An interesting case under my care in the N.Y. Ophthalmic Hospital shows that Apis may be of service in parenchymatous keratitis. A boy, 11 years of age, was brought to me with the right cornea densely infiltrated, moderate redness and photophobia. Inflammation was just commencing in the left eye. The history of hereditary syphilis was clear. There was an exostosis on inferior maxilla; the joints were enlarged and painful, so that he could not walk; high fever and loss of appetite. He was taken into the hospital and several remedies given with no avail,. Both corneae became worse, when infiltrated and inflamed, until vision was nearly lost in both eyes. His fever also increased and was accompanied with drowsiness thirstlessness. Apis1 was given, with immediate relief of the drowsiness, fever and inflammatory symptoms of the eye. Under its influence the cornea began at once to clear and a complete cure was the final result.
A case of hydrops retinae, with pressive pain in the lower part of the ball, with flushed face and head, was partially relieved by Apis, but not cured.- T.F.A.
Asthenopic troubles, especially affections from using the eyes at night, causing redness of the eyes, with lachrymation and stinging pains, may call for this remedy.
The character of the pains will usually serve to distinguish the Apis from the Rhus cases, which are objectively very similar. Apis does not seem to control suppurative inflammations of the deep structures of the eye as does Rhus, though the puffiness of the lids might seem to indicate it; these are at first generally painless and the external swelling is not bright red, as are the local and external troubles of Apis.
The burning, hot lachrymation calls to mind Arsen., but the discharges are not acrid and excoriating in Apis, though they feel burning hot; besides the Arsenicum cases usually present a well marked cachexia.
ARGENTUM METALLICUM.
Margins of lids very thick and red. Violent itching and stinging in the canthi.
Clinical.- This remedy has proved useful in some cases of blepharitis, relieving the severe itching of the lids and angles of the eye. On case of stricture of the lachrymal duct improved very rapidly under its use until lost sigh of.- T.F.A.
ARGENTUM NITRICUM.
Objective.- Ophthalmia, often with intense pain, abating in the cool and open air, but intolerable in a warm room. The conjunctiva, both ocular and palpebral, becomes greatly swollen, congested and infiltrated, with scarlet redness. The caruncula lachrymalis is swollen and looks like lump of red flesh; clusters of intensely red vessels extend from the inner canthus to the cornea. Profuse mucous discharge in the morning on waking, with dullness of the head, especially in the forehead and root of the nose. The margins of the lids are red, sore and thickened, with but little secretion; the canthi red and sore. Opacity of the cornea.
(From the local application of this drug, most violent inflammation of the conjunctiva, of the lids and eyeballs ensues, with profuse muco-purulent discharge which is not excoriating to the lids.)
Subjective.- Heaviness over the eyes, which open with difficulty. Boring above the left eye. Infra-orbital neuralgia. Photophobia. Burning, biting and itching in the eyes, especially in the canthi; heat and pain in the ball on motion and touch; aching pain, deep in the eye, early in the morning.
Vision.- The letters become blurred before the eyes; the sight vanishes when reading or writing. Vanishing of sight. Obscuration of sight with anxiety; heat in the face and lachrymation; gray spots and bodies in the shape of serpents move before the vision.
Clinical.- It is useful in blepharitis if the lids are very red, thick and swollen, especially if complicated with granulations, conjunctivitis or some deeper inflammation of the eye. In one case of ciliary blepharitis with entropium, caused by being over a fire, and ameliorated in the cold air or by cold applications, it effected a cure.
Acute conjunctivitis resulting from bathing, with profuse discharge and dark redness of the conjunctiva, has been relieved.
