In traumatic iritis, ice compresses may be used with great advantage.
Atropine.-The next point in the treatment of iritis is one of great importance and should always be attended to, viz., complete dilatation of the pupil as early as possible by the use of Atropine. As soon as the nature of the disease has been detected a solution of Atropine should be instilled strong enough to produce the desired result, and when the dilatation is complete we should endeavor to keep it so by a continued application of the mydriatic. In severe cases of iritis it may be necessary to use the Atropine every hour. Dryness of the throat or flushing of the face will indicate that it must be used at longer intervals or perhaps discontinued entirely. If the pupil is already bound down by adhesions which cannot be torn after several days’ trial it is sometimes better to discontinue the mydriatic until the inflammatory symptoms have subsided, when it may again be tried to break up the adhesions. A solution of Atropine, four grains to the ounce of water, is most commonly employed, but the pupils must be dilated if possible, even if we have to employ the crude substance. These remarks regarding Atropine will apply to the various forms of iritis, with the exception of the serous variety, in which dilatation must be carefully watched, as glaucomatous symptoms may arise, when the use of Atropine must be stopped and possibly Eserine employed. If Atropine should act as a irritant or the eyes show a great antipathy to its use, some other mydriatic, as Scopolamine, Duboisine, Daturine, or Homatropine, may be substituted. The relative strength of mydriatics and myotics has been shown by Jackson, Journ. Am. Medorrhinum Assoc., Oct., 1895. who found the weakest solutions producing any effect on the pupil were Homatropin hydrochlorate, 1/30000 gr., Eserine sulphate 1/100000 gr., Atropin sulphate 1/1500000 gr., and Hyoscyamine hydrochlorate 1/3000000 gr.
An iridectomy may be made in the later stages or if other treatment fails. It may also be indicated in serous iritis, if glaucomatous symptoms supervene, though frequent paracentesis of the cornea may relieve without causing the disfigurement from an iridectomy.
Mercurius.-Mercury in its various combinations is our “sheet-anchor” in the treatment of all forms of iritis, especially syphilitic, and the cases which call for its use present a great variety of symptoms, differing widely in both character and intensity. The pains are usually severe, of a tearing, boring, cutting; burning nature, chiefly around the eyes, in the forehead and temples and accompanied by throbbing, shooting, sticking pains in the eye, though in rare cases they may be almost or entirely absent. These pains, as well as all the symptoms of the mercurials, are always worse at night after going to bed and in damp weather, in this respect corresponding very closely to the disease. There is generally much heat both in and around the eye and soreness of the corresponding side of the head to touch. Great sensitiveness to heat or cold may be found; also to light, especially the glare of a fire. Acrid lachrymation may be present. The pupil is contracted and overspread by a thin bluish film, while there is great tendency to the formation of adhesions ( posterior synechiae). The iris is discolored, aqueous cloudy and ciliary injection marked.
Hypopyon may be present or not. Gummata may also be found on the iris. The lids may be red, swollen and spasmodically closed, or even normal in appearance. The concomitant symptoms of nocturnal pains in different portions of the body, perspiration at night, condition of tongue, mouth and throat and eruptions on the skin are of great importance in selecting this drug and in choosing between the different preparations.
The Corrosivus is most frequently employed and proves most beneficial, as the intensity of the symptoms is more marked under this than any other form.
The Solubis comes next in order of usefulness and should be given if the above symptoms are present and if the inflammation is of medium intensity or lower grade and if certain characteristic general symptoms are observed.
The Dulcis is to be thought of when iritis is found in very scrofulous subjects, especially children with pale, flabby skin, and when associated with corneal ulceration.
The Proto-iodide should be chosen from concomitant symptoms, as thick yellow coating on the base of the tongue, enlarged glands, etc., and when superficial ulceration of the cornea complicates the difficulty, especially if found during the course of pannus.
Kali iod.- An important remedy in syphilitic iritis, especially after mercurialization and if the secondary eruption on the skin is present. The special indication are not marked, though the inflammation is usually of high degree. It has given upon general principles in many instances with excellent success. It often relieves when given in large doses when the potencies have failed.
Aurum.-Chiefly serviceable in syphilitic iritis and after over dosing with mercury or potash. There is much pain, much seems to be deep in the bones surrounding the eye, of tearing, pressing nature, often extending down into the eyeball, with burning heat, especially on trying to open the eyes; the pressing pain is usually from above downward and from without inward, aggravated on touch. The mental condition of the patient is that of great depression; this, together with the bone pains in other portions, aid us materially in our choice.
Cinnabaris.- Of great value in the treatment of iritis, particularly syphilitic and if gummata are present in the iris. The characteristic pain commences at the inner canthus and extends across the brow or even passes around the eye, though there may be shooting pains through the eye into the head, especially at the inner canthus. Sharp pain over the eye, or soreness along the course of the supra-orbital nerve and corresponding side of the head. Like mercury, the nocturnal aggravation is usually marked and the symptoms intermit in severity.
Hepar.- Especially serviceable if the inflammation has extended to the neighboring tissues, cornea (kerato-iritis) and ciliary body (irido-cyclitis) or after gummata have ruptured, and if there is pus in the anterior chamber (hypopyon). Especially in suppurative iritis. It is also of value in purulent irido- capsulitis after cataract extraction. The pains are pressing, boring or throbbing in the eye, ameliorated by warmth and aggravated by motion. The eye is very tender to touch. There is usually much photophobia and great redness of the conjunctiva, even chemosis, while the lids may be red, swollen, spasmodically closed and sore to touch. The patient feels chilly and wants to keep warmly covered.
Rhus tox.- Idiopathic or rheumatic iritis, if caused by exposure to wet, or if found in a rheumatic patient. Suppurative iritis, particularly if of traumatic origin, as after cataract extraction, more often calls for Rhus than any other remedy. Also useful in kerato-iritis. The lids are oedematously swollen, spasmodically close, and, upon opening them, a profuse gush of tears takes place. There is chemosis, the photophobia is marked and the pains are various, both in and around the eye, worse at night, especially after midnight, and in damp weather. The swelling of the lids often involves the corresponding side of the face and may be covered by a vesicular eruption. Concomitants must be taken into consideration.
Bryonia.- Iritis resulting from exposure to cold not infrequently calls for this drug, especially if occurring with a rheumatic diathesis. The pains may be sharp and shooting in the eyes, extending through into the head, or down into the face, or there may be a sensation of soreness and aching in and around the ball, especially behind it, extending through to occiput; the patient also sometimes describes the pain “as if the eye was being forced out of the socket.” All the pains are generally aggravated by moving the eyes in their sockets, or upon any exertion of them, and at night, The seat of pain often becomes sore to touch. In the serous form it also proves serviceable.
Asafoetida.- Especially indicated in the syphilitic variety and after the abuse of mercury. The pains are severe in the eye, above it and in the temples, of a throbbing, pulsating, pressing, burning or sticking character and tend to become periodic; they extend usually from within outward and are relieved by rest and pressure (reverse of Aurum).
Thuja.- Syphilitic iritis, with gummata on the iris. Large wart-like excrescences on the iris, with severe, sharp, sticking pains in the eye, m aggravated at night and ameliorated by warmth. Usually accompanying the above we find much heat above and around the eye and in the corresponding side of the head; there may also be tearing, dull, aching pains in the brow, or a pain above the eye (left) as if a nail were being driven in. Ciliary injection decided, even in some cases amounting to inflammation of the sclera. Lids may be indurated, noises in the head, etc.
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.