Cedron.- This remedy is particularly of value in relieving the severe ciliary neuralgia observed in iritis, if supra- orbital, seeming to follow the course of the supra-orbital nerve, especially if there is marked periodicity.
China.- Iritis dependent upon the loss of vital fluids, or malaria. The pains are variable, but have a marked periodicity. The muriate of quinine, in appreciable doses, will often relieve severity of the pains, especially when of an intermittent type and accompanied by chills and fever.
Nitric acid.- Chronic syphilitic iritis of a low degree, with very little or no nightly pain. the pains may be worse during the day and are of a pressing, stinging character. Posterior synechiae will be found.
Arsenicum.- Iritis, with periodic burning pains, worse at right, after midnight, ameliorated by warm applications. Frequently indicated in serous iritis.
Aconite.- In the very first stage, or, in a sudden reappearance, this remedy is often of the greatest value, especially if occurring in young, full-blooded patients and when the cause can traced to an exposure to a cold draught of air. It is the most commonly indicated remedy in traumatic iritis. The ciliary injection is usually marked, pupils contracted and pains often severe, beating and throbbing, especially at night. There is a sensation of great heat, burning and dryness in the eyes.
Arnica.- Rheumatic iritis has been benefited, though its special sphere of action is in the traumatic variety, in which it may be employed with advantage.
Belladonna.- Early stages of iritis, caused from a cold; or chronic plastic iritis, following cataract extraction, with much redness and severe throbbing pain in the eye and head, worse at night Sensitiveness of the eyeball to touch, congestion of the face, etc.
Clematis.- By some, this drug is considered to be as frequently called for as Mercury, in iritis and kerato-iritis, though we have never used it to the same extent. Chronic syphilitic iritis, with very little pain. The pains are similar to those of Mercurius, but there is usually much heat and dryness in the eye and great sensitiveness to cold air, to light and bathing.
Conium.- Descemetitis, with excessive photophobia and but little redness or apparent inflammation.
Euphrasia.- Rheumatic iritis, with constant aching and occasional darting pain in the eye, always worse at night; ciliary injection and photophobia great; aqueous cloudy; iris discolored and bound down by adhesions.
Gelsemium.- In serous iritis alone or complicated with choroidal inflammation, Gelsemium is the most prominent remedy. There is hypersecretion and cloudiness of the aqueous, with moderate ciliary injection and pain.
Hamamelis.- Iritis traumatica, or other forms in which haemorrhage has taken place into the iris or anterior chamber.
Kali bichrom.- It is the remedy for true descemetitis characterized by fine punctate spots on the posterior surfaces of the cornea, especially over the pupil, with moderate redness and very little photophobia. May be required in syphilitic iritis.
Natrum salicyl.- Iritis with intense ciliary neuralgia, especially resulting from operations on the eye.
Nux vomica- May be useful at the beginning of the disease or as an intercurrent, especially in the syphilitic form, if there is much photophobia, lachrymation, etc., in the morning.
Petroleum.- Syphilitic iritis accompanied by occipital headache. Pain in eyes pressing or stitching and skin around the eyes dry and scurfy.
Spigelia.- Rheumatic iritis, if the pains are sharp and shooting both in and around the eye, especially if they seem to radiate from one point
Sulphur.- Iritis, particularly if chronic and found in strumous subjects, may find its remedy in Sulph, also if hypopyon complicates the trouble. May be of service as an intercurrent, even if it does not complete the cure. The pains are usually of a sharp, sticking character, worse at night and toward morning. General indications will decide our choice.
Terebinth.- Rheumatic iritis with intense pains in the eye and head, especially if resulting from suppressed perspiration of the feet. Pain in the back and dark urine will be present.
The following remedies have also been employed in occasional cases with favorable results. Their meagre indications can be found by reference to Part II. Argentum nit., Crot. tig., Prunus. sp., Pulsatilla, Silicea, Staphysagria and Zincum met.
Tumors of the Iris.- Both simple and malignant tumors and met with in the iris.
