SYMPTOMS-Patients will complain of a diminution of vision as though looking through a mist, and the field of vision may be somewhat impaired. The ophthalmoscope will show a hyperaemia of the retina and optic papilla, together with a diffuse grayish of bluish appearance of the retina, especially in the vicinity of the optic disc, the outlines of which are slightly blurred and indistinct. The vessels may be slightly covered, as with a veil, or appear perfectly distinct.
CAUSES-This form of inflammation may precede or extend into other types of retinitis. It has been attributed to exposure to cold, heat or strong light, and as a result of over use of the eyes by poor light especially when there is some refractive error and in many cases it is impossible to assign a distinct cause.
PROGNOSIS.- If the disease leads to no more serious form of inflammation, recovery, with perfect restoration of vision, is the rule. Neuro-retinitis is a more common diagnosis, as the optic nerve the retina are usually inflamed at the same time.
TREATMENT-Rest is the most important aid in all cases whether inflammatory or only hyperaemic, and the more complicate it is, especially in neuritis or retinitis, the better for the patients. they should be artificial light. Some authors, Stellwag and others, recommend the confinement of the patient in a darkened room and the employment of a bandage. Such severe measures are, however, not required except in extreme cases. It is better to allow moderate exercise in the open air, taking care that the eyes are properly protected from the irritating influence of bright light by the use of either blue or smoked glasses.
Proper hygienic rules, according to the nature of the case, demand our most careful attention.
Belladonna-One of the most frequently indicated remedies for both hyperaemia and inflammation of the optic nerve and retina. the retinal vessels will be found enlarged and tortuous, particularly the veins, while a blue or bluish-gray film may seem to overspread the fundus (oedema). Extravasations of blood may be numerous or few in number. The optic disc is swollen and its outlines ill-defined. the vision is, of course, deteriorated. The pains are usually of an aching, dull character, cough may be throbbing and severe, accompanied by throbbing, corrective headaches with visibly beating carotids and flushed face. Phosphenes of every shape and hue, especially red, may be observed by the patient. Decided sensitiveness to light. The eyes feel worse in the afternoon and evening when all the symptoms are aggravated.
Duboisia-Of great value in the treatment of both hyperaemia and inflammation of the optic nerve and retina. Retinal vessels large and tortuous, especially the veins. Optic papilla swollen and outlines ill-defined (engorged papilla). Haemorrhages in the retina, aching in the eyes and pain through the upper part of the eyeball just beneath the brow, which may be very severe. Chronic hyperaemia of the conjunctiva.
Phosphorous-Hyperaemia or inflammation of the optic nerve and retina, especially with extravasations of blood. Degeneration of the coats of the blood-vessels. The eye may be sensitive to light and vision improved in twilight. vision impaired, muscae volitantes, photopsies and chromopsies are present, halo around the light. The eyeballs may be sore on motion and pain may extend from eyes to top of head.
Pulsatilla.-Hyperaemia and inflammation of the optic nerve and retina accompanied by more or less severe pains in the head always relieved in the open air. Sensation as if a veil were before the eyes, or the vision may be nearly lost. All the ophthalmoscopic appearances of engorged papilla or simple hyperaemia and be present if dependent upon menstrual difficulties or associated with acne of the face or disorders of the stomach.
Bryonia.-Serous retinitis or hyperaemia, with a bluish haze before the vision and severe sharp pain through the eye and over it. Eyes feel full and sore on motion or to touch. Great heat in the head, aggravated by stooping.
Mercurius.-Retinitis with marked nocturnal aggravation and sensitiveness of the eyes to the glare of the fire. Congested conditions of the fundus found in those who work at a forge or over fires. Degeneration of the blood-vessels, with haemorrhages into the retina. Concomitant symptoms will assist us in the selection.
Cactus.-Retinal congestion, especially if heart trouble is present.
Cactus.-Retinal congestions, especially if heart trouble is present.
Conium.-Fundus congested, with much photophobia, ciliary muscle weak.
