TREATMENT- The general indications mentioned under other varieties of retinitis are, of course, applicable in this form of rental inflammation.
Mercurius-Especially the remedy for this form of inflammation of the retina. The solubis or corrosivus have been more commonly employed, though the other preparations are also useful when special indications point to their use. The retina will be found hazy, congested and often complicated with an inflammatory condition of the choroid or neighboring tissues. The eye is particularly sensitive to artificial light. Nocturnal aggravation of all the symptoms is always present. More or less pain is experienced both in and around the eye, especially during the evening and after going to bed.
Kali iod-For syphilitic retinitis this should be one of the first remedies thought of, especially if there is choroidal complication, though the chief indications for its use will be furnished by the general condition of the patient.
Aurum-Especially after over-dosing with iodide of potassium or mercury, and if accompanied by detachment of the retina. Eye sensitive to touch, with pain in and around, seeming to be deep in the bones. A general syphilitic dyscrasia is perceptible in the constitutional symptoms which govern our selection of Aurum.
Asafoetida- When accompanied by severe boring, burning pains above the brows, especially at night; also if there is pain in the balls from within outward, ameliorated by pressure (reverse of Aurum)
Other anti-syphilitic remedies may be useful, given according to general indications, or we may find a remedy recommended for the other forms of retinitis, serviceable in this variety when particular indications are present.
Retinitis Punctata Albescens(Central Punctate Retinitis)- This is a circumscribed form of retinitis to which Mooren gave the name of punctata albescens.
Its essential features consist of numerous small white glistering dots and striae, closely packed together, giving a stippled appearance to that part of the fundus involved. In one case under my observation, a few years ago, the entire fundus was filled with these small white dots and yet the patient had nearly perfect central vision.
The usual location of this disease is in the posterior pole of the eye in the vicinity of the macula lutea.
In this form of retinitis there is usually but slight if any inflammatory symptoms-merely an increased tortuousity of the retinal veins and possibly a few small haemorrhages. No special cause has been assigned for this form of retinitis, which usually occurs in those of middle age. Burnett Archiv. Ophthal., vol. xii., I, p. 22. reports one case under his own observation and gives an abstract of five other recorded cases, from which he concludes that the prognosis is, and a rule good-some cases going on the complete recovery, while none seem to lead to destruction of the vision.
Retinitis Proliferans-A development of connective tissue in the retina may occur at any part of the fundus and appears as a shred-like or membranous formation. These masses are of a bluish-white appearance and often extend into the vitreous, hiding the optic disc and covering the fundus to quite an extent. They sometimes seem to follow the course of some of the larger vessels, which are in parts covered by the formation and again are seen passing over it. The formation of these patches may have resulted from a previous retinitis or neuritis, although Loring (loc.cit) has seen cases which he believed were either congenital or acquired in very early Leber Graefe and Saemisch, vol. v., p. 666. attributes the cause of these formations to repeated haemorrhages, which gradually become organized.
Rotinitis pigmentosa (Sclerosis of the Retina, Pigment Degeneration of the Retina)- The name retinitis pigmentosa is according to Frost plus Brit. Medorrhinum Journ., Dec. 14, 1889. a misnomer, because the disease is much more of a degenerative change than it is an inflammatory condition.
PATHOLOGY-This consists of a hypertrophy of the connective tissue throughout the retina, with atrophy of the nervous element (especially the layer of rods and cones) and the migration of pigment. There is also a new formation of pigment, and at some points an atrophy of the pigment occurs. There is a considerable thickening of the walls of the vessels, with a corresponding diminution in their calibre. the changes commence first in the outer layers of the retina, and later the granular layers are affected, then the layer of rods and cones is destroyed and the entire retina becomes changed and sometimes adherent to the choroid in spots. There is a colloid thickening of the vitreous membrane of the choroid, which extends into the retina and becomes covered with pigment. The disease begins at the periphery of the fundus and gradually extends toward the posterior pale.
