In the treatment of chronic inflammation of the margins of the lids, external application are of great value and without their use a cure is often impossible. It is true that a careful attention to cleanliness, together with the internal administration of the indicated remedy, will cure a large proportion of the cases but the duration of treatment will be usually much longer than if we employ local means at the same time we give internal remedies.
Cosmoline or Vaseline.- This unguent has been of great service in the treatment of blepharitis. It may be used alone or to form a base for the administration of other remedies. It prevents the formation of new scales and the agglutination of the lids, besides seeming to exert a beneficial influence over the progress of the disease. This, like all other ointments, should be used once or twice a day, or even oftener if the case is very severe. All scales or crusts should be carefully removed; after which a very little of the ointment may be applied to the edge of the lids with the finger or a camel’s hair brush. The smallest amount possible, to oil the ciliary margins of the lids should be applied, as aggravation of the inflammation may result from its too free use.
Mercury.- For years this has been a favorite local application in blepharitis. It seems to be better adapted to the severe forms of inflammation of the lids than Graphites, for there, is more redness, more swelling, more secretion and more tendency toward ulceration. The two following prescriptions have been employed with the most favorable results, especially the yellow oxide:
Rx. Hydrarg oxyd. flav.,…………..gr. ij.
Vaseline,……………………..3 ij.
Misce.
Rx. Liq. Hydrarg nitr……………….gtt. iij.
Vaseline,……………………..3 ij.
Misce.
In some cases more of the mercury is used, in others less according to the severity of the symptoms.
Grapho-Vaseline- Graphites, as will be seen in the symptomatology, is more commonly indicated in blepharitis than any other one remedy. Many cures have resulted from its internal administration alone, when indicated but more brilliant results may be obtained by employing at the same time locally the following unguentum.
Rx Graphites……………………. gr.ij
Vaseline,……………………. 3ij
Misce.
Various other ointments and washes have been used with variable success. The use of milk cream, lard and simple cerate, to prevent the lids from sticking together have also been of aid with internal medication.
Graphites.- This in one of the most important remedies we possess for the chronic form of this disease, though it may be indicated in acute attacks, especially if complicated with ulcers or pustules on the cornea. Particularly useful if the inflammation occurs in scrofulous subjects covered with eczematous eruptions, chiefly on the head and behind the ears; which are moist fissured and bleed easily. The edges of the lids are slightly swollen, of a pale red color and covered with dry scales or scurfs or the margins may be ulcerated. The inflammation may be confined to the canthi especially the outer, which have a great tendency to crack and bleed upon any attempt to open the lids. Burning and dryness of the lids are often present, also biting and itching causing a constant desire to rub them. It is important in eczema of the lids if the eruption is moist with tendency to crack while the margins are covered with scales or crusts.
Mercurius sol.- Very favorable results have been gained by this remedy in blepharitis, especially if dependent upon or found in a syphilitic subject or if caused from working over fires or forges. The lids are thick red, swollen and ulcerated (particularly the upper) and sensitive to heat or cold and to touch. Profuse acrid lachrymation is usually present which makes the lids sore, red and painful, especially worse in the open air or by the constant application of cold water. All the symptoms are worse in the evening after going to bed and from warmth in general, also from the glare of a fire or any artificial light. The concomitant symptoms should receive special attention as excoriation of the nose from the acrid coryza, flabby condition of the tongue, nocturnal pains etc.
Hepar Sulph.- The is the remedy most frequently employed in acute phlegmonous inflammation, especially after the first stage has passed and suppuration is about to, or has already taken place. The lids are inflamed, as if erysipelas had invaded them, with throbbing, aching, stinging pains, and very sensitive to touch; the pains are aggravated by cold and from contact, but ameliorated by warmth. It may also be useful in certain forms of blepharitis in which the lids are inflamed sore and corroded, as if eaten out or if small red swellings are found along the margins of the lids, which are painful in the evening and upon touch. There is general amelioration from warmth. Often called for when the Meibomian glands are thick and honeycombed in character on and around the lids, it is very valuable.
Pulsatilla.- Blepharitis, both acute and chronic especially if the glands of the lids are affected (blepharo-adenitis) or when there is a great tendency to the formation of styes or abscesses on the margin of the palpebrae. Blepharitis resulting from high living or fat food and when accompanied by acne of the face; also in cases in which the lachrymal passages are involved. The swelling, redness and discharges vary, though the latter are more often profuse and bland, causing agglutination of the lids in the morning. Itching and burning are the chief sensations experienced. The symptoms are usually aggravated in the evening in a warm room or in a cold draught of air, but ameliorated in the cool open air.
Calcarea carb.- Blepharitis occurring in persons inclined to grow fat, or in unhealthy “pot-bellied” children of a scrofulous diathesis who sweat much about the head. The lids are red, swollen and indurated. Inflammation of the margins of the lids, causing loss of the eyelashes, with thick, purulent excoriating discharge and burning, sticking pains. Great itching and burning of the margins of the lids, particularly at the canthi; throbbing pain in the lids. Most of the eye symptoms are worse in the morning, on moving the eyes and in damp weather. Great reliance should be placed on the general cachexia of the patient.
Calcarea iod.- Seems to act better than the carbonate in blepharitis found in those unhealthy children afflicted with enlargement of the glands and especially of the tonsils.
Rhus tox.- Its chief use is in acute phlegmonous inflammation of the lids and erysipelas; lids oedematously swollen (especially the upper) and accompanied by profuse lachrymation; there may be erysipelatous swelling of the lids, with vesicles on the skin; chemosis is often present. The pains are worse at night, and in cold, damp weather but relieved by warm application. It may be of service in acute aggravations of chronic inflammation from exposure in wet weather or when worse at that time, with much swelling of lids and profuse lachrymation.
Mezereum.- Blepharitis accompanied by tinea capitis; or eczema of the lids and head, characterized by thick hard scabs, from under which pus exudes on pressure.
Antimonium crud.- Obstinate cases in which the lids are red, swollen and moist with pustules on the face. Especially in cross children. Pustules on the ciliary margins.
Arsenicum.- Inflammation of the margins of the lids, which are thick, red and excoriated by the burning, acrid lachrymation. The cheek may also be excoriated. The lids are sometimes oedematously swollen and spasmodically closed, especially when the cornea is at the same time affected. The characteristic burning pains are important and usually present. The general condition of the patient decides us in the selection, as the great prostration, restlessness, aggravation after midnight and thirst are commonly seen in scrofulous children. Often useful in the early stages of abscess of the lids.
Sulphur.- A remedy called for especially in the chronic form of this disease and when found in children of a strumous diathesis who are irritable and cross by day and restless and feverish by night; also for blepharitis appearing after the suppression of an eruption or when the patient is covered with eczema. The lids are red, swollen and agglutinated in the morning or there may be numerous small itching pustules on the margins. The pains are usually of a sticking character though we may have itching, biting, burning and a variety of other sensations in the lids. There is generally great aversion to water so that they cannot bear to have the eyes washed. Eczematous affections of the lids, like eczema in other portions of the body, which indicate Sulphur, are often controlled.
Psorinum.- Old chronic cases of inflammation of the lids especially when subject to occasional exacerbations. It has also been of service in the acute variety when the internal surface of the lids was chiefly affected with considerable photophobia. Particularly indicated in a strumous diathesis with unhealthy, offensive discharges from the eyes.
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.