From: The Medical Counselor – January, 1896.
In this day of specialties and specialists the diagnosis and treatment of diseases of the eye may properly be said to belong to the oculist, but many communities are destitute of men in that line, so it often falls to the lot of the family physician to treat inflamed eyes. It is the desire to be helpful to the hard-worked practitioner in such cases that prompts the writing of a paper, which shall set forth a few clear-cut, diagnostic symptoms and a simple and effective line of treatment.
Your patient says “Doctor, I have a sore eye.” You remove the handkerchief he wears to exclude the light, and because he didn’t know what else to do for it, and discover this condition of affairs : — more or less redness of the eyeball, which may remind you of conjunctivitis, but on turning your attention to the iris you see it has lost its lustre and its pretty pencilings, and assumed a muddy appearance, and a reddish or dirty gray color, quite in contrast with its healthy mate. The pupil is small, and does not change in size when suddenly uncovered and exposed to a bright light; especially is this true if its border is adhered to the lens capsule.
The pupillary space may be clear and black or may be filled with the products of inflammation so as to appear milky or opaque.
There is usually pain of a burning, aching or shooting character in or about the eye, which is often very sensitive to light, sometimes so sensitive that you can hardly examine it. The aqueous humor is frequently cloudy, the degree of cloudiness, depending upon the duration of the attack and the variety of the disease, i. e. serous, plastic or suppurative. Often little points of exudation will adhere to the posterior surface of the cornea, or a pyramid of pus, base down, forms in the lower portion of the aqueous chamber. The case may simulate, in some features, several other forms of disease, such as, conjunctivitis, blepharitis, etc., but the appearance of the iris will settle decisively the question of diagnosis. Be guarded in your prognosis, especially if the iris is adhered to the lens capsule.
As adhesions are to be guarded against, as destructive to the eye, a solution of atropine, 4 grs. to the ounce of distilled water, a drop in the eye from one to three times a day is sufficient, in ordinary cases, to widely dilate the pupil, at the same time drawing it away from the lens, preventing adhesions, putting the inflamed tissue to rest, relieving pain, and subduing inflammation, thus shortening the attack. If adhesions have formed which will not separate by the use of atropine in the above strength, no time should be allowed to pass before consulting an oculist, who will make every effort to break them up.
Quiet in a darkened room, and non use of either eye should be enjoined, and dark smoked glasses worn when exposure to light is unavoidable.
Heat, either moist or dry, applied continuously for an hour or two hours twice a day or more often, and as hot as can be well borne, is usually grateful and beneficial.
Cold applications are seldom of use after the first 18 hours of an attack, though they may be freely used early after an injury, rather to prevent than to subdue inflammation.
Of internal remedies there are many from which to select, indicated by the form, stage and cause, as well as by the symptoms presented, but for the majority of cases, one of the following will suffice:
Aconite, if you see the case within the first twenty-four hours, if the attack can be traced to exposure to cold winds, and if anxiety and restlessness are prominent.
Belladonna also early in the attack, but lacks the mental symptoms of Aconite while redness of the conjunctiva, with flushed face and throbbing headache are present.
Bryonia, when rheumatism accompanies or causes the iritis, which is accompanied by sharp, shooting pains in and about the eye by motion.
Gelsemium for the serious variety, with cloudy aqueous and concomitant symptoms of the remedy.
Hepar Sulph. when pus has formed and deposited in the anterior chamber. The eye is very sensitive to touch and to cold.
Mercurius, for the nightly aggravation, with bone pains and other mercurial symptoms. In some of its forms very frequently needed for any of the varieties of iritis.
Rhus Tox is often indicated in the rheumatic and traumatic forms, with swollen lids spasmodically closed, with a gush of tears on opening the eye; also if the trouble is worse at night, after midnight, and in damp weather.
Spigelia and Cedron relieve the neuralgic pains, the latter having a marked periodicity.
Sulphur rouses the reactive forces, often starting chronic cases on the road to recovery, as well as relieving the sharp, sticking pains.
In the syphilitic variety you will find Asafoetida useful when the bone pains are marked and from within outwards, relieved by rest and pressure, while aurum has pains from without inwards worse from touch, with suicidal melancholy. Both are useful after too much mercury, which is not often indicated in this variety, but will cure in the potencies if at all.
Nitric Acid in the chronic syphilitic form, worse by day; also after mercurialization.
Thuja where syphilitic gummata have formed on the iris, with sticking pains, worse at night, like Mercuris, but relieved by warmth, which aggravates the Mercurius patient.
Your Materia Medica will prove to be your best friend in these cases, and when you are not clear as to the right course to pursue, consult an oculist rather than let your patient’s eye go to the bad.