Cannabis sat.- Interstitial inflammation of the cornea from hereditary syphilis. Cornea densely opaque and vascular. The photophobia is intense and lachrymation profuse.
Hepar.- Keratitis parenchymatosa in scrofulous subjects. Cornea opaque and vascular with deep ciliary injection severe iritic pains, excessive photophobia, profuse lachrymation and great sensitiveness of the eyeball to touch. Of service in clearing the cornea after the inflammatory process has been checked.
Mercurius sol.- Especially indicated if the cause can be traced to either acquired or hereditary syphilis. The ciliary injection, aggravation and general concomitant symptoms. The inflammation is more active then under Aurum.
Calcarea phos.- Parenchymatous inflammation of the cornea of strumous origin. The infiltration into the cornea may be dense. Photophobia is usually present. Enlargement of the tonsils and other Calcarea symptoms will be found.
Arsenicum.- Interstitial keratitis cornea hazy with commencing vascularity Intense photophobia and profuse lachrymation, with burning pain in and around the eye, worse after midnight.
Apis.- Cornea densely infiltrated, with moderate redness and photophobia. History of hereditary syphilis, with exostoses, swelling of the joints high fever drowsiness and thirstlessness may be present.
Baryta iod.- Interstitial keratitis occurring in scrofulous subjects, with great enlargement of the cervical glands which are hard and painful on pressure.
Kali-mur.- Diffuse infiltration of the cornea with some pain, moderate photophobia and redness.
Sepia.- Keratitis parenchymatosa complicated with uterine disturbances.
Sulphur.- Indicated in strumous subjects, even if the inflammation is in an active stage. Especially useful, however in promoting the absorption of the infiltration into the cornea, after the inflammation has been allayed by proper remedies.
Other preparation of Calcarea, kali and Mercurius may prove of service in the treatment of this disease.
Opacities of the Cornea.- These are often classified according their density as leucoma, macula, nebula, etc.- the leucoma being the most dense or non-transparent. This sub- division is of no exact value or practical importance, as the impairment in vision will be oftentimes surprisingly great from almost imperceptible nebula over the pupil, while a dense leucoma at the periphery of the cornea will cause no loss of vision. Very sharp, careful scrutiny of the cornea with the oblique illumination is often necessary to recognize a very faint opacity, which may be the cause of more or less loss of vision. We have frequently seen our students make a protracted examination of an eye both with glasses and with the ophthalmoscope in order to determine the cause of the impaired vision which was due to a very faint opacity that had been overlooked. Distant vision is always more affected by a faint opacity than is near vision.
Congenital Opacity is sometimes met with, and in these some gradual spontaneous clearing up may be expected.
Arcus Senilis or Gerontoxon is a light gray arc or oval ring at the periphery of the cornea. It is perfectly smooth and more intense toward the limbus, from which it is separated by a narrow, transparent strip. It appears first above and then below and is due to a deposition of a colloid substance in the more superficial layers of the cornea.
Opacities are most frequently caused by corneal ulcers which when recent, are of a gray, dull appearance, but later become, smooth and bluish-white. They also may results from deposits of lead or lime in corneal cicatrices. Pannus, inverted eyelashes, etc., cause opacity.
Sclerosis of the cornea is another form of opacity resulting from an infiltration of the cornea. It is produced by a damming up of the corneal canals with a dilatation of the lacunae, and from this pressure upon the corneal tissue its transparency is changed to resemble more the tissue of the sclerotic and it is sometimes difficult to determine where the sclera ends and the cornea begins. This condition generally results from keratitis, episcleritis, etc.
PROGNOSIS.- In recent opacities a gradual absorption may be expected especially if occurring in a young subject. Central opacities may cause strabismus, or, of semi-transparent, may simulate myopia as the patient will hold objects nearer to the eyes in order to obtain a clearer retinal image. Bilateral corneal opacities in young children may cause nystagmus. The prognosis of opacities of the cornea varies according to their duration and character. If they are dependent upon infiltration into the cornea, proper treatment will usually cause their absorption; but if they result from new scar tissue, as in extensive ulceration, the prognosis is not favorable. Time will, however, do considerable in clearing the cornea especially in the opacities of children.
