Another method of toning up a weakened muscle which may be employed with benefit is forcible stretching of its antagonist in the following manner : After cocainizing the eye take hold of the eyeball firmly with the fixation forceps over the insertion of the impaired muscle acts, carrying it also moderately in the opposite direction. Do this two or three times at one sitting. This can be repeated at intervals of from two day to a week.
Both faradism and galvanism have also proved of much value in the restoration of muscle power. Galvanism seems to have given the best results in my hands, and is now universally employed in all cases immediately after the prism exercise, using from two to four milliamperes, the positive pole applied to the temple, and the negative, through a small ball electrode, to the lid directly over the insertion of the impaired muscle. Locally the patient is advised to apply to the closed eyelid three or four times each day a solution of equal parts of brandy and water or a weak solution of the remedy used, especially Ruta. Gelsemium, or Senega.
Internal medication for the relief of asthenopic symptoms is of the first importance.
Ruta grav.- Aching in and over the eyes, with blurring of the vision after using or straining the eyes at fine work. The eyes feel hot like balls of fire, appear irritable and run water, especially toward evening after working all day.
Onosmodium.- Heaviness and dullness of the eyes. Dull, heavy pains and soreness of the eyeball. Tense, drawing and tired feeling in the ocular muscles. Pain in and over left eye. Pains in the left side of the head. Dull, heavy pain in the occiput with dizzy sensation, eyes feel as though they were wide open, vision blurred. Great muscular prostration and tired feeling over the entire body. The muscles feel unsteady and treacherous, as thought you dare not trust them to move.
Gelsemium.- Asthenopia, with weakness of the external recti, or if associated with blepharitis or hyperaemia of the conjunctiva. Soreness of the eyeballs. Drawing over the eyes. Diplopia which can be controlled by an effort of the will.
Senega.- Is a remedy of special value in cases of asthenopia from hyperphoria. Confused feeling in the head. Dullness of the head, with pressure and weakness of the eyes. Tired, aching or pressing pains in or around the eye, smarting and burning of the eyes. The headache is of the whole head and not centered in any particular spot, and is often relieved in the open air. Aggravation of all the symptoms upon use of the eyes.
Natrum mur.- No remedy is more often indicated in asthenopia than this. The vision soon becomes dim and the letters run together upon using the eyes for near vision and sometimes for distant vision. The internal recti are usually weak. The muscles feet stiff and drawn and ache on moving the eye in any direction. Pain in the eye upon looking down. Burning, smarting, itching and heat in the eyes upon reading or writing, with a variety of other sensations, even headache. Heaviness and drooping of the lids on use of the eyes for near vision. The eyes appear irritable, with some dread of light, so the patient desires to close them firmly.
Sepia.- Smarting in the eyes and a variety of other sensations may be experienced, as can be seen by reference to the verified symptomatology. Aggravation of the symptoms morning and evening.
Argentum nit.- Letters blur, and sight vanishes on reading or writing.
Cinnabar.- Asthenopia, with pain in the inner canthus, extending above or around the eye, worse in the evening and upon using the eyes. Soreness over exit of supra-orbital nerve.
Aconite.- Asthenopia from over-use of the eyes. Lids spasmodically closed, with a heavy feeling in them; while the eyes feel very hot and dry after using. Conjunctiva may be hyperaemic. Cold water may relieve temporarily the heat in the eyes.
Agaricus.- Asthenopia, especially muscular, if accompanied by sudden jerks of the ball, twitching of the lids, etc.
Calcarea.- Pale, flabby subjects, inclined to grow fat; with coldness of the extremities and perspiration about the head. Eyes pain after using, and are generally worse in damp weather and from warmth. Burning and cutting pains in the lids, and sticking pains in the eyes on reading. Dim vision after fine work. Objects run together.
Conium.- Letters run together on reading. Burning pain deep in the eye. Great dread of light.
Kalmia.- Stiff drawing sensation in the muscles upon moving the eyes (Nat. mur.).
Lachesis.- Asthenopic symptoms, especially in the left eye, with a variety of pains and sensations, worse upon thinking of them, using the eyes and on waking in the morning.
Lilium tigrinum- Burning, smarting, and heat in the eyes after reading, relieved in the open air (Pulsat.). Photophobia.
Mercurialis peren.- Asthenopia, with a sensation of dryness of the eyes and heaviness of the lids. Mist before the eyes in the morning. Burning pain in the eyes in evening, and upon reading.
Phosphorus.- Mistiness and vanishing of vision, with pain and stiffness in the eyeball. Light aggravates, so the patient is better in the twilight. Muscae volitantes. Photopsies.
Rhododendron.- Insufficiency of the internal recti muscles, with darting pains through the eyes and head, always worse before storm.
Spigelia.- If accompanied by sharp, stabbing pains through the eye and around it, extending back into the head.
In addition to the above, many other remedies have been employed with success. Attention is particularly directed to the following: Ammonium carb., Apis, Arnica, Asarum, Carbo Veg., Causticum, Crocus, Euphrasia, Ignat., Kali Carb., Ledum, Lith carb., Macrotin, Nux vomica, Paris quad., Phosphorus ac., Pulsat., Santon, and Sulphur.
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.