Rhus tox.- Useful in the early stages when there is an oedematous swelling of the lids especially if associated with conjunctivitis and profuse lachrymation.
Graphites.- Useful in preventing the recurrence of styes. (Compare general symptoms of patient.)
Staphisagria.- Recurrence of styes, especially on the lower lid, which are inclined to abort and leave little hard nodules in the lids.
Sulphur.- To prevent the recurrence of successive crops, especially in a strumous diathesis, as shown by eruptions of the body. Cannot bear to have the eyes washed, and is restless and feverish at night.
Thuja.- Obstinate forms of styes which seem to resist treatment and form little hard modules on the margins of the lids.
The following remedies have also been recommended and used with advantage: Aconite, Arsen., Calcarea, Causticum, Conium, Lyco., Merc, Pic. ac., Phosph. ac., and Silicea.
Ptosis is a drooping of the upper lid, due to either partial or complete paralysis of the levator palpebrae superioris. It may occur alone or be associated with a paralysis of the other muscles supplied by the third nerve, and is sometimes congenital. When complete, the upper lid covers nearly the whole of the cornea. The most frequent causes are syphilis, when of a central origin and trauma when peripheral. The so-called spurious ptosis is a drooping of the lid due to increased weight rather than to any diminished power of the levator muscle of the lid. This condition is found in thickening of the tissue from chronic trachoma from new growths, etc. Ptosis adiposa, a condition in which a relaxed fold of the skin hangs down like a pouch over the free border of the lid when it is raised also comes under this heading.
TREATMENT: Chief reliance must be placed upon internal medication though sometimes electricity proves of great value, either used alone or in connection with the indicated remedy. If the disease-dependent upon irremedial causes resists all treatment, operative measures must be resorted to.
Causticum.- More benefit has probably been derived from this remedy in the treatment of ptosis than from any other. Its special indication is drooping of the lid, resulting from exposure to cold ( Rhus, from damp cold). The symptoms in the provings very strongly point to Caust, as a remedy in this disorder, as “inclination to close the eyes; they close involuntarily. Sensation of heaviness in the upper lid as if could not raise it easily, ” etc.
Rhus tox.- Especially if found in a rheumatic diathesis, and if the cause can be traced to working in the wet, getting the feet damp or to change in the weather. Heaviness and stiffness of the lids, like a paralysis, as if it were difficult to move them.
There may be aching, drawing pains in the head and face or they may be absent. The concomitant symptoms will point to its selection, though it has proved useful when none are present.
Alumina.- The upper lids are weak, seem to hang down as if paralyzed, especially the left. Burning dryness in the eyes, especially on looking up. Absence of lachrymation. Particularly useful for loss of power in the upper lids met with in old dry cases of granulations.
Euphrasia.- If caused from exposure to cold and wet and accompanied by catarrhal symptoms of the conjunctiva.
Ledum.- Ptosis resulting from an injury, with ecchymosis of the lids and conjunctiva.
Spigelia.- Ptosis, resulting from inflammation or other causes, times hot, scalding lachrymation accompanies the above.
Gelsemium Stannum and Conium have been favorably employed in this affection especially, the former. (Compare paralysis of the muscles.)
Many operative measures have been recommended for the relief of Ptosis. The old method was simply the removal of a portion of the skin and fibres of the orbicularis muscle, and this, in some cases of partial ptosis, may suffice.
Pagenstecher, in 1881, introduced the operation of inserting subcutaneous sutures, running from near the margin of the lid to the forehead above the brow, and tied tightly, expecting by the resulting cicatrices, as the sutures cut their way out, to raise the lid.
Wecker combines the operation of sutures with the old method of excision, as follows: He removes an elliptical portion of the skin and muscular fibres. He then inserts a strong thread above the brow running underneath the skin to the upper edge of the wound, over which it passes to the lower border of the wound and then pierces the skin near the free border of the lid; it is now carried parallel to the lid for about five millimetres, where the puncture is again made and it travels backward on a reverse course, parallel to its downward path, to the brow. The two ends are now tied together over a roll of plaster and tightened from time to time as they become loose (Figs. 31 and 32). Two such sutures are introduced. The wound is in this way closed, and, as the sutures cut through, cicatrices are formed which hold the lid up permanently.
