Clinically this remedy has proven of great value in parenchymatous keratitis where there is excessive inflammation. The cornea appears as though a haemorrhage had occurred in its layers. Excessive lachrymation and photophobia.
FLUORIC ACID.
Sensation as if the eyelids were opened by force and a fresh wind were blowing on them; after that, sensation like sand in the eye, which had the same feeling as if the eyes were inflamed.
Clinical.__ A case of lachrymal fistula on the left side, of one years’ duration, with clear, yellow scab on the cheek, near the inner canthus, which is but slightly red and painful to pressure. Every three or four days it begins to itch, grow moist, then heals again; it is sometimes painful before it opens. Fluoric acid 30 cured.-C. HERING.
The symptom, as if cold wind were blowing in the eye, has been frequently verified in various ophthalmic diseases.
GELSEMIUM.
Objective.__Drooping of the eyelids. Eyelids half closed, with apparent inability to move them. Lids close on looking steadily at anything. Irritability of the conjunctiva. Pupils dilated. Iris sluggish. Eyeballs oscillate laterally.
Subjective.__ Soreness of the eyeballs. Great heaviness of the lids. Drawing over the eyes. Dull, full feeling (attended with some aching) in the whole of the orbits. Aversion to light. Orbital neuralgia. Eyes tire upon using for near vision. Pain running from over the eyes to the occiput, aggravated on the right side. Bruised pain above and back of the orbits.
Vision.- Dimness of vision. Dimness of sight and vertigo. Black and bright specks before eyes. Glimmering appearances before the eyes. Smoky appearance before the eyes, with pain above them. Objects appear double. Diplopia which can be controlled by an effort of the will. Diplopia when inclining the head toward either side, but vision single when holding the head erect.
Clinical.-Gelsemium is rarely found of benefit in superficial affections of the eye, but is especially adapted to diseases of the fundus and paralysis of the nerves.
Its action upon the uveal tract is very marked, especially in the serous form of inflammation, either when it involves the iris, ciliary body and choroid separately or all three at the same time. In serous iritis, the hypersecretion and cloudiness of the aqueous humor, together with moderate ciliary injection and varying amount of pain in the eye and head, will be our chief indications. (Compare with Kali bichrom., which is the remedy for descemetitis, improperly classed by some authorities under serous iritis).
In serous choroiditis Gelsem. is a remedy of the first importance. According to Dr. W. A. Phillips in a paper read before the Am. Hom. Ophth. and Otol. Soc., in 1881, the symptomatic indications for its use in serous choroiditis are: “1. A dull pain in or about the eye, extending all of the time, or periodically, or finally, to the back of the head, and ameliorated by hot applications, but not by cold. 2. Impairment of vision gradually developed and not characterized by sudden changes, either for the better or the worse. 3. Heaviness of the lids. 4. Inability to accommodate the eye quickly for varying distances. 5. The asthenopic symptoms not marked by great irritability of the eye, but resulting from an evident want of tone or energy of the muscular structures__in other words, a passive asthenopia rather than active. 6. In general, a feeling of depression and lassitude, which is not relieved by food or stimulants.” In addition to the above it will usually be found that the haziness of the vitreous is very fine, the tension tends to increase, the pupil to dilate and the eyeball to become sore to touch, with aching pain over and in the eye. The impairment of vision is not necessarily constant, as it may vary greatly, being one day very dim and the next quite bright.
Its usefulness in serous inflammation of the whole uveal tract (irido-choroiditis) is sufficiently illustrated in the following case: A woman, aet. 32, had complained of the eyes being weak for two months, but worse recently. Right vision 20/100 with difficulty. Left vision, counted fingers at 20 feet. Ophthalmoscope showed serous inflammation of the iris and choroid, deposits on the membrane of Descemet, aqueous and vitreous hazy in both eyes and left pupil dilated and sluggish. There was a sensation of pressure over both eyes and headache in the temples. She was a seamstress and would not take proper rest. R. Gelsem. 30. Two weeks later she reported that she began to improve immediately on taking the above powders, had taken no other medicine and had used the eyes all the time for sewing. Right vision 20/30 with difficulty. Left 20/20 with difficulty. Eyes appeared perfectly well, with the exception of a few small points on the posterior surface of the cornea and slight dilatation of the left pupil, which eventually disappeared.