TREATMENT.- If there is some vascularity of the cornea remaining, which indicates that the opacity is recent, the application of irritants to the cornea to promote the dispersion of opacities is often of great advantage. The following have been found most efficacious and should be applied directly to the opacity; sulphate of soda, aluminate of copper bichromate of potash or carbolic acid and glycerine (gtt. vi. ad 3Zj.)
In order to cut off the irregularly refracted rays of light in some forms of opacities, stenopaic spectacles, either with or without convex or concave glasses may be of advantage.
The use of electricity may be of some value to clear up recent opacity of the cornea.
Various operative procedures have been used in appropriate cases. In an old, dense and large central opacity, an iridectomy opposite a transparent portion upon the cornea from lead, lime or other substances, it may be removed by scraping or excision of the superficial layers containing the deposit. Oil and a wet compress should then be applied. When the opacity is very dense and disfiguring it may, for cosmetic effect, be covered by tattooing with India ink. In this operation care must be taken not to do too much at one sitting on account of possible disagreeable reaction. The eye is cocainized and the opacity covered with a paste of the finest quality of India ink, a needle or bundle of needles then pricks the epithelium obliquely and forces the ink under the epithelium. Care must be taken that a flow of tears does not spread the ink into any wound of the conjunctiva made by the fixation forceps.
As there is usually a total lack of eye symptoms is these cases we must chiefly rely upon the general condition of the patient though the following are the drugs which have been found more commonly indicated; Aurum Calcarea carb and iod., Cannabis, Cuprum al., Hepar., kali bichr., Nat. Sulph sil and sulphur.
Staphyloma Corneae is a bulging forward of the cornea either in part or of the whole and is due to perforation of the cornea in within a prolapse of the iris and a large adhesion to the cornea. A central perforation with no adhesion of the iris will not cause staphyloma. Total staphylomas results from larger perforation, such as are apt to be found in purulent or diphtheritic conjunctivitis or hypopyon keratitis, while the partial staphyloma is more apt to result in case of pustular keratitis in children. Staphyloma is directly due to the glaucomatous symptoms resulting from the adhesions of the iris and cornea, which blocks up the filtration passages or excretory channels of the eye. Thus excretion being partially or totally prevented and secretion constantly going on, something must give, and the cornea, weakened by inflammatory changes, bulges. The tension in staphyloma is usually slightly increased and a glaucomatous cupping of the nerve has been demonstrated. A partial staphyloma may increase to an involvement of the entire cornea, or total. When the bulging has increased so as to protrude between the lids, its exposure is apt to produce inflammatory exacerbations, which cause a still greater increase in the staphyloma. Its shape is usually spherical and the sclera or whole anterior part of the eyeball may be involved. The lens may have escaped at the time of the perforation or if it remains, is usually cataractous. The appearance of a staphyloma is usually densely white or bluish and with large vessels coursing over it, or it may appear thinner and darker in color.
TREATMENT.- In partial staphyloma paracentesis, frequently repeated, may prevent its increasing although as a rule, iridectomy, which acts by diminishing the intra-ocular pressure, is better. When complete and the vision destroyed, our aim should be to improve the appearance and relieve the pain by a removal of the protrusion. This may be done in several ways. Abscission is the operation which has given the best results in our hands, and is made after the method proposed by De Wecker Chirurgie Oculaire, p. 188. who first separates the conjunctiva all around the cornea nearly back to the equator of the eyeball. Four sutures of different colors are passed through the conjunctiva about three mm. from the margin of the wound. The protrusion is then cut off by transfixing it through the middle, and cutting outward then seizing the end of the flap thus formed and removing the rest with scissors. The sutures are then tied and the eye closed without much loss of its contents or risk of bleeding. This operation is preferable to enucleation, because it furnishes a much better stump for the wearing of an artificial eye. The objections to it are the danger of setting up a severe inflammatory reaction or of causing perhaps, should not be made where the staphyloma is subject to inflammatory attacks or where the other eye shows any evidence of sympathetic irritation.
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.