Nitrate of silver is not homoeopathic to granular lids in the later stages, but is the appropriate remedy in the early stage of acute granular conjunctivitis, in which the conjunctiva is intensely pink or scarlet-red and the discharge is profuse and inclined to be muco-purulent. Although these may be confounded with Euphrasia cases, there is a wide difference, more easy to recognize than to describe. In Euphrasia the profuse discharge causes soreness of the lids and more or less swelling; the character of the inflammation is more acute and short lived and, as a rule, the redness is much less brilliant. In Nitrate of silver cases we may, indeed, have very little discharge, except, perhaps, flakes of mucus, when the patient complains of itching and biting in the eyes and a dry, burning sensation without real dryness. (Cantharis has intense heat and real dryness; Sulphur is very often indicated in these dry conjunctival catarrhs, especially if there be sharp sticking pains under the lids as if splinters were sticking into the eyeballs. Compare also Alumina, Graphites and Natr. mur.)
The greatest service that Argent. nitr. performs is in purulent conjunctivitis. With large experience in both hospital and private practice, not a single eye has been lost from this disease when seen before the cornea has been destroyed, and most of them have been treated with nitrate of silver, which should be used internally and in all severe cases locally as well. In the mild cases where the discharges is not excessive and the chemosis not great I am in the habit of using a solution of form ten to twenty grains of the first potency to the ounce. When the discharge is thick, yellow and profuse, especially if the chemosis is extensive, it should be used locally in a solution of from two to five or even ten grains to the ounce. In the very first stages of purulent conjunctivitis it may sometimes be aborted by a single application of a solution of nitrate of silver, thirty grains to the ounce. The most intense chemosis, with strangulated vessels, most profuse purulent discharge, even the cornea beginning to get hazy and looking as though it would slough, have been seen to subside rapidly under this treatment. The subjective symptoms are almost none; their very absence, with the profuse purulent discharge and the swollen lids, swollen from being distended by a collection of pus in the eye or swelling of the sub-conjunctival tissue of the lids themselves (as in Rhus or Apis) indicates the drug.
It has also relieved and contributed to the cure or diseases with destruction of tissue, as ulceration of the cornea; in one case with pains like darts through the eye mornings, better evenings; in another case there were small ulcers on the upper part of the cornea with much inflammation, burning pain and profuse discharge.
It has also been useful in kerato-iritis, with violent congestion of the conjunctiva; the cornea was vascular and eroded, with terrific pains from the vertex into the eye and with burning heat in the eyes.- T.F.A.
Coldness of the eye, with boring pain in the head and sensation as if the scalp was drawn tightly, has been removed by Argentum nitr.-T.F.A. (Acidum fluoricum has a sensation of cold air blowing into the eye.) In the Argentum nitr. cases we sometimes meet with trembling of the whole body and headaches.
A case of retino-choroiditis was successfully treated by this remedy.- W.H. WOODYATT.
Argentum nit. has greatly improved two cases of atrophy of the optic nerve.- C.M. THOMAS.
Dr. Woodyatt was the first to call attention to Argentum nitr. as a remedy for weakness or paralysis of the accommodation. Since then it has been found of great service in many cases of this kind, especially if dependent upon errors of refraction, in which the asthenopic symptoms on using the eyes are not relieved after correction with the proper glasses.
ARNICA.
The margins of the upper eyelids are painful when the lids are moved, as if they were too dry and a little sore. Cramp-like tearing or pressure in the eyebrow (left). Headaches between the eyes. There is some burning and itching of the eyes with slight lachrymation and photophobia. Feeling of heaviness of eyes; eyeballs are inflamed.
Clinical.- Arnica has been employed with marked success in a variety of eye troubles resulting from blows and various injuries; sometimes applied locally (tincture diluted with water) and sometimes given internally. It seems to be better adapted to contused than lacerated wounds, and to injuries before inflammatory symptoms have become prominent, although benefit has been derived from its use in inflammation of the lids, conjunctiva, and even of the whole globe,, when of traumatic origin. (Aconite, Calendula)
In hastening the absorption of extravasations of blood in the conjunctiva, aqueous humor, retina, or other ocular tunics, especially if resulting form injuries or the straining in whooping-cough, Arnica often acts well; it seems also, sometimes, to correct the relaxed condition of the blood-vessels and the too fluid condition of the blood, which predisposes to sub- conjunctival haemorrhages in whooping-cough. (Hamamelis is more frequently used in haemorrhages into the anterior chamber, and Ledum in sub-conjunctival ecchymoses.)
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.