In addition to the operations described, Birnbacher makes an operation to connect the tarsus with the frontalis by cicatrices. He passes three sutures through the upper border of the tarsus up under the skin and out in the eyebrow. Where they are tied over a roll of lint and left in place for three weeks. Panas endeavors to bring about a union between the lid and frontalis muscles by fastening a flap from the lid to the skin of the forehead. Eversbusch and Hugo Wolff both propose an operation for congenital ptosis to increase the power of the levator by advancing its insertion.
Blepharospasm.-Spasmodic closure of the lids, due to reflex irritation of the ophthalmic division of the fifth nerve, is often dependent upon some conjunctival irritation, or it may be due to a foreign body, an ulcer of the cornea, iritis, refractive errors, carious teeth, hysteria, or other reflex conditions. The spasm of the lid may be of the tonic variety, in which there is continued and complete closure of the lids, with perhaps an inversion of the eyelashes, which will of course cause great irritation of the eye. In obscure cases where no lesion of the eye itself can be found search should be made for “pressure points,” i.e., a point upon some branch of the third nerve, or the supraorbital at the orbital notch; or it may be the infra- orbital, temporal, supramalar, inferior alveolar, or even some remote point along the course of some other nerve, that will stop the spasm.
TREATMENT- This should first be directed to the cause of the irritation, and, as it is usually dependent upon corneal troubles, is relieved with them. When however, it is independent of other affections remedies must be prescribed for the spasm per
se.
Agaricus-Twitchings of the lids, with a feeling of heaviness in them, relieved during sleep and sometimes temporarily by washing in cold water. Spasms of the lids. It is very rare to meet a case of morbid nictitation which will not yield to this remedy. (Four-drop doses of the tincture two or three times a day will often relieve when the potencies fail.)
Other remedies which have proved useful in individual cases are Alumina, Cicuta, Ignatia, Nux v., Physos and Pulsat. Division of the affected nerve may be necessary in aggravated cases. The use of galvanism is often of great value in some cases-the positive pole is applied on any discoverable pressure point and the negative to the back of the neck. Canthomy, the division of the structures at the outer canthus by means of scissors, may be valuable in cases of tonic spasm.
Nictitatio-Constant blinking is frequently met with, especially in children and nervous, delicate persons. It is also sometimes present in exhaustion from excessive drinking, etc. This condition is generally due to some irritation in the eye itself, or may be reflex, from worms, decayed teeth, etc. Remove the cause, if determinable, and Agaricus will complete the cure.
Blepharophimosis-Narrowing of the palpebral opening from contraction of the skin of the lid is usually caused by chronic conjunctivitis, especially when flabbiness of the skin in old age favors such a formation and is relieved by canthotomy.
Symblepharon-Adhesion, partial or complete, of the eyelid to the eyeball. This condition occurs when, as the result of destruction of the mucous membrane from burns, as acids or lime, etc., or after diphtheritic or trachomatous conjunctivitis, two opposed portions of the conjunctiva grow together and may be either partial, when but one or more bands extend between the lid and globe, or complete, when the entire surface of the lid is attached, to the globe. The lower lid is most commonly adherent, and more or less limitations in the movements of the eye ensues. It may comprise the cul-de-sacs or the border of the lids (Fig- 33). The thickness of the adherent portions may vary, and we will have a sarcomatous, membranous or fibrinous symblepharon. Owing to the restrictions in the movement of the eye, and from the possible loss of vision due to its covering the pupil, every means must be tried to prevent adhesions in burns of the conjunctiva. To accomplish this the wounded surfaces must be separated daily during healing by some mechanical means, and the application of oil or vaseline to prevent their sticking together. The mucous membrane in these cases is destroyed to such an extent that simply dividing the adhesions will do no good, as they will at once grow together again. There are two methods of operating upon these cases with some prospect of success. First by separating the affected portions and inserting conjunctival flaps brought from neat by or from the opposite side of the cornea between them, or second, failing in this, to transplant from another person.
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.