on 3/16/06 9:48 AM, Sridhar Kotti at sridhar.kotti (AT) oracle (DOT) com wrote:

> Hi,
> One of my aunt had cataract operation.
> She was on Arnica and Ledum after that. The healing was quick and fast
> excepting for the dilation.
> Doctor says that the dilation has not reduced and in some cases it may
> remain as such which may cause severe headaches etc.
> Any Rubrics on this?
> Thanks,
> Regards,
> Kotti
>
Some Rubric/searched ideas:
complete 2000
>>EYES; PARALYSIS; iris (10) : acon., Arn., bell., chloram., coloc., kali-bi.,
naja, par., stram., verat-v.

Pupils [2] dilated [2] traumatic: arn., phys.

Arnica (surgery after) or Acon (shock after surgical injuries) are ideas...

Soft-tissue injuries from incision by mechanical instruments (Staph)

Surgical Diseases of the Head: Paralysis, as one of the remote consequences,
in persons of lax fibre: Gels (Gilchrist)

referenceworks
Pupil/pupillary/iris [2] paralysis/paralyzed: acon.10, aml-n.15, 3Arn.8,
art-v.15, atro.8, 3Bell.8, bov.54, carb-ac., carbn-o., chin-ar., chloram.,
coloc.37, con.38, crot-h.36, dendro-p.1189, dubin.38, 2gels.38, hydr-ac.8,
hyosin.38, kali-bi., kali-i.171, naja36, nux-v.1101, olnd.15, 2op.8, par.8,
2phys.8, plb.8, sol-t.85, spig.46, stram.8, tab., tub.56, 2verat-v.46

EYES; PUPILS; contract, difficult to (1) : nit-ac.

Are the pupils equal in dilation?

More General (could not find Paralysis after surgery after a quick look, but
it could be somewhere)
GENERALITIES; PARALYSIS; general; injuries, after (1) : wild.
GENERALITIES; PARALYSIS; general; old people, of (5) : bar-c., con.,
kali-c., Op., stry-ar.


Interesting aside from Burnett (Diseases of Veins):
"In my own practical experience I trace cases of diabetes and cataract to
the surgical traumatism inflicted in operating for piles."

on 3/17/06 2:32 PM, Sridhar Kotti at sridhar.kotti (AT) oracle (DOT) com wrote:

Hi
Ah...
She is diabetic.
Thanks,
Kotti

((( Following Burnetts clinical experience, (and Burt-- "I have often been
struck with the grave head symptoms that occur at the same time as rectal
troubles, and these former are made much worse by all surgical
interference." ... did she ever have hemorrhoid surgery. If so, can you use
hemorrhoids as part of the case... Or :

(the following search has not been inspected carefully for spurious):
Hemorrhoid/piles [3] surgery/operation/removal/surgical: aegle., aesc.,
aloe, arg., ars-i., berb., calen., coll., 3Croc., frax., ham., hyper.,
kali-c., kali-p., lob., mag-c., med., nit-ac., nux-v., puls., sal-ac.,
staph., sulph., symph., tell., thuj.

Kali-p has paralysis after surgery...

This search below may be of more relevance (this one has been sorted) which
have ailments after cataract surgery. From the rest of the case, and
depending on whether she did have hemorr. surgery, this one may be of
service...

Cataract [sen] surgery/operation: alum.54, 3Alumn.8, arn.8, atro.38,
calc-f., cina108,, guare.188, ham., lol.188, nat-sal., phos.37, phys.15,
2phyt.8, polyst.214, prot.149, puls.62, rhus-t.8, 2seneg.8, 2staph.8,
sulph.8

>>>>>>Here is more focus on iris:
Iris [3] cataract [sen] surgery/operation: alum.54, 3Alumn.8, arn.8,
phys.15, staph.

The rx with hemorrhoid surgery ailments from; cataract surgery ailments
from; and known for ailments after surgery with sharp instruments (incision
wounds) is Staphysagria. Any confirmatory from rest of case...

Another idea after arn tried again, acon, or from the above or below rubrics
given is Stram -- wide eyed (so analogically wide pupilled??) (sublimated
ailments from fright of surgery on eyes? (it would scare me)...

