Clinical Homoeopathy V

Ophthalmology Module
Eyelid conditions;
• Ptosis
• Blepharitis
• Internal vs External Hordeolum (stye)
• Meibomian cyst (chalazion)
Ptosis (drooping of eyelid)
Cause Description

Congenital Incomplete development of levator palpebre superioris (LPS)

muscle

Disease of Myasthenia gravis, muscular dystrophy – systemic disease

muscles resulting in muscle weakness

Disease of lid Pseudoptosis - prolapse of lax eyelid tissue – common in

tissue elderly

Disease of 3rd nerve palsy – Innervates LPS muscle

nerve supply Horner’s syndrome – sympathetic innervation of Muller’s
muscle
Homoeopathic treatment - Ptosis
EYE - PARALYSIS - Lids, of – Upper -
Acon. Alum. alum-p. anh. apis arn. Ars. bar-m.
botul. bufo Cadm-s. CAUST. chlol. cina cinnb.
Cocc. Con. crot-c. crot-h. cur. Dulc. euph. ferr.
GELS. germ-met. Graph. hydroph. kali-c. kalm.
Led. lyss. Mag-p. Med. Merl. morb. Morph. naja
nat-ar. nat-c. nat-s. NIT-AC. Nux-m. op. Phos. Plb.
RHUS-T. Sec. SEP. SPIG. stann. Syph. Verat. vip.
Zinc.
 Causticum
• Drooping of the lid from cold exposure.
• Inclination to close the eyes, close involuntarily.
• Sensation of heaviness in upper eyelid – cannot
be raised easily, as if stuck to the lower lid (can’t
be loosened).
• Opening lids is difficult.
• General peripheral paralysis of muscles (Levator
palpabre superioris, orbicularis, external rectus
and ciliary muscle) < cold dry wind or diphtheria.
 Gelsemium
• Drooping of eyelids, eyes half closed with
apparent inability to move the lids.
• Lids close on looking steadily at anything.
• Sensation of heaviness of eyelids.
 Rhus toxicodendron
• Ptosis with rheumatic diathesis.
• From working in the wet, getting the feet
damp, or change of weather.
• Heaviness and stiffness (paralysis) of the lids
as if difficult to move them.
• Inflammation and swelling of eyelids – tears
gush out on opening.
• Lids puffy, heavy and stiff as if paralyzed,
difficult to move.
 Alumina
• Ptosis - Weakness of upper lids, hangs down
as if paralyzed.
• < left side.
• Burning, dryness, absence of lachrymation.
• Loss of power in upper lids associated with old
granulations – difficult to raise
 Other remedies - ptosis
Euphrasia
• Exposure to cold and wet accompanied by
conjunctival catarrh.

Ledum
• Ptosis from injury with ecchymosis of lids and
conjunctiva.
 Other remedies - ptosis
Nitricum acidum
• Difficulty in raising upper eyelids in the morning.
• Characteristic stitching pains like splinters in eye (fish bone, glass).
• Lids may be swollen and hard.

Spigelia
• Ptosis from inflammation with sharp, stabbing pains through the eye.
• Scalding hot lachrymation may be present.
• Lids lax and paralyzed, hang low and must be raised with the hand.
• Pain in upper lid as if it were hard and immovable.
• Main remedy for ciliary neuralgia.
 Other remedies - ptosis
Sepia officinalis
• Drooping of lids with dull headache.
• Lids feel heavy, inclined to close as from
paralysis.
• Pressure as if from sand < rubbing and
pressing lids together.
• Soreness and roughness < walking in cold
wind.
Anatomy
 Chalazion (Meibomian cyst)
Chronic granulomatous enlargement of the meibomian gland
from occlusion of its duct – often following inflammation of
the gland

Signs and symptoms:

q Initially indistinguishable from style (hordeolum)
q Lid oedema, swelling and irritation
q Resolution with painless, slowly growing round mass in
eyelid
q Skin over lump is moveable
q In tarsus of lid base seen as red/grey mass
(subconjunctivally)
Chalazion (meibomian cyst)
 Chalazion (Meibomian cyst)
EYE - MEIBOMIAN GLANDS; complaints of

EYE - INFLAMMATION - Meibomian glands

EYE - TUMORS - Lids - nodules in the lids - Alum.

calc. caust. Con. graph. hep. PLATAN-OC. puls.
Sil. STAPH. sulph. Thuj. tub. zinc.
 Meibomian cyst (Chalazion)
PLATAN-OC; STAPH; Thuj; Calc-c; Caust; Con; Hep; Puls; Zinc

Platanus occidentalis (Sycamore-Buttonwood)

• Tarsal tumours.
• Acute and old cases with scaring and
destruction of tissue causing deformity of the
lid – restored to normal.
• Very good in children, used over a period of
time.
Staphysagria
• Enlarged glands of the lids, which are red.
• Accompanied by tensive, tearing pains <
evenings.
• Successive crops of tarsal tumours.
• Blepharitis with dry lid margins and little hard
nodules.
Thuja

• Tarsal tumours of any sort especially appearing like condylomata.

