Comes on from colds and over use of the eyes. Syphilis the most frequent cause, but may be due to scrofula, rheumatism, gout, after injuries, or secondary to other inflammations of the eye.
6. Lids red and puffy.
7. Conjunctiva inflamed, chemosed.
8. Sub-conjunctival or scleral injection.
9. Lachrymation and photophobia.
10. Cornea may be slightly hazy.
11. Iris always discoloured
12. Pupils sluggish but contracted.
13. Posterior synechiae usually present and pupil may be partially closed by exudation.
14. Greenish reflex from pupil absent.
15. Aqueous cloudy, anterior chamber normal.
16. Severe pain in the eye and head, which is worse at night and in damp weather.
17. Tension may be slightly increased in rare cases.
18. Eye sensitive to touch.
19. Vision may be impaired.
20. Ophthalmoscopic examination may reveal slight hyperaemia of the optic disc.
Iritis Syphilitica is one of the most frequent varieties of iritis. It occurs as a secondary manifestation of acquired syphilis and inherited syphilis as well. When occurring as a secondary manifestation, it is usually one of the latest symptoms manifestation, it is usually one of the latest symptoms to appear, although it may be one of the earliest. When the result of inherited syphilis, it most generally occurs about puberty, although it may occur in early infancy. The diagnosis as due to syphilis cannot be determined from the appearance of the eye alone, except when we find more or less prominent yellowish-red or dirty brown nodules (iritis nodosa) in the iris; but, when these nodules vary from about the size of the head of a pin to sometimes of sufficient size to entirely fill the anterior chamber and may even involve the cornea and break through at the corneo-scleral junction and become external. The usual size is about that of millet seed. They are always found at either the papillary or peripheral edge of the iris and may undergo fatty degeneration or become absorbed, but leave a broad synechia behind them. Syphilitic iritis has all the characteristic symptoms already described and is apt to be more tedious in its course. In most cases syphilitic iritis appears within the first year after infection. Very rarely it occurs in the later stages of syphilis, and in exceptional cases nodules appear, which are gummy tumors in this class (iritis gummosa).They may be observed in both the iris and ciliary body, and may attain great size, even perforating the eyeball.
Iritis Rheumatica.-Rheumatism as a cause of iritis is considered by some to be far more frequent than any other. Berry Diseases of the Eye. says, ” the rheumatic form is decidedly the most common.” In our own experience, however, syphilitic iritis has been very much more frequently met with. Rheumatic iritis is especially found in articular rheumatism and occurs in adults-from twenty to fifty years of age. Attacks of this form of iritis are apt to be more severe, of a much longer duration and relapses are especially prone to appear.
Iritis Spongiosa.-This clinical division of iritis is applied where there is found in the anterior chamber of yellowish-white, spongy looking mass, which may completely fill the anterior chamber. This condition is due to haemorrhages into the stroma of the iris, the fluid part of the blood transuding into the anterior chamber. The absorption of this peculiar exudation always begins in the parts nearest the cornea, and, in the progress of absorption, may sometimes appear like an opaque lens dislocated into the anterior chamber, for which it has been mistaken.
Iritis Parenchymatosa (Suppurative, Purulent or Traumatic Iritis).-In this we have all the previous symptoms of iritis together with greater swelling of the iris, exudation on the surfaces and the circulation impeded so that large blood-vessels may be seen coursing across the iris; there may be extravasation of blood into the iris and occlusion of the pupil forms rapidly. Occurs especially after operations on the eye, as in cataract extractions. It commences with considerable oedema of the lids, profuse lachrymation, chemosis and hypopyon. The iris is very much swollen and there may be a layer of pus on the anterior surface or large drops of pus in the pupil. The severity of the attack depends upon whether or not septic matter or any foreign body has remained in the eye. This form of iritis is usually complicated with an inflammation of the ciliary body or choroid and often forms a part only of a general suppurative destruction of the eye.
Iritis Serosa consists of a serous exudation which deposits on the posterior surface of the cornea an amorphous exudate, which may be mixed with some cell elements. These spots of exudation soon fall off into the anterior chamber and are either absorbed or remain and form hypopyon. There may be infiltration into the stroma of the cornea, which may result in sclerosis of the corneal fibres. It runs a slow chronic course and show but few signs of inflammation.
SYMPTOMS.-(See Choroiditis Serosa.) There is a hypersecretion of the aqueous humor, which becomes slightly cloudy. Deposits of lymph attach themselves to the posterior surface of the cornea or settle to the bottom of the anterior chamber. These deposits on the posterior surface of the cornea generally take a pyramidal shape, the base of the triangle at the periphery and the apex at the centre. By changing the position of the head the triangular-shaped mass will also change, thus proving that the deposit is on the posterior surface of the cornea and that the pyramidal form is due to gravity. The increased secretion causes a slight increase in the tension, and, as a result, the pupil becomes moderately dilated and sluggish. The anterior chamber may also be visibly deeper from the same cause. The iris is only slightly discolored. The photophobia, lachrymation, pain and pericorneal injection are very moderate and, as a rule, much less than in other forms of iritis. If the inflammation is severe and of long duration, it may result in a descemetitis or a parenchymatous keratitis. The disease is usually found complicated with some inflammatory process of the deeper structures, particularly chronic irido-choroiditis, though isolated cases uncomplicated by other diseases occasionally arise. It is much more frequently found in women than in men. The prognosis, so far as a complete cure without synechiae, is more favorable than in plastic.
TREATMENT OF IRITIS.-Under this heading will be included all varieties of iritis, syphilitic, rheumatic, idiopathic, traumatic, sympathetic, purulent, spongy and serous, also descemetitis.
The first point that demands our attention is the removal of any exciting cause, as, for instance, a foreign body in the conjunctiva, cornea or interior of the eye. If it be due to swelling or dislocation of the lens forward, or to a portion of the lens substance lying against the iris, an incision should be made and the irritating object removed. When dependent upon sympathetic irritation from the other eye, which has already been destroyed, enucleation of the injured eye should be performed as early as possible. If previous synechiae are the exciting causes, an iridectomy frequently becomes necessary.
We are sometimes compelled to treat quite severe cases of this disease as out-patients and often with excellent results, though it is far better and safer in all cases to confine the patient to the house. We should, however, in all cases, especially if severe, most positively insist upon the patient remaining in a darkened room and in bed, in order that perfect rest may be obtained both from the irritation of light and from muscular movements. A low or milk diet usually proves beneficial, unless the patient is too much debilitated. Alcohol and stimulating food are to be avoided.
Warmth is one of our most important aids in the treatment. It may be employed in various ways, though I would especially advise dry warmth, covering the eye and corresponding side of the head with a large, thick cotton pad, for by this the heat may be kept more uniform than by the application of moisture. Small bags, partially filled with five table salt, applied hot to the eye will often relieve the severe iritic pain experienced at night.
The use of cold applications in all forms of iritis, excepting the traumatic iritis, has always been condemned by the best authorities until quite recently, when Helfrich Trans. Hom. Medorrhinum Soc., State of New York, vol. xxvi., p. 167, 1891. reported its use in cases of iritis of the rheumatic form, in which there was an unusual amount of conjunctivitis, or what he says might appropriately be termed an irido-conjunctivitis. Schenck also reports in the same transactions its use in cases of syphilitic iritis. The result from the use of ice in these cases was extremely satisfactory and affords another means of combating certain intractable forms of iritis. The best method of application is the ice-bag, and in its use it is necessary to keep the patient under close supervision, as the continuous use of ice may affect the nutrition of the cornea and must be discontinued as soon as any haziness of the cornea appears.
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.