EYES; PARALYSIS; iris (10) : acon., Arn., bell., chloram., coloc., kali-bi.,
naja, par., stram., verat-v.

Chloramphenicolum (only antibiotic with a nitro group) (Reckeweg) The
attenuations are prepared from the antibiotic Chloramphenicol. The main
indications are: Vitamin depletion following damage to the intestinal flora
by antibiotics an chemotherapy. Other iatrogenic damage. Agranulocytosis.

Chloram (Julian) Optic neuritis. (T)
Paresis of accommodation (ciliary muscle). (T)


dont get any result for:
dilateddilationparalysis3cataract surgeryoperation

Best,
Andy

AH wrote:
on 3/16/06 9:48 AM, Sridhar Kotti at sridhar.kotti (AT) oracle (DOT) com wrote:


Hi,
One of my aunt had cataract operation.
She was on Arnica and Ledum after that. The healing was quick and fast
excepting for the dilation.
Doctor says that the dilation has not reduced and in some cases it may
remain as such which may cause severe headaches etc.
Any Rubrics on this?
Thanks,
Regards,
Kotti


Some Rubric/searched ideas:
complete 2000

EYES; PARALYSIS; iris (10) : acon., Arn., bell., chloram., coloc., kali-bi.,

naja, par., stram., verat-v.

Pupils [2] dilated [2] traumatic: arn., phys.

Arnica (surgery after) or Acon (shock after surgical injuries) are ideas...

Soft-tissue injuries from incision by mechanical instruments (Staph)

Surgical Diseases of the Head: Paralysis, as one of the remote consequences,
in persons of lax fibre: Gels (Gilchrist)

referenceworks
Pupil/pupillary/iris [2] paralysis/paralyzed: acon.10, aml-n.15, 3Arn.8,
art-v.15, atro.8, 3Bell.8, bov.54, carb-ac., carbn-o., chin-ar., chloram.,
coloc.37, con.38, crot-h.36, dendro-p.1189, dubin.38, 2gels.38, hydr-ac.8,
hyosin.38, kali-bi., kali-i.171, naja36, nux-v.1101, olnd.15, 2op.8, par.8,
2phys.8, plb.8, sol-t.85, spig.46, stram.8, tab., tub.56, 2verat-v.46

EYES; PUPILS; contract, difficult to (1) : nit-ac.

Are the pupils equal in dilation?

More General (could not find Paralysis after surgery after a quick look, but
it could be somewhere)
GENERALITIES; PARALYSIS; general; injuries, after (1) : wild.
GENERALITIES; PARALYSIS; general; old people, of (5) : bar-c., con.,
kali-c., Op., stry-ar.


Interesting aside from Burnett (Diseases of Veins):
"In my own practical experience I trace cases of diabetes and cataract to
the surgical traumatism inflicted in operating for piles."

From: "Robyn" <folco (AT) tpg (DOT) com.au>
Date: Sat, 18 Mar 2006 14:26:20 +1000
Subject: Eyes: dilation does not reduce


The dilated pupil (mydriasis) can be caused by a build-up of Intraocular
pressure (IOP), which itself is thought to be able to be caused by an agent
used in the surgical procedure used to remove cataracts. If this pressure is
not reduced, then the pupillary sphincter can become damaged which can
eventually be permanent. Other structures of the eye may also be damaged,
as in glaucoma. Thus from another angle the case can be treated as if a
glaucoma sequela -- a kind of 'glaucoma from injury.'

There appears to be two main types of agents used in cataract surgery, one
with worse dilation sequelae than the other. One of these agents is
hydroxypropyl methylcellulose. There have been lots of trials on this ---
and there is disagreement as to whether the IOP should be treated
prophylactically after these surgeries for cataracts or not. Some do, and
some don't.

It is however, a serious complication of what should be a simple procedure.
In someone who has IOP to begin with, they are unlikely to do the
surgery -- at least in the US.

Cataract and glaucoma are often found together, and mydriasis is one of the
symptoms of glaucoma.