• Tarsal and other tumors, prevents return after excision.
• Sycosis
• See styes.

Silicea terra

• Tarsal tumors.
• Sensitive to cold, long lasting ulcers and suppuration, > warmth.
 Hordeolum (stye)
An acute localized pyogenic infection of one or
more of the glands of Zeis or Moll (external
hordeolum) OR infection of meibomian gland
(internal hordeolum)
Aetiology:
ØUsually Staphylococcus infection
ØSecondary to blepharitis
ØReoccurrence is common
External Hordeolum
 Hordeolum (stye)
External hordeolum:
q Pain, redness and tenderness at lid margin
q Small round tender lump (indurated)
q Lacrimation
q Photophobia
q Foreign body sensation
q Localised or diffuse oedema
q ‘pointing’ small yellow spot of pus in center
q Rupture and discharge followed by relief of pain and
resolution
q Superficial, well localised at base of eyelash
Internal Hordeolum
 Hordeolum (stye)
Internal hordeolum:
qMore severe then external
qPain, redness, swelling oedema more local
qInspection under eyelid (conjunctival side) – with
small elevation or yellow area
qAbscess forms pointing to conjunctival side
(sometimes through the skin)
qReoccurrence is common
qVisible through tarsal conjunctiva
 Hordeolum (stye) – Rubrics
Eye – styes
Eye – styes – recurrent
Eye – styes – induration from
Eye – styes – lid - upper
Eye – styes – lid – lower

Ars; Graph; Hep; Lyc; Merc; Phos-ac; Pic-ac; Puls;

Rhus-t; Sil; Staph; Sulph; Thuj;
 Hordeolum (stye) – Rubrics
EYE – STYES
adeps-s. aegle-m. agar. allox. alum. alum-p. alum-sil. am-
c. ambr. ant-t. Apis ars. Aur. aur-m-n. bar-c. bar-ox-suc.
bor-ac. bry. cain. calc-f. calc-pic. CARBN-S. carc. caust.
Chel. coch. colch. CON. cortiso. cupr. cypr. Dig. dys. elaps
fago. Ferr. ferr-p. gaert. GRAPH. hep. Jug-c. Jug-r. kali-br.
kali-p. kola kreos. lac-f. lach. lap-a. lappa LYC. m-aust.
mand. med. meny. Merc. morg-g. morg-p. nat-m. osteo-a.
Ph-ac. phos. pic-ac. Psor. PULS. Rhus-t. sacch-l. sanguis-s.
seneg. SEP. Sil. sol-o. stann. STAPH. staphycoc. sulfa.
sulfonam. SULPH. Thuj. tub. uran-n. valer. viol-o. zinc. ziz.
 Treatment - Styes
Naturopathic treatment
• Pointing may be hastened by warm
compresses for 10 minutes t.d.s.
• Gently pulling out the eyelash from the stye
aids drainage of pus.
Homoeopathic treatment
• Ars; Graph; Hep; Lyc; Merc; Phos-ac; Pic-ac;
Puls; Rhus-t; Sil; Staph; Sulph; Thuj;
 Pulsatilla
• Excellent for styes of any sort & at every stage of the
disease (if given early aborts process, if given late hastens
process and gives relief, prevents recurrence)
• Styes associated with gastric derangement esp. over-
indulgence (fats)
• Styes associated with acne of the face.
• Amenorrhoeic females and or Pulsatilla temperament.
• Morning agglutination
• Margin of lower lid inflamed and swollen, with morning
lachrymation.
• Itching, biting and burning in lids in evening – provokes
rubbing and scratching.
 Hepar sulph
• When suppuration has commenced
• Associated throbbing pains.
• Great sensitivity to touch > warmth.
 Rhus toxicodendron
• Early stages with oedematous swelling of the
lids.
• Associated conjunctivitis and profuse
lachrymation.
 Graphites
• Useful for preventing recurrence of symptoms.
• General symptoms of patient.
 Staphysagria
• Recurrent styes (especially of lower lid) that
abort leaving little hard nodules in the lids.
 Sulphur
• Prevents recurrence of successive crops.
• Can’t bear to have eyes washed.
• Restlessness and feverish at night.
 Thuja
• Obstinate styes that resist treatment and form
hard nodules on the lid margins (Staph)
 Other stye remedies
Acon; Ars; Calc; Caust; Con; Lyc; Merc; Pic-ac;
Phos-ac; Sil.
 Blepharitis

• Main remedies

Ant-c; Apis; Ars; Bell; Calc-c; Calc-I; Euph; Graph; Hep; Merc;
Nat-ars; Nat-m; Puls; Rhus-t; Sulph

Euphrasia officinalis

• Lids and margins swollen and red burn and itch.

