114.-Conjunctivitis-Ophthalmia.
DEFINITION. – Inflammation of the conjunctiva-the membrane which covers the posterior surface of the eyelids and the anterior surface of the globe of the eye.
Inflammation of the conjunctiva is met with at all ages, and at all seasons of the year, but some forms are more common in the spring and autumn.
Cases are very frequent in poor, ill-fed children, and very commonly these also suffer from chronic coryza, have sores about the nostrils and lips, eczema of the face, perhaps discharging ears. Good food and cleanliness are here of the first importance. Plenty of fat food-milk, cream, and butter-should be given. The internal administration of cod-liver oil is the best cure for the disease in these cases.
Conjunctivitis may be acute or chronic. An acute conjunctivitis may become chronic.
CAUSES. – Apart from mechanical or chemical irritation, inflammation of the conjunctiva is almost always caused by micro- organisms gaining access to the conjunctival sac; or perhaps in some cases by the sudden development under favourable conditions of those which had been already present in a latent condition. They can easily be detected in the discharge; and are the cause of its infectious nature. Infection takes place by the direct transference of the secretion from person to person, or indirectly by the common use of the same article by different people.
An attack may follow any irritation, such as exposure of the eyes to dust, smoke, heat, accidental splashes of foreign fluids, winds, glare of light, prolonged exertion in using the eyes when there is an error of refraction. The reflex irritation of decayed teeth, gastritis, ingestion of stimulating foods, will produce the same symptoms. When these causes of irritation are repeated or prolonged a chronic form of conjunctivitis results the eyes are always bloodshot, sore, and watery.
SYMPTOMS. – In no disease can the classical features of inflammation-heat, pain, redness, swelling, and alteration of function – be better seen.
Swelling varies from a barely perceptible oedema to a swelling so intense as to render lid and eyeballs immobile, and the skin may be swollen and glassy-looking.
Pain is always present in acute cases. It is peculiar that patients complain of the presence of sand or grit in the eye, even, sometimes, of a feeling as if broken pieces of glass were rolling under the lids. The membrane is sensitive to cold air.
Excluding cases where the eyes are closed by oedema of the lids, there is even in slight cases some blurring of vision.
Tears are excessive and a secretion of mucus or muco-pus glues the lids together in the morning.
There is bright redness of the conjunctiva and frequently extreme intolerance of light.
TREATMENT. – Bathe the eyes several times daily with warm boracic lotion. If there is muco-purulent discharge use instead a lotion of Calendula O 5 drops, to a wineglassful of warm water. After bathing instill Boracic or Calendula ointment within the lower eyelid, – while the patient looks up, draw down the skin of the lower lid, and with a clean glass rod or spatula place a piece of ointment the size of a match-head on the exposed conjunctiva lining the lower lid. If the lids are agglutinated in the morning they should not be opened without being first moistened with lotion, but any gumming of them together is prevented by smearing the edges at night, or better still, instilling within the lower lid, a little ointment.
Exposure to currents of cold and damp air should be avoided, and if the weather be inclement the patient should remain in a room of uniform temperature. As long as the eyes remain sensitive they may be protected by a shade, or by plain blue or smoke- coloured glasses. They should be used with extreme moderation, and an impure atmosphere avoided.
The food should be simple, nourishing, and digestible.
It is important to remember that many forms are highly contagious, the infection being not unfrequently transmitted by towels, sponges, water, etc. Those articles which will stand boiling in a little washing soda may be disinfected by that process.
PURULENT OPHTHALMIA is a severe and dangerous form of conjunctivitis, due in nearly all cases to contagion from gonorrhoeal discharges.
It is most commonly seen in infants infected by vaginal discharge at birth, and it makes its appearance about the third day after the confinement. The lids become red and swollen and their edges stick together; on opening them yellowish pus exudes. If the disease be neglected there is great risk to the cornea from ulceration and sloughing with consequent incurable blindness. In the L.C.C. Blind Schools 37 per cent. of the children are blinded by this one cause.
The disease is preventable (1) by curing the leucorrhoea of the mother during pregnancy; (2) by instilling a 1 per cent. solution of silver nitrate, or a 15,000 perchloride of mercury solution into the conjunctival sac as soon after birth as possible in order to kill the gonococcus should it have gained access to the conjunctiva. In the child’s first toilet, the face should be washed in separate water and dried with a separate towel to that used for the body, and at no time should the mother’s towels be used for the baby.