There was one diagnostic issue that (might) be of use? --- to tell the
difference between mydriasis from atrophy of optic nerve; or from paresis
of ciliary nerve. In the first, the pupil is circular, but in paresis of
ciliary nerve the pupil is oval or egg-shaped. This could make a difference
to the remedy chosen (?).

Some additional rubric ideas:
EYE - GLAUCOMA - injuries; after

Note:
Cineraria (Reckeweg)
The main indications are: Cineraria is an unproved remedy but is said to
have proved its worth in glaucoma and corneal opacity. In such conditions
generally the pure juice of plant is dropped into the eye externally, and
the treatment continued for months. However, internal use is also said to be
successful, especially where the formation of glaucoma follows injury, or in
corneal opacity or even senile glaucoma. Thus in cases where there is no
strict indication for surgery it is recommended to attempt treatment with
Cineraria Maritima.

Physostig (Clarke)
In ocular tension, and especially when glaucoma has been the result of
injury.

Euphrasia (Hoyne)
CASE 1366. Opacity of cornea, inflammation of eyes returning monthly
following the rothen with formation of opacities in the cornea, of that only
the outmost periphery of the cornea remained clear. About two years before
this he had injured the eye and a dense glaucoma remained. He now received
every eight days a few drops of Euphrasia (the undiluted tincture); after a
few weeks the opacities began to diminish but the recurring attacks of
inflammation aggravated the trouble from time to time; after taking the
Euphrasia six times the dense leucoma from the injury had disappeared. Dr.
H. Goullen, Jr.

Gels (Vermeulen Concord)
glaucoma and descemetitis.

Jaborandi (Reckeweg)
Pilocarpine is used in ocular medicine in order to contract the pupils, e.g..
in injuries to the iris and in glaucoma, a 1% -2% solution being employed.
Compared with eserin, pilocarpine has the advantage of a less powerful
action, the accommodation being affected to a lesser degree, and the
tendency towards iritis being enhanced to a lesser degree than with eserin.
Good results have also been obtained in daily headaches which occur around
midday and are associated with accelerated respiration and also with
pressure on the chest, anxiety palpitations, pain in the precordial region,
vertigo and pulsating pain on the vertex. It should also be tried in
disorders of accommodation, especially with spasm of the muscles of
accommodation while reading. when the letters suddenly disappear, it becomes
difficult to see in detail and there is myopia. Good results could be
expected in swelling of the middle ear (cf. Euphorbium), and in a sensation
of emptiness in the lower abdomen, in painless diarrhea, in flushing of the
face with outbreak of sweat, and in sudden violent pain in the bladder,
shooting into the urethra, so that the patient has to cry out, and also in
burning in the urethra with urging to urinate. An important indication is
also its use in pulmonary edema with frothy expectoration and watery or
mucous secretions, generally accompanied by excessive sweating at various
locations on the body.

EYE - PUPILS - dilated
EYES - Ciliary - muscle - paretic condition
EYE - PUPILS - angular
EYE - PUPILS - irregular
EYE - PARALYSIS - Eyeballs - Muscles - Ciliary muscles
EYE - GLAUCOMA
EYE - ATROPHY - Optic nerve


Robyn

a couple of ideas: phys, dub.

Duboisinum (boericke)
Ciliary muscle: paretic condition. 2>5>0
Conjunctiva: inflammation, acute and subacute catarrhal. 12>14>0
Iritis. 6>19>0
Optic nerve: neuritis, choked. 0>8>0
Pain: location: supra-orbital. 6>10>0
Pupils: dilated. 0>11>13
Retina: congestion. 0>4>6
Retina: inflammation: simple and serous. 0>4>6


