Apis-Is especially indicated in the first stage of this affection, in which the swelling of the conjunctiva is very great.
Argent nit-If the lids are swollen, inflamed, everted and the puncta lachrymalis very red and prominent. The discharge of tears and pus is profuse.
Hamamelis vir.-A dilute solution of “Pond’s Extract” applied locally is said to have cured a case occurring during the course of a severe conjunctivitis.
Little reliance must be placed upon internal medication in either entropium or ectropium, as operative measures are almost invariably necessary, except occasionally in the first stage.
Molluscum Contagiosum is an affection of the sebaceous glands. It consists of small, round, umbilicated whitish prominences which may become inflamed and go on to suppuration. It is a hypertrophy of the gland and the tumor is composed of epithelial elements. The contents can often be pressed out through the depression at the summit of the tumor. For treatment see chalazion.
Xanthelasma is a hypertrophy of the sebaceous glands and a fatty degeneration of the connective tissue of the skin. They appear as yellowish patches, especially on the upper lid. lvins The Hahnemannian Monthly, December, 1897. reports a case cured in fifteen treatments by the galvanic current of five milliamperes applied for fifteen minutes at each sitting., He used a special pliable silver electrode, two rods, 3/32 of an inch in diameter, so adjusted as to be easily approached to contact or separated to two inches. These two electrode points, wet in salt water, were so separated as to bring one at each end of the patch, on the normal skin. They may be removed when small by excision, for cosmetic purposes. Excision of large patches in some cases might result in ectropium.
Milium are small, circular, white tumors. They are removed by incision and pressing out of the contents.
Papillomata (warts) are occasionally found upon the edge of the eyelid and upon the conjunctiva. They should be snipped off.
Dermoid cyst is congenital, and contains hair-follicles, hairs, connective tissue, fat, etc. It is generally situated at the outer angle of the orbit, develops slowly and causes but little inconvenience. It should be removed without rupturing the tumor, if possible.
Naevi are found on the eyelids and are similar in appearance to those occurring elsewhere. They are best removed by the galvano-puncture.
Chalazion (Meibomian or Tarsal Cyst)- Latest authorities seem to consider a chalazion as a granuloma in connection with a Meibomian gland, and not a mere retention cyst. There is, however, at the same time associated with it an inflammation of the larger than a good-sized pea; several may occur at the same time or they may recur in successive crops. It is hard and tense to the touch, and the skin is freely movable over it, but the tumor is adherent to the underlying tissues (Fig.41)
It develops slowly, causing to inconvenience for months. It may suppurate, and, when it does, it usually points on the conjunctiva.
TREATMENT-Excision, as a rule, is the most satisfactory treatment of tarsal tumors, providing there are only one or two. But as it is usually tedious and painful to remove entire a small solid tumor, we may substitute for excision, opening of the tumor, squeezing out its contents, and stirring up the sac with the point of a knife. The opening of a chalazion should always be through the conjunctiva if possible. It may have to he repeated several times, but as there will be little pain attending the operation, no objection will be made by the patient. After opening, I usually give Hepar low to promote absorption of the sac. In the case of cystic tumors the whole of the cyst wall should be removed; it may be destroyed by the use of seton, but removal with the knife is usually more satisfactory. Many cases have been cured by internal medication alone, and remedies should always be employed, whether the knife is used or not, for they no doubt hasten the cure and serve to prevent recurrence.
Staphisagria-An important remedy for tumors of the lid. It is my custom to apply the tincture externally at the same time the remedy is being taken in potency. Enlargement of the glands of the lids, which are red and accompanied by tensive tearing pains, especially in the evening. For little induration of the lids, resulting from styles, or for successive crops of small tarsal tumors, this drug is especially indicated.