Nux vomica-Retinitis occurring with gastric disturbances, especially in drunkards. The eye indications vary, but are usually aggravated in the morning.
Veratrum viride-Engorged disc, with severe pain at menses and general vaso-motor disturbances.
In addition to the above, the following remedies may be of benefit in rare cases or as intercurrents; Aconite, Arsenicum, Aurum, China sulph., Gels, Kali, iod, Kali mur., Lach, Spigelia and Sulph.
Dazzling of the Retina-Under this heading we shall class all those cases accompanied by a dazzling sensation, due to exposure to the bright glare of the sun, upon snow or water, to the electric light, etc. These conditions may produced a diffuse retinitis or neuro-retinitis, or, again, such exposure may be followed by amblyopia, with no ophthalmoscopic signs. Widmark Revue generale d’ophthalmologie, Paris, Aug., 1890. considers the trouble as produced by direct irritation of the part affected and that this is caused almost exclusively by the ultraviolet rays which exert a similar influence upon the skin. the patients complain of a dazzling, a central scotoma and slight impairment of the vision. Objects appear in a mist and the air seems to flicker. Cases of retinitis have also been reported as the result of a single intense flash of light. The treatment of these cases consists in the prevention of all use of the eyes and in protection from the light.
Retinitis Albuminurica- (Renal Retinitis, Papillo retinitis, Retinitis of Bright’s Disease).
PATHOLOGY-The pathological changes in albuminuric retinitis are numerous and variable in the different stages of the disease. There is at first a slight granular exudation into the retina, with a fatty degeneration of the walls of the vessels. Following this there is a hyperplasia of the connective tissue of the retina with subsequent fatty degeneration. the nerve-fibres become remarkably swollen; these swellings are club-shaped and highly refracting and the whole layer is much thickened. Later these fibres undergo fatty degeneration and atrophy. The ganglion cells may undergo a similar degeneration or remain unaltered. The granular layer become infiltrated and thickened and pass into a fatty degeneration. Haemorrhages, which result from the degenerated walls of the retinal vessels, may occur at any place, but are found most numerous in the nerve-fibre layer, and serve to increase the destruction of the retinal elements. there may be a slight proliferation of pigment, but this layer is but little affected. There are usually found pathological changes in the choroid, nerve, and other parts of the eye. According to Weeks, Archiv. Ophthal., vol. xvii., 3, 1888. we may divide this disease into two classes of cases-those occurring in all forms of acute disease of the kidneys, such as pregnancy, scarlet fever, and, in the other class, he places those dependent upon a general diseased condition of the vessels in which the eye symptoms precede those of the kidney. In the first form, which is by far the most frequent, oedema and white patches appear first, to be followed by haemorrhages, while in the second class a slight haemorrhage near the macula and a few bright dots are the first evidenced, followed later by the oedema and white patches.
SYMPTOMS-The only subjective symptoms noticed by the patient is that of impairment of vision, which may vary from a slight cloudiness to complete blindness. The field of vision and also the color vision remains good. Frequently the disease is diagnosed by ophthalmoscope before the patient is aware that there is seen swelling and hyperaemia of the disc; the retinal arteries are somewhat diminished and the veins increased in size; there is a diffuse haziness of the retina, together with haemorrhage and the formation of white patches.
In a well-marked case there is in the macula or its immediate vicinity numerous fine white spots, which are, in the early stages, small and separate, but later on, or a truly typical case, from a star-shaped figure, at the centre of which lies the fovea centralis. These specks are due to the infiltration with fat of Muller`s fibres. Other of these spots and somewhat larger in size, due to the fatty degeneration of the two granular layers, are usually seen around the papilla, and in this locality they will often coalesce into a broad zone around the optic nerve entrance, giving it he appearance usually designated as surrounded by a snow bank. These peculiar white spots of the retina are due to a fatty degeneration of the nerve-fibre and granular layers, and, when seen, may be considered almost pathognomonic of albuminuria, particularly so when assuming the star-shaped arrangement at the macula.
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.