DUBOISIA. (Norton)
(The sulphate of Duboisin is more commonly used than the whole plant,
Duboisia, but as the two are so similar in action, both will be considered
under the above heading.)
Objective. Lids slightly oedematous. Agglutination of lids in the
morning. Dilatation of the pupils. Vessels of the optic disc much enlarged
and tortuous, so as to be easily visible. Disc red and outline indistinct.
Retinal veins dilated and tortuous. Retinal arteries diminished. Fundus of
the eye generally very hyperaemic.
Subjective. Eyes hot and dry. Eyes feel tired as if overworked. Pain in
eyeball, just beneath brow. Sharp pain in the upper part of the eyeball.
Vision. Complete paralysis of the accommodation; could not read at any
distance and could not look at food while eating, on account of pain. Can
read better and the print looks blacker at doubles the usual distance.
Paralysis of the accommodation takes place before dilatation of the pupil
and continues after the latter has recovered.
Clinical. From a very valuable paper upon the clinical and
physiological action of Duboisin, Dr. Charles Deady, in the Trans. of the
Am. Hom. Oph. and Otol. Soc., 1880, the following conclusions upon its
usefulness in diseases of the cornea and conjunctiva are cited: "The results
obtained in the cases of ulcer of the cornea, in which it has used, are
sufficiently good to warrant a trial in cases which prove intractable under
other remedies. So far as we have been able to observe it seems to be
adapted to a slow form of ulcer, more or less deep and without severe
photophobia and lachrymation; in cases of superficial ulceration, or in
which much photophobia was present, we have thus far obtained no benefit
from its use.
"The drug has been successfully used in several cases of chronic
hyperaemia of the palpebral conjunctiva, involving to some extent the border
of the lids. The symptoms calling for its use in this condition strongly
resemble those of Aconite, viz., bright redness of the palpebral
conjunctiva, with heat and dryness of the eye. The difference between the
two drugs consists in the fact that the hyperaemia which Duboisin cures is a
chronic affection, such as is found in hyperopes and which is not always
relieved by the use of diseases. "
In diseases of the fundus, especially of the optic nerve and retina,
Duboisin has proved, as might be expected, an important remedy. It is of the
utmost value in hyperaemia of the retina associated with weakness of the
accommodation.
In optic neuritis and retinitis Duboisin is, no doubt, often indicated,
for several cases have yielded promptly to its influence, as the following
will illustrate: A man, aet. 42, had suffered from attacks of vertigo for
three months. There was a history of syphilis twenty years and of a blow on
the head seventeen years before. When first seen he complained of
sleeplessness day and night, severe headache from the back of the neck over
the head to the eyes, worse at night, and eyes painful as if the balls were
being pressed into the head. V. 20/40 o. u. with difficulty. The
ophthalmoscope revealed a typical picture of "engorged papilla" in each eye,
marked enlargement of vessels on the disc and extravasations on the right
optic papilla and in the retina immediately around it. Bell. 3, was given
for ten days with slight change in the symptoms except that haemorrhages
were found on both discs, pain above the eyes with constant aching in them
and heavy pressure on the vertex, worse in the morning. Within two weeks
under Duboisin 3, the pain in the head had been relieved, the haemorrhages
in the nerves and retina had disappeared, and the inflammation was decidedly
less. V. 20/20 o. u. There were one or slight aggravations after this, but
not important, when the patient was lost sight of.
True weakness of the accommodation may call for this remedy, as already
suggested by the symptomatology (compare Ruta, Con., Arg. nitr.). I use the
term "true weakness," for I believe many of the so - called cases of
asthenopia are dependent upon an "irritable weakness" of the accommodation,
which is controlled by Jaborandi or one of that class of drugs.


