. The pains are severe and of a throbbing, aching, stinging character, ameliorated by warmth and aggravated by cold or uncovering the eye and in the evening. There is marked sensitiveness of the eye to touch. The lids may be red, swollen, spasmodically closed and bleed easily upon opening them. For the absorption of pus in the anterior chamber (hypopyon) there is no better than Hepar. Cases found in strumous, outrageously cross children, should suggest this drug. Generally symptoms of chilliness, etc., are important.
Mercurius sol.-Mercury in some of its preparations is a common prescription for ulcers and abscesses, and as the soluble mercury of Hahnemann is perhaps more commonly employed than any other, we shall describe this more in detail and afterward give simply the variations found in the other forms.
Is adapted to both superficial and deep ulceration, especially in syphilitic or strumous subjects. The cornea, at the point of ulceration, is usually quite vascular, though may be surrounded by a grayish opacity, due to infiltration between its layers; the conjunctival redness is also marked. The dread of light is generally great, especially of artificial light, and the lachrymation is profuse, burning and excoriating, while the discharges are thin and acrid in character. The pains are often severe and vary in character, but are always aggravated at night, by damp weather or extreme cold and ameliorated temporarily by cold water. The lids are thick, red, swollen and excoriated by the acrid discharges, sensitive to extreme heat or cold and to contact and are forcibly closed. The concomitant symptoms of excoriation of the nostrils, flabby tongue, night-sweats, pain at night, etc., are usually present.
Calcarea Carb.-Particularly valuable for corneal ulcerations found in fat, unhealthy children with large abdomens, who sweat much, especially about the head and are very susceptible to cold air; also in deep, sloughing ulcers, found in weak, cachectic individuals. The pain redness, photophobia and lachrymation are variable, and though it is a prominent remedy for this disorder, there are no characteristic eye symptoms and we are guided in its selection chiefly by concomitant indications.
Calcarea iod.-Ulcerations in strumous subjects, with enlargement of the tonsils and cervical glands.
Calcarea hypophos.-This preparation of lime is most commonly called for in deep sloughing ulcers or abscesses found in weak, debilitated individuals. Especially indicated in crescentic ulcers following purulent conjunctivitis.
Arsenicum.-Especially when found in scrofulous, anaemic, restless children. The ulceration is chiefly superficial and has a tendency to recur first in one eye and then in the other.
The photophobia is usually excessive and the lachrymation hot, burning, acrid and profuse. The pains are burning, sticking; there may be throbbing, pulsating, or tearing, around eye, worse at night. The burning pains predominate and are worse at night, especially after midnight, when the child becomes very restless and cross. Bathing in cold water often aggravates, while warm water may relieve. Eyeballs sore to touch. Conjunctiva quite red; chemosis. Marked soreness on the internal surface of the lids, which are swollen externally (oedematous), spasmodically closed and often excoriated by the acrid discharges.
Rhus tox.-Superficial keratitis, with excessive photophobia and lachrymation, so that the tears gush out upon opening the spasmodically closed lids; if a child, will often lie with its face buried in the pillows all day. Profuse flow of tears is a very important symptom under this drug, and benefits is frequently derived from its use in superficial ulcerations of the cornea with granular lids in which this symptom is prominent. Keratitis caused from exposure in the water often calls for Rhus (Calcarea)
The redness of the eye is generally marked, with chemosis. The lids are oedematously swollen, especially the upper. An eruption may frequently be found around the eye, characteristic of the drug. The symptoms are generally worse in damp weather and at night after midnight, therefore the patients are restless at night and disturbed by bad dreams. A rheumatic diathesis would also influence our choice.
Conium.-An important remedy in superficial ulceration in which the surface of the cornea only is abraded. Thus, owing to the exposure of the terminal filaments of the nerves or to hyperaesthesia, there is intense photophobia and much lachrymation. On account of the great photophobia the lids are spasmodically closed, and when opened a profuse gush of tears occurs (Rhus). The discharges are usually slight and the pains variable, though aggravated by any light. But, notwithstanding all this photophobia, pain and lachrymation, we find upon examination very little or no redness of the conjunctiva, not sufficient to account for the great photophobia, which is out of all proportion to the amount of trouble. Strumous conditions, enlarged glands, etc., would assist us.
(Conium 0 has sometimes cured when the higher potencies have failed.)
Sulphur.-Both acute and chronic cases have been relieved, though it is more often to be thought of in the latter form, even in cases in which the destruction of tissue is great and pus is present in the anterior chamber, especially if the inflammation be indolent in nature, with no photophobia and but slight vascularity. Ulcerations occurring in or dependent upon a scrofulous diathesis, as shown by eruptions, etc., suggest this remedy. The most prominent eye indications which would lead us to its selection are the plains which are usually sharp and sticking as if a needle or splinter were sticking in the eye, or there may be sharp. shooting pains through the eye into the head, during the day or evening, rarely call for Sulphur, but for Spigelia, Bryonia, Cimicif., or the like). Again we may have a great variety of other sensations. The intolerance of light is generally great and the lachrymation profuse, though both are variable.
Mercurius prot.-Serpiginous ulceration of the cornea that commences at the margin and extends over the whole cornea, or a portion of it, especially the upper part, involving only the superficial layers. This form of ulcerations is more commonly found during the course of trachoma and pannus, in which the protoiodide of mercury has often proved its value. The vascularity of the cornea and conjunctiva is usually great, while the photophobia is excessive. The pains are the same as those given under Mercurius sol. Non-vascular central ulcer of the cornea with pain at night. A thick yellow coating at the base of the tongue is generally present.
Kali bichrom.-Especially of value in those cases of indolent ulceration, which prove so intractable to treatment; cases in which there is no active inflammatory process, only a low grade of chronic inflammation, therefore marked by no photophobia and no redness. The pains are generally slight and variable and the discharge, if any, of a stringy character. Ulcers which have a tendency to bore in, without extending laterally.
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.