Thuja-This is one of the most valuable remedies for tarsal tumors, whether single or multiple, especially if they appear like a condyloma, either of the internal or external surface of the lid. We have seen them disappear by simply giving the drug internally, though it usually seems to act more speedily if we use, at the same time, the tincture externally. It is also recommended for the prevention of their return after removal by the knife. For condylomata, or warty excrescences on the lids, especially if occurring in syphilitic subjects, this drug deserves attention.
Hepar-Tarsal tumors that have become inflamed and are sensitive to touch. It also aids absorption after operation.
Calcarea carb.- Tarsal tumors occurring in fat, flabby subjects.
Causticum-Tumors, especially warts, found on the lids and eyebrows.
Conium-Induration of the lids remaining after inflammation.
Pulsatilla-Tarsal tumors of recent origin that are subject to inflammation, or are accompanied by catarrhal conditions of the eye. The temperament and general symptoms will decide the case.
Zincum-Tumors of the lids with soreness and itching in the internal canthi.
Baryta car, and iod., Graphites, Lyco., Kali iod., Mercurius, nitric acid, Sepia, Silicea and Sulph. may be required.
Epithelioma is the most frequent malignant growth affecting the eyelid. It rarely occurs before the age of forty, and appears first as small hard nodules, and later becomes covered with a scab, which, on being removed, shows a slight excoriation; this increases to an ulceration of considerable depth, with purulent secretion and irregular, hardened edges. It may remain indolent for months, then assume an active stage, leading rapidly to extensive destruction of tissue. In the early stage there is little or no pain, but becomes excessively painful in the later stages.
Epithelioma, lupus and chancre have a very similar general appearance.
DIFFERENTIAL DIAGNOSIS.
Epithelioma.
Indurated irregular edges.Slow growth.Attacks middle-aged and elderly people.
Lymph glands of neck involved late. Lupus.
Less induration. More inflamed.Growth slower than epithelioma Lymph glands involved late. Generally associated with lupus elsewhere in body.
Chancre.
Indurated, but edges more rounded. Rapid growth. Usually in younger subjects. Lymph glands early involved.Other symptoms of syphilis.
Lupus and Sarcoma have both been found affecting the eyelids. A lupoid growth is more slow in development than an epithelioma, and both may result in ulceration; but as Noyes Diseases of the Eye, 1890. so well says, “A discrimination between them is hardly needful for practical purposes.”
TREATMENT-Excision is advised in all malignant growths of the lids, if the disease is circumscribed and moderate in extent; care being taken that all the morbid tissue is removed. The edges of the wound may be brought together by sutures, or a plastic operation may be made, bringing the integument from the temple or some adjoining point.
Juler 2 Ophthalmic Science and Practice, 1884. advises scraping away all the diseased tissue by means of a small steel scoop. This is attended with considerable haemorrhage and is tedious, but he claims its success in arresting this malignant affection is marvellous.
Various caustics have been employed, chief among which may be mentioned caustic potash, nitrate of silver, chloride of zinc, arsenic paste and acetic acid. An objection to the use of caustics lies in the deformity apt to occur afterward. Electrolysis has been recommended.
If the disease is very extensive, involving the tissues of the face to such an extent that extirpation is impracticable, we then rely chiefly upon our internal remedies, using only such local applications as prove agreeable and of temporary relief to the patient. For instance, if the discharge is profuse and offensive, a weak solution of carbolic acid, salicylic acid, or some other disinfectant proves of service. An application from which we have often seen excellent results is carbolic acid and linseed oil (4 grains to the ounce): it relieves the patient and seems to exert a beneficial effect over the progress of the disease.
Iodoform-Dr.George A.Shepard reports surprising results in two cases of lupus from the administration of this drug in the third decimal trituration.
Apis-Lupus non-exedens, sharp, stinging pains, and tendency toward puffiness of the lower lids.
Hydrocotyle asiatica-Has obtained a high reputation in the hands of Dr. Boileau as a remedy for lupus and deserves our attention.
Phytolacca dec-Benefit seems to have been derived in relieving, if not curing, malignant ulcers of the lids, when used both externally and internally.
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.