Iritis Serosa Usually follows upon some intraocular inflammation.Hypersecretion of aqueous, which is cloudy. Deposits of lymph on the posterior surface of the cornea, taking a pyramidal shape, with the base at the lowest point, changing with the position of the head, and due to gravity. Anterior chamber deeper. Iris somewhat discolored. Tension may be slightly increased.
TREATMENT.- The patient should be ordered a good plain nourishing diet, together with plenty of exercise in the open air. The eyes may be protected with smoked glasses when there is much photophobia. The chief dependence is upon the use of the homoeopathic remedy. Kali bich, has proven in our hands to be the remedy in this disease. Other such as Gels, Aurum, Calcarea, Conium., Arsenicum, Hep, and Merc, may be be of service. For special indication refer to keratitis and iritis.
Keratitis Parenchymatosa (Keratitis Interstitialis, Diffusa, Profunda Syphilitic).
PATHOLOGY.- In this form of keratitis there is first an infiltration of round cells into the affected portion of the cornea, with a little later, proliferation of the corneal fixed cells. The infiltration is usually in the innermost layers of the corneal lamellae, and when confined there, the epithelium remains unaltered; but if the outer layers, adjoining Bowman’s membrane, become involved, the epithelium becomes irregular, thickened and loses its normal lustre and smoothness. This infiltration usually heals by absorption, either with or without the formation of new blood-vessels, which when present, disappear during the process of recovery, except in rare cases. When absorption does not take place the infiltration produces sclerosis of the involved part, which is the result of new formation of translucent connective tissue between the normal transparent lamellae with subsequent obliteration of the corneal canals.
SYMPTOMS.- The characteristic appearance of the cornea is that of a deep seated grayish opacity accompanied by slight injection of the ciliary vessels. The opacity usually commences at the periphery of the cornea, and gradually extends concentrically from all sides toward the centre, or it may advanced by sending in processes which afterward become confluent. In other cases the centre is first affected by small dim gray maculae, which increase in number and extend further and further toward the margin, but are always massed most thickly in the centre where they frequently become confluent. The density of the infiltration is apt to vary indifferent portions of the cornea but is always thickest at the centre over the pupil. The cornea is frequently so opaque that the iris is quite invisible. The odor of the opacity also depends upon its density assuming a decidedly yellow hue at the thickest part and from that shading to white at the thinner spots (See Chronic-Lithograph, Plate I Fig.6) The extent of the irritation and inflammation varies so much in this disease that some authors speak of it as of two forms the vascular and non-vascular-but as the amount of the inflammation is the only distinguishing feature of the two varieties, we shall consider it simply as one disease.
We find the majority of the cases of the disease without any vascularity of the cornea and occasionally without any congestion of the conjunctiva but as rule there is more or less pericorneal injection together photophobia lachrymation and pain which are usually more pronounced the greater the amount of vascularization.
Occasionally the vascularity of the cornea will be so great that the appearance will be that of an extravasation of blood into the corneal layers. As the opacity clears up, these new vessels gradually disappear. The vision is always impaired if the centre of the cornea is involved and often to such an extent that only shadows are descernible. Parenchymatous keratitis in generally complicated with inflammation of the uveal tract in severe cases iritis and choroiditis is nearly always present.
COURSE.- Both eyes are usually affected in this disease commencing generally in one eye first and when this is well advanced the second will become inflamed, or sometimes the second eye will not be involved until long after the first has recovered.
The course of the disease is very slow and protracted in fact, it may last from three months to as many years although as a rule the majority of cases will recover in from two to ten months. In most cases the infiltration will seem to steadily increase, regardless of all treatment, for one to three months before it reaches its height where it will seem to remain nearly stationary for a short period and then begin gradually to clear up from the margin the central portion over the pupil being the last to clear.
CAUSES.- It is more frequently found in girls than in boys and from the fifth to the twentieth year, and is more often met with in feeble delicate children due, perhaps, to want and privation, or from close confinement in a vitiated atmosphere. The most frequent predisposing cause is inherited syphilis or scrofula and some authors attribute as high as 90 per cent of the cases to these causes. It is certainly the fact that in the large majority of cases of parenchymatous keratitis, if the teeth are examined, one can find the deformities to which attention was first called by Mr. Jonathan Hutchinson and by him considered a manifestation of inherited syphilis. The so-called Hutchinson teeth consist essentially of a single broad notch in the cutting edge of the tooth, especially found in the upper central incisors, and in addition to this characteristic peculiarity they will sometimes diverge or slant toward each other. In addition to the teeth we should always look for other evidences of inherited syphilis. The child is apt to be thin, anaemic and of stunted growth, with flat nose, cicatrices at the angles of the mouth, and often more or less deaf.
PROGNOSIS.- In the majority of cases the recovery will be nearly or entirely complete; that is, the haziness will disappear and vision will be restored to normal or nearly so. In view of the possibility of incomplete clearing of the cornea the prognosis should always be guarded as to the ultimate amount of vision. Cases accompanied by vascularity of the cornea are less favorable than those where no vessels appear in the cornea. Where the disease is complicated by inflammation of some adjoining tissues of the eye the prognosis should be more guarded dependent upon the existing disease.
COMPLICATIONS.- There is a great tendency of the iris to become inflamed and when it is often overlooked on account of the haziness of the cornea. Cyclitis is a more dangerous but fortunately a less frequent complication. Choroiditis and opacities of the vitreous may also occur as a complication of this disease, while in extremely rare cases shrinking of the cornea and even phthisis of the eyeball have occurred. An extension of the inflammatory process would be suspected if there was noticed an increased vascularity, lachrymation, photophobia and ciliary neuralgia, if the sight should be diminished more than the opacity of the cornea would indicate and if the field of vision became contracted and the eye sensitive to touch.
TREATMENT.- In a large majority of cases the use of the homoeopathic remedy is all sufficient and gives decidedly better results than any other mode of treatment. Here homeopathy shows its great advantage over the old school for we can often check the progress of the disease in a speedy manner by the careful selection and administration of our drugs.
As the disease is nearly always found in those of an enfeebled, debilitated constitution, the diet should be nutritious and easily digestible, while the use of tonics and stimulants maybe advisable. The eye should be protected from the light and wind. During repair fresh air and out-door exercise should be advised. In those cases where the infiltration is so dense that the iris cannot readily be watched, Atropine should be instilled to prevent involvement of the iris. In some extremely indolent cases good effect is obtained from the use of the yellow precipitate ointment or the dusting of the eye with powdered calomel. Hot fomentations have sometimes seemed beneficial in causing the development of new blood-vessels to hasten the absorption and also in preventing the lymphoid infiltration.
In regard to remedies the following have proven of the greatest value in this disease.
Aurum Mur.- The muriate of gold has been most commonly used and in the lower potencies. It is especially important in all those cases in which the cause can be traced to hereditary syphilis, and as the majority of cases of genuine interstitial keratitis are of this origin it can readily be seen how common a remedy this may be. We have seen it act speedily and permanently in both the vascular and non-vascular variety of the disease. The subjective symptoms are not prominent and may be absent, though usually there is some photophobia irritable condition of the eye and dull pain in and around the eye, which often seems deep in the bone.
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.