From its value in serous inflammations and from some temporary benefit derived from Gelsemium in glaucoma, it is recommended for this disease, especially if dependent upon increased secretion. (Glaucoma is probably usually due to obstruction in excretion.) Dr. F. Park Lewis reports that it has been of use to him in “one case of glaucoma after iridectomy. Notwithstanding a large coloboma in both eyes, the sight began to diminish and pain and tenderness to come back in the head. Gelsem.1 received the pain and somewhat benefited the sight.”
Dr. C. M. Thomas writes me: “In disseminate choroiditis and retino-choroiditis with no outside symptom, the good effect of Gelsem. is undoubted and it is used by me almost to the exclusion of other remedies.”
A case of retinitis albuminurica, in which the dimness of vision came on suddenly during pregnancy and was worse after delivery, was cured under Gelsemium. There were white patches and extravasations of blood throughout the retina, while the outer part of the optic nerve appeared whiter than usual. There was no pain, only an itching of the eyes.__T. F. A.
Another great sphere of usefulness for this drug is to be found in detachment of the retina. Dr. F. H. Boynton first reported a case cured under Gelsem. in which the detachment had been present three weeks and was dependent upon an injury. It was accompanied with diffuse haziness of the vitreous and serous inflammation of the choroid and retina. In one month, under Gelsem.30, the vision improved from perception of light to 20/70 and the retina became completely re-attached. Since then similar results have been obtained from its use in detachment of the retina, from myopia. (Compare Arnica and Aurum.) It is no doubt the most commonly indicated remedy in this affection.
In paresis or paralysis of any of the ocular muscles, decided benefit has often been derived from the use of this remedy. It has been of service in paralysis following diphtheria (Buffum), and when associated with paralysis of the muscles of the throat, although often when indicated there is a complete lack of all subjective or objective symptoms, with the exception of the impairment of the muscle.
In asthenopia, dependent upon weakness of the external rectimuscles, Gelsem. was highly recommended by Dr. W. H. Woodyatt. As a remedy for clearing up troublesome asthenopic symptoms, even local irritations, such as blepharitis and conjunctival hyperaemia, due to refractive errors, Dr. C. M. Thomas has found it more serviceable than any other drug.
In paralysis of the nerves, compare Gelsem. with Causticum, Conium and Rhus, and in serous choroiditis compare with Bryonia. The condition which indicates Gelsemium is usually one of stolid indifference to external irritants, in which respect it stands in marked contrast to Conium, whose paralytic symptoms are characterized by great reflex irritability, photophobia, etc.
GRAPHITES.
Objective.__ A stye on the lower lid, with drawing before the discharge of pus. Red, painful inflammation of the lower lid and inner canthus. Very inflamed margins of the lids. Canthi crack and bleed easily. Inflammation of the external canthus. Dry mucus in the lashes. Agglutination of the eyes in the morning. Redness of the whites of the eyes, lachrymation and photophobia, with a micro-purulent, thin and excoriating discharge. Lachrymation.
Subjective.__ Sensation of dryness in the lids and pressure. Heaviness of the lids. Heat about the lids. Heat, burning and biting in the eyes. Smarting and biting in the eyes.
Vision.__ Vanishing of sight during menstruation. Intolerance of light, with redness of the eyes. Great sensitiveness of the eyes to daylight. Letters appear double and run together when writing. Flickering before eyes.
Clinical.-The are few remedies in the materia medica so commonly indicated in inflammatory conditions of the lids, conjunctiva and cornea as Graphites, especially if occurring in scrofulous subjects, with eczematous eruptions, which are moist, fissured, bleed easily and are situated chiefly on the head and behind the ears.
It is particularly indicated in the chronic form of blepharitis, or in eczema of the lids, though sometimes called for in acute attacks, especially if complicated with such affections of the cornea as ulcers and pustules. In chronic ciliary blepharitis, in which Graphites is useful, the edges of the lid will usually bee found slightly swollen and of a pale red color: the inflammation may be confined to the canthi (blepharitis angularis), especially to the outer, which have a great tendency to crack and bleed easily upon any attempt to open the lids; the margins may be ulcerated; dry scurfs are usually present on the cilia; there may be burning and dryness in the lids and biting and itching, which cause a constant desire to rub the eyes. (Compare with Antimon, crud., which is adopted to pustules on the margins of the lid.)
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.