SYMPTOMS-Central vision is but slightly affected in the earlier stages of the degeneration, and only becomes materially diminished when the process has involved the region of the maculalutea. the field of vision becomes concentrically contracted, extending as the disease advances until often there is such extreme narrowing of the field that the patient is only able to read by fixing a single word at a time. He may read fine print, yet be unable to cross the street alone, owing to the contraction in his field of vision. In extreme cases the contraction progress to complete blindness. Hemeralopia or night blindness is usually one of the earliest symptoms and often the first to attract the patients’ attention- they notice that on approach of dusk their movements become uncertain and that they are apt to stumble over objects.
Ophthalmoscopic examination presents a striking and characteristic appearance. (See Chromo-Lithograph, Plate II., Fig 5.). The entire periphery of the fundus will generally show beautifully arranged masses of pigment, which assume the shape and appearance of bone corpuscles, the process from which extending off to unite with each other form a network which encircles the periphery of the fundus. The pigmentation will often extend farther toward the macula, on the temporal than on the nasal side and is frequently seen extending farther backward along the course of the vessels. The retinal vessels, both arteries and veins, become greatly contracted. the optic-disc becomes of a greyish-yellow appearance, at the same time the vessels are gradually narrowing, owing to the loss of capillary circulation.
COURSE- This condition, commencing either congenitally or in early childhood, may remain stationary at some period, but usually advances steadily, with increasing contraction of the field, until finally, a little after middle life, vision has become nearly destroyed. Both eyes are almost invariably affected.
CAUSES-It is undoubtedly of hereditary origin in nearly all cases and consanguinity seems to be an important factor, as intermarriage, one or two generations remote, can generally be found. Congenital deaf-mutism, epilepsy and idiocy are frequently seen in cases of retinitis pigmentosa. This disease is more frequently found in men than in women. The prognosis is unfavorable.
DIAGNOSIS-Retinitis pigmentosa may be confounded with disseminated choroiditis, but in the latter the shape and arrangement of the pigment is decidedly different, the patches are more less less circular, are isolated and present signs of exudation with atrophy and we find corresponding white patches with irregularly pigmented borders. In retinitis there are no spots of choroidal atrophy, the pigment is stellate and is more apt to be along the vessels or covering them in spots.
COMPLICATIONS-Nystagmus is frequently present and more especially so in those cases that have become far advanced in very early life. Posterior polar cataract may also be found in the later stages and very rarely vitreous opacities.
TREATMENT-Over use of the eyes and exposure to bright light must be avoided. Much attention must be given to the general health for a long period. Lyco., Nux vomica and Phosphorus are suggested as remedies.
Detachment of the Retina-(Amotio Retinae Ablatio Retinae).
PATHOLOGY-In simple or idiopathic cases the fluid behind the detachment is found to be albuminous in character and contains blood and lymph corpuscles, fat cells, pigment, epithelium, etc. The vitreous is usually liquid and the retinal changes consist in a destruction of the rods and cones; fibrous tissue may be formed in the retina and atrophy of the nerve elements ensues. when detachment occurs as a result of morbid conditions of other structures, such as cyclitis and choroiditis, there is, of course, the added pathological changes of those disease.
SYMPTOMS-There is more or less loss of vision, which may come on suddenly. This is usually the first symptom to attract the patient’s attention to the eyes, although sometimes black spots floating before the eyes, or flashes and rays of light, have been noticed as preceding a detachment. Vision is not wholly lost, unless the region of the macula is involved in the detachment. There is a limitation in the field of vision which appears to the patient as a dark cloud. This restriction in the field often escapes observation in fresh detachments, unless the examination be made carefully and with a weak light, because the retina being nourished by its own vessels still retains its function to a certain extend. When the detachment is due to a tumor, the defect in the field of vision is more sharply defined than when the result of an exudation and the central vision may remain unaffected. If the detachment be of the lower part of the retina, the upper portion of vision is lost, and, if above, the lower, and so on, Patients complain of a distortion of objects (metamorphopsia), of black spots floating before the vision-due to opacities of the vitreous-and of various light sensations and phosphenes. Night blindness may or may not be present.
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.