Cysts, both epidermoid and serous, are in the large majority of instances due to traumatism. The epidermoid is usually the result of a penetrating wound, by which one of the cilia is carried into the iris and is found to consist of cells covered with pavement epithelium and sometimes surrounded by a thin connective tissue and it may undergo fatty degeneration. The serous cyst in merely distended iris tissue, which may become so thin as to be simply a structureless membrane. The appearance is that of a grayish white or translucent tumor and its contents are similar to the aqueous humor.
The treatment consists excising them as early as possible, and care should be taken not to be rupture the cyst wall during removal.
Melanoma is an extremely rare from of humor affecting the iris. It is merely a hyperplasia of the pigmented cells of the stroma of the iris and appears as a small black humor. They are benign, usually congenital, more or less stationary and produces no irritation. Rarely they have been seen to develop into a melanosarcoma.
Granuloma may very rarely appear in children as a pale red or yellow vascular tumor, which may gradually increase, involve the cornea and perforate, when it appears like a spongy mass, bleeding easily and resembling a sarcoma. They may also occur from a prolapse of the iris or after operations. They have been found to consist of numerous small, round, irregular or spindleshaped cells, with a few large nucleated cells and may be covered with epithelium.
Sarcoma are very rarely found occurring primarily in the iris. On reported by Andrews N.Y. Medorrhinum Journ., June 1, 1889. as first excised with a piece of the iris and one week later the eye enucleated. They are usually an extension form the choroid or cilary body and are most frequently of the pigmented variety. Limbourg plus Archiv. Ophthal., vol. xix., p. 239, 1890. reports a case of leucosarcoma with complete details of the microscopical examination. The eye should be enucleated.
Tubercles appear chiefly in children and most frequently at the periphery of the iris and are accompanied by more or less inflammation. They appear in two forms, either as miliary tuberculosis characterized by a number of grayish semi- translucent nodules, which may subside spontaneously, or as solitary tubercle of a yellowish-white color, which may increase to such a size as to finally perforate the cornea. The treatment when they are increasing in size is either to excise by an iridectomy or enucleation. They may increase in size and number and should be either excised or the eye enucleated.
Mydriasis.- Dilatation of the pupil may occur in one eye or both, and may result from various causes.
Irritation mydriasis occurs from intestinal irritation, as in worms; from spinal or cerebral irritation, as in hyperaemia or new growths and in acute mania or melancholia. It is also found in hysteria and sexual irritation.
Paralytic mydriasis is found in diseased processes at the base of the brain, in orbital processes, or intra-ocular tumors where there is pressure on the ciliary nerves, in glaucoma, diphtheria, syphilis. etc., from injuries, simple cold or draughts of air. Von Graefe (++) Archiv. f. Ophthal., III, pt. III. p.350. considers unilateral mydriasis occurring at short intervals, first in one eye than the other, as a premonitory sign of mental derangement.
Mydriasis occurs as a paralytic affection of the third nerve or as result of some irritation of the sympathetic. It causes a dimness of vision from too much light and an increase of the circles of diffusion.
This functional disturbance of the pupil is, therefore, usually merely a symptom of deeper and more serious trouble and requires remedies adapted to that condition. It is, however, sometimes found uncomplicated with other disorders, being dependent upon cold, trauma, etc., in which case Arnica, Belladonna, Causticum and a score of remedies may be indicated. The instillation of sulphate of Eserine is often also of great service. As mydriasis is generally associated with paralysis of one or more of the ocular muscles, refer for treatment to paralysis of the muscles.
Myosis.- Contraction of the pupil is, physiologically, greater in infants and old age than in middle life; is greater in hyperopes than in myopes and in those who use the eyes steadily at fine work.
Spastic myosis or contraction of the pupil due to spasm of the third nerve may be dependent upon some irritation or inflammation of the eye, as in hyperaemia of the iris, or from some irritation of the cerebral centre, as in the early stages of inflammation of the brain or its meninges and when this myosis gives way to mydriasis it is a serious prognostic sign indicating the stage of depression with paralysis of the third nerve. It also occurs in the early stage of apoplexy, intra-cranial tumors, hysteria or in epileptic attack and in tobacco or alcoholic amblyopia.
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.