LEADING INDICATIONS FOR SOME OPHTHALMIC MEDICINES
Belladonna. – Pain, redness, and swelling; throbbing pains in the temples; flushed cheeks, glistening eyes, and great intolerance of light. A dozen drops of the tincture may be mixed with a half a dozen tablespoonfuls of water, and a spoonful given during the acute stage every hour, and afterwards every three to six hours. Aconite is often required in alternation with Belladonna when there are general feverish symptoms; or two doses of Aconite may precede Belladonna
Aconitum. – Conjunctivitis, with quick pulse, dry skin, thirst, and when arising from cold. The early administration of this remedy, with the local use of Calendula or Boracic lotion bath, will generally promptly relieve and cure Catarrhal Ophthalmia.
Mercurius Sol. – Conjunctivitis marked at first by a copious discharge of watery fluid, which afterwards changes to mucus and pus; agglutination of the lids; smarting heat and pressure, with aggravation of the pains when moving or touching the eyes. There is not much fever present, but considerable itching and irritation.
Euphrasia. – Catarrhal Conjunctivitis, with profuse secretion of tears, sensitiveness to light, and catarrhal Inflammation of the frontal sinuses and of the lining of the nose. In simple Catarrhal Inflammation, profuse lachrymation being the chief symptom, it often cures without the aid of any other remedy.
Mercurius Cor. – In the most violent forms of Acute Conjunctivitis with extreme dread of light, or in chemosis the 1x or 2x of this remedy will often cut short the attack.
Argentum Nit. – This remedy is especially valuable in the Purulent Ophthalmia of children, which it cures rapidly and completely, without the local use of the nitrate. It is also valuable in Chronic Conjunctivitis.
Phytolacca. – Itching in the eyes, aggravated by gaslight; chronic conjunctivitis with rheumatic pains; reddish-blue swelling of the lids.
Gelsemium. – Squinting; desire for light; Orbital Neuralgia.
Pulsatilla Nuttalliana. – Eyelids agglutinated; increased secretion of tears; neuralgic pains in the eye-balls.
Arsenicum. – Obstinate Ophthalmia in weak, nervous patients, particularly if the secretion be acrid, with burning, tearing, or stinging pains in the globe and lids, aggravated by light.
Phosphorus. – Chronic and obstinate cases which have resisted the usual remedies, with sensitiveness to light, heat, and itching of the eyes, sudden attacks of blindness, black spots floating before the eyes, and secretion of viscid mucus.
Ac.-Nit.-Purulent Conjunctivitis; swelling and redness of the mucous membrane and lids; secretion of viscid mucus or pus; burning and smarting in the eyes; Photophobia; nightly agglutination; and pains in the bones and parts around the eyes. Ac.-Nit. is required in cases originating in Syphilis, or aggravated by mercurial preparations.
Hepar Sulph. – Similar cases to Ac.-Nit., which it may follow if necessary.
Arnica.-Inflammations affecting either the mucous membrane, or the deeper structures of the eyes, from mechanical injuries. In addition to its administration, the eye should be bathed with a lotion of Arnica O (five drops to four tablespoonful of water). After well bathing the eyes, a piece of lint or linen should be saturated with the lotion, applied to the eye, covered with oil- silk, and secured by a hand-kerchief.
Other remedies-Sulph., Silicea, Pulsatilla, Lycopodium, Aurum, Rhus, Spigelia
ACCESSORY MEASURES. – In the treatment of the various forms of Conjunctivitis, and weak and imperfect vision generally, the causes of the disease should be correctly ascertained, so that they may, as far as possible, be removed and guarded against. Patients in crowded and unhealthy towns should remove to the country, at least for a time, where they may take daily out-of- door exercise, and enjoy a pure, bracing air. Frequent careful tepid washing of the eyes to prevent accumulations of matter; a spacious well-ventilated apartment; and avoidance of all causes likely to keep up the inflammatory process, are all necessary precautions. The food should be plain and nourishing, coffee and fermented drinks being excluded; the habits early and regular and frequent bathing should be practised.
LICENTIATE OF THE ROYAL COLLEGE OF PHYSICIANS; MEMBER OF THE ROYAL COLLEGE OF SURGEONS; LICENTIATE IN MIDWIFERY, LONDON AND EDINBURGH, ETC. PHYSICIAN TO THE READING AND BERKSHIRE HOMOEOPATHIC DISPENSARY.
Author of "The Stepping Stone to Homeopathy and Health,"
"Manual of Homoeopathic Treatment". Editor of "The Homoeopathic World."