Physostigma (Hempel)
PARALYSIS with feeling of great weakness along the whole length of the
spine, and in the lower extremities; trembling of the body; pressive
headache; copious urination; sighing respiration; flatulence.
Physostigma is an important drug in the hands of the skilled oculist.
Its action upon the pupil of the eye, causing as prompt contraction as
atropine causes dilatation of the pupil, brings it into frequent requisition
in ophthalmic surgery. According to Donders and Graefe the previous
application of calabar bean renders the operation for glaucoma comparatively
in cases where the pupil of the eye is excessively dilated.
In cases of injury to the cornea, where hernia of the iris is feared,
the external application of eserin is said to prevent the hernia, or to
reduce it if it already exists; this is done by mere mechanical action. (In
an ‹ operation for cataract, a small piece of the iris that was caught in
the incision, was drawn back by the use of eserin.)
Dr. Woodyatt (Hahn. Monthly April, 1878,) says: Eserin is indicated: 1..
In staphylomatous processes connected with anterior synechia. 2. In certain
forms of glaucoma, particularly in the haemorrhagic, but here it must be
used with caution, as improper application may bring forth haemorrhage into
the vitreous body. 3. In the slightest degree of prolapsed iris. 4. In
keratocele and conical cornea, also in opacities. 5. In deep corneal ulcers,
phlyctenular keratitis, diffused keratitis, and serpiginous ulceration. In
the latter, Wecker advises that a paracentesis be first made. 6. Finally in
purulent ophthalmia of children, when the lens must be removed on account of
severe injury to the iris.
Atropia, dropped into an healthy eye, diminishes the intraocular
pressure in the vitreous chamber, when that pressure is above the normal
degree.
Calabar, on the contrary, increases the pressure in the vitreous
chamber, but diminishes it in the aqueous.
It is acknowledged that these chambers are entirely separated from each
other.
Eserin is contra ‹ indicated: 1. In necrotic abscesses of the cornea.
These must be incised and treated with atropia and compressive bandages. 2.
In small corneal ulcers. 3. In all superficial ulcers of the cornea which
have no connection with the state of the intraocular pressure.
Much attention is now being paid by the physiological school to the
antagonistic action of remedies, and elaborate comparisons have been made by
Frazer and, of late, by Bartholow, of the physiological actions of atropine
and eserine. Dr. Bartholow sums up as follows (Cartwright Lectures, Medical
Record, December 4, 1880): First, Physostigma or eserine, and atropia are
antagonistic in their action on the pupil. Second. They are different, but
probably not antagonistic in their action on the heart. Third. They are
opposed in effect upon the respiratory function; physostigma paralyzing, and
atropia stimulating it. Fourth. They are not opposed in their action on the
cerebrum. Atropia produces delirium and hallucinations, whilst physostigma
does not affect the cerebral functions; but both cause more or less carbonic
acid narcosis. Fifty. They act differently, but not antagonistically, on the
spinal cord and nerves. Both cause paralysis; but while atropia impairs the
irritability of the motor nerves, physostigma does not. Physostigma
increases the irritability of the sensory nerves; while atropia, if it has
any effect at all upon them, diminishes this. Sixth. They are antagonistic
in their action on secretion; physostigma stimulating it and atropia
arresting it.
From the above conclusions it follows that atropia overcomes the lethal
effects of physostigma, by stimulating the respiratory function; but it is
certainly very doubtful whether physostigma is of any practical service in
poisoning by atropia.




Further ideas on this angle:

Glaucoma [sen] paralysis: 3Acon., coenz-q., 2gels., phos.

Aconite (Eli Jones, perhaps the greatest cancer doc of all time):
By persevering treatment with minute doses, Aconite has the power of
taking hold of and relieving deep - seated chronic ailments, such as Chronic
Rheumatism - Gout - Exostosis - Paralysis - Scirrhus - Glaucoma, etc.

Gels (Neatby)
Eyes. Besides the ocular paralyses for which gelsemium is so useful, it is
very valuable for internal congestions and serous effusions into the
eyeballs, and is therefore one of the principal remedies for glaucoma,
detachment of the retina, serous choroiditis and choroido - retinitis.