• Excoriated lids from profuse, acrid muco-purulent
discharge.
• Associated with profuse acrid lachrymation.
• Photophobia, frequent inclination to blink.
Ulcerative blepharitis
Ulcerative blepharitis
Seborrheic blepharitis
Seborrheic blepharitis
Allergic blepharitis
 Euphrasia officinalis
• Lids and margins swollen and red burn and
itch.
• Excoriated lids from profuse, acrid muco-
purulent discharge.
• Associated with profuse acrid lachrymation.
• Photophobia, frequent inclination to blink.
 Graphites
• NB for chronic cases also acute ulcerative
attacks, associated with corneal ulcers.
• Scrofulous subjects with eczema.
• Dry red scurfs/scales on margins.
• Bleeding and cracking of outer canthi on
opening the lids.
 Hepar sulph
• Suppuration about to start or has started.
• Throbbing pains in lids, very sensitive to touch
> warmth < cold.
• Lids sore, corroded, “as if eaten out”
 Merc sol
• Syphillitic subjects, working with fire or forges.
• Lids thick, red swollen, ulcerated < upper.
• < heat, cold, touch with profuse, acrid
lachrymation.
• <evenings going to bed < warmth < glare of
fire/artificial light.
 Pulsatilla
• Acute and chronic with associated lid glands
effected (blepharo-adenitis)
• Discharges usually profuse and bland with
agglutination in mornings.
• Itching and burning sensations.
• < evenings < warm room or cold draught >
cool open air.
 Rhus toxicodendron
• Acute phlegmonous inflammation of the lids
and erysipelas.
• Lids oedematously swollen < upper with
profuse lachrymation and chemosis.
• Pains < night < cold damp > warm
applications.
• Acute exacerbation’s of chronic cases from
exposure to wet weather.
 Sulphur
• Blepharitis after a suppression of skin
condition e.g. eczema or children of strumous
diathesis, irritable/cross by day and restless
and feverish at night.
• Lids red, swollen and agglutinated in morning,
with many small itching pustules on the
margins.
• Sticking pains, or itching, biting or burning.
• Aversion to water, cannot bare to have eyes
washed.
Others:
• Acon; Alum; Arg-met; Arg-n; Aur; Calc-pic; Caust; Cinnab; Kreos; Lyc; Merc-
cor; Merc-nit; Merc-prot; Mez; Nux-v; Petr; Pic-ac; psor; Sang; Sen; Sep;
Staph; Tell; Thuj.
RUBRICS
• Eye – inflammation – lids
• Eye – inflammation – lids – margins
• Eye – ulceration – lids
• Eye – ulceration – lids – margins
• Eye – ulceration – lids – surfaces under
• Eye – swelling – lids
• Eye – swelling – lids – margins
• Eye – eruptions – lids – pustules
• Eye – eruptions - lids – crusts
• Eye – agglutinated
•
Entropion
• Remedies are useful if inversion is recent and to a slight degree.

Arg-nit, Borx; Calc; Graph; Merc; Merc-c; Nat-m; Nit-ac; Sil; Sulph.

RUBRICS

• Eye – inversion of lids

• Eye – ingrowing eyelashes
_________________________________________________________

Ectropion

Homoeopathic treatment

• Mostly to treat the complications of ectropion (and entropion), operative measures are almost
invariably necessary – except in the very early stages.

Apis; Arg-met; Arg-nit; Calc; Ham; Lyc; Merc; Merc-c; Nat-m; Nit-ac; Staph; Sulph

• Apis – First stage with swelling of conjunctiva

• Arg- nit – Lids swollen, red inflamed, everted, puncta lachrymalis very red and prominent.

• RUBRICS

• Eye – eversion of lids

 References
• Welch-Allyn. 1996 EENT/CD An Interactive Guide to the Eye, Ear, Nose and Throat. [CD-ROM]
Welch-Allyn: New York.
• Bankes, J.L.K. 1987. Clinical Ophthalmology: A Text and Colour Atlas. Churchill Livingstone:
London. 130p. ISBN 0-443-03597-2.
• Bickley, L.S., Szilagyi, P.G. and Bates, B. 2003. A guide to physical examination and history taking.
8th ed. Lippincott Williams & Wilkins: Philadelphia.
• Berkow, R., Beers, M.H. (ed.) 1999. The Merck manual of diagnosis and therapy. (17th ed.) Merck
research Laboratories: New Jersey.
• Buffum, J.H. 1991. Essentials of Diseases of Eye and Ear. B. Jain Publishers: New Delhi. 315p.
• Collins, J.F., Donnenfeld, E.D., Perry, H.D. & Wittpenn, J.R. 1991. Ophthalmic Desk Reference.
Raven Press LTD: New York. 686p. ISBN 0-88167-808-2.
• Cheng, H., Burdon, M.A., Buckley, S.A. & Moorman, C. 1997. Emergency Ophthalmology A
symptom based guide to diagnosis and early management. BMJ publishing :London. 335p.
• Elkington, A.R. & Khaw, P.T. 1988. ABC of Eyes. British Medical Journal: London. 55p. ISBN 0-7279-
0240-7
• Munro, J. & Edwards, C.R.W. (ed) 1995. Macleod’s Clinical Examination. 9th. Ed. Churchill
Livingstone: London. 379p. ISBN 0443 048568.
• Schroyens, F. 1997. (ed.) Synthesis repertorium homeopathicum Syntheticum. Homeopathic
Book Publishers: London.

CLEO101 – Clinical Endocrinology &

Ophthalmology – Ocular signs and
symptoms