Reckeweg Coenz-q
The attenuations are prepared from Ubiquinone, Coenzyme Q1O.
In pathological situations, Ubiquinone is formed in increased quantity
from the body's own fat-deposits. In general practice it is one of the most
frequently needed quinones, since in most people the fat metabolism is
disordered.
Quinone-like substances (2, 3-dimethoxy - 5-methylbenzoquinone with an
isoprenoid side-chain), isolated from numerous animal organs, mitochondria,
yeast, etc. are incorporated in the phosphorylation of the respiratory
chain. Ubiquinone has a powerful regeneratory action on blocked respiratory
enzymes, and thus it is indicated in all impregnation, degeneration and
neoplasm phases, also in viral diseases etc. It is complemented well by
Fumaricum Acidum, since both substances are interdependent. The type of
person corresponding to the picture of Ubiquinone looks well-nourished, has
ruddy cheeks and, although strongly built in any case has a tendency to be
over-weight and a predisposition to inflammatory illnesses. There is a
sensitivity to colds and similar infections especially of the respiratory
passages and a tendency towards suppurative, ulcerative processes on the
skin and in the internal organs. Ubiquinone acts in all disorders of the
digestive area, in hypercholesterolemia, and where there is an inability
fully to utilize amino acids from the diet. These illnesses, which manifest
as deficiency-symptoms in the albumin metabolism, respond well to
Ubiquinone. Apart from inflammatory skin diseases, from soreness in infants
to malignant, oozing skin degeneration in old-age, which call for
Ubiquinone, it is also indicated in chronic, suppurative processes of the
mucosa with changes in the composition of the white blood cells and an
increased ESR, likewise septic illnesses of all kinds with high fever and a
danger of phlegmonal formation, the respiration being shallow, the urine
smelling fetid, or being retained, with an uremic headache.
Ubiquinone can also completely change the course of vaccinial damage
following smallpox vaccination, or in cases of severe reaction to
vaccination. Ubiquinone can also act favorably on acne vulgaris which is
leaving scars, or on unclean, greasy, shiny facial skin covered with
pustules, often accompanied by a tendency to violent headaches. The
Ubiquinone patient has a tendency towards strokes. This is often suggested
by poor memory and vascular symptoms, which occur where there is a high
cholesterol level. In such cases Arnica is a good complementary remedy. In
chronic mucosal inflammations and suppressions with excoriating secretions,
in septic cold-infections, descending bronchitis, also for follow-up
treatment of tuberculosis (tuberculostatics), in highly febrile pneumonia
and in asthmatic attacks (less threatening than in Fumaricum Acidum or the
other quinones), and in tormenting nocturnal cough, particularly when
provoked by every movement, Ubiquinone is indicated.
Ubiquinone has special affinities for the eyes, e.g. conjunctivitis,
but it is also indicated in toxoplasmosis infections, corneal erosions,
paralysis of the eye muscles following diphtheria and in infantile glaucoma,
and may be used successfully in many cases of glaucoma and retinal disease.
Further indications for Ubiquinone are otitis media, mastoiditis,
otosclerosis, eczema of the auditory canal with offensive discharge, and
Eustachian tube catarrh with a sensation of internal itching in the ear.
Ubiquinone is related to the vagus nerve, and can compensate for vagotonia
by switching to the sympatheticotonal stage, which in many cases manifests
as an activation of masked focuses of disease. This can lead to a favorable
resolution of neuralgia and neuritis with severe pains. A reddening of the
skin may develop above the affected site, or even an eruption of herpes
zoster or herpes simplex. Ubiquinone is called for in lumbar back pain and
pain in the area of dorsal vertebrae 3 and 4; also in progressing multiple
sclerosis. It is also good for nervous symptoms of drinkers, with moral
decay and red or pale yellow facial discoloration, Ubiquinone helping
addicts to develop a new, regenerated will power. Post-operatively,
Ubiquinone can prevent the danger of embolism, since its action on the
vascular walls is similar to that of rutin, taking effect within a few
minutes when suitably indicated, especially if given by intravenous
injection. An important indication is the very painful mastitis with copious
suppuration, occurring during the puerperium while breast-feeding. Likewise,
Ubiquinone acts favorably on boils (from chronic pork-consumption).
In the alimentary canal Ubiquinone acts on disorders of
enzyme-activity, fermentative dyspepsia, heartburn following consumption of
meat and fatty foods, putrid eructations hours after having eaten, stomach
ulcers which are slow to heal, and especially in acute enteritis, whilst
degenerative intestinal diseases respond to Anthraquinone. An indication for
Ubiquinone in intestinal disease is especially the vicariation with skin
conditions, e.g. intestinal disorder following suppressed eczema. Ubiquinone
should also be interpolated in the treatment of kidney damage following
inoculations, after surgery, in weakness of the sphincter vesice with
dribbling of urine, papilloma of the bladder with sudden hemorrhages, and
after every course of antibiotics, likewise after conventional treatment of
syphilis and after protracted gonorrhea, particularly if the skin-discharges
have an unpleasant odor and are associated with eczema. It should also be
interpolated where there is cancer of the genitalia, and in breast cancer
with ulceration, when degenerative symptoms appear, and also after
cancer-surgery when the wounds are reluctant to heal and there is chronic
suppuration. Ubiquinone effects an improvement in all inflammatory skin
diseases. Acne vulgaris. Oozing eczema's with intolerable itching. Pustules..
Seborrhea and falling of the hair. Stubborn scrotal eczema, skin cancer with
discharge of serous fluids, also sore skin of infants and inflammation where
a little soap remains on the skin, are also pointer to Ubiquinone. Generally
speaking, Ubiquionone is to be used in all cellular phases, either
intercurrently or throughout.

================================================== ======
Glaucoma [sen] dilation: 3Atro.8, 3Cocc.8, jab., kali-i.8, phys.15

Atropinum

But in glaucoma, the surface of the cornea will be found more or less
anesthetic, while in iritis it will be abnormally sensitive. In glaucoma the
pupil will be found moderately or widely dilated, while in iritis the pupil
is almost invariably contracted. In glaucoma the anterior chamber will be
found shallow, while in iritis the depth of the chamber is unchanged.
Though the state of the intra - ocular tension the shape and size of
the field of vision, and appearance of optic disc, are to the specialist
points of great importance, I shall lay but little stress upon them in
connection with our present subject; first, because few general
practitioners would be capable of determining them with certainty, and
secondly, because the other symptomatic variations already given, if
carefully sought for, should be sufficient guide so far as the question with
regard to the use of atropine is concerned.
The risk of converting an unnoticed and non - inflammatory glaucoma
into an acute attack through the use of atropine is one that could only be
avoided by previous examination of the face of the optic nerve for signs of
optic nerve excavation and by a careful testing both of the ocular tension
and field of vision; but, as before intimated, it could hardly be expected
that the general practitioner would be prepared to say with any certainty
that an eyeball is below or above its standard of hardness, and he could
hardly be expected to provide himself with the means for field - taking,
etc.; hence the only remedy will lie in a most cautious use or avoidance of
mydriatics and more especially that most powerful one, atropine, in all
cases past middle life - the period before with glaucoma is most rare -
where there may exist with an unaccountable impairment of vision a sluggish,
dilated pupil and perhaps a suspicion of corneal anesthesia.
To recapitulate symptomatically by way of formulating rules for the
guidance I should say:
1. Atropine may be employed to advantage or its use be absolutely
demanded in all inflammatory and traumatic conditions associated with
photophobia, lachrymation and pain, more or less impairment of vision,
circumcorneal redness, dimness of cornea, or iris, or both, plus a
contracted pupil (spasmodic or otherwise), and this picture would cover
fairly well iritic and corneal inflammations.
2. The avoidance of atropine is imperative in all cases associated with
photophobia, lachrymation and pain, more or less impaired vision, a
circumcorneal redness, a steamy, insensitive cornea, plus a dull, dilated
iris - and this picture would correspond sufficiently well to the ordinary
inflammatory glaucoma.
In fact, for all practical purposes, so far as the general practitioner
is concerned, the distinction might, in a general way, be safely narrowed
down to this:
A contracted pupil calls for or justifies the use of atropine.
A dilated pupil is a distinct warning against the use of atropine;
since glaucoma is the only inflammatory affection, expecting serious iritis,
in which the pupil is found

======
Cocculus (lilienthal)
[OPHTHALMIA.] Rheumatic glaucoma, with venous hyperaemia, dilated pupils,
insensibility to light, haziness of lens and vitreous humor, severe pain in
and around the eyes; iritis; with corneal and scleral complications, pupils
irregular and contracted, blue border around cornea, photophobia, no
lachrymation, tearing pains in brow and left side of head.

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kali-i (Hering)

€ Incipient glaucoma in syphilitic subjects, dull, discolored state of
iris, burning in eyes, lachrymation dilated pupils, amaurotic symptoms.