DETACHMENT OF THE RETINA—A CASE.
BY JAS. A. CAMPBELL, M. D., ST. LOUIS.
BY JAS. A. CAMPBELL, M. D., ST. LOUIS.
BY JAS. A. CAMPBELL, M. D., ST. LOUIS.
In May, 1885, Geo. H., age thirty-seven, came to me from Indiana, with the following history: He had been very nearsighted all his life, but had never worn glasses. His eyes had never troubled him in any other way, until a few days before he came. He then noticed a few floating white spots before his left eye. This gradually increased, and the vision of this eye, by degrees, grew less and less until after four days the sight of the left eye was gone. There was no pain in either eye.
Examination showed vision of the right eye was 4/200; with a — 13 Ds. glass, 15/200. With the left eye he could just distinguish light in the outer upper field of vision. With the ophthalmoscope only the lower fundus of the left eye could be made out, where the retinal vessels were seen up to the lower edge of the optic disk. The disk itself could not be made out, but above it a bulging, detached retina was prominent, with a hemorrhagic spot at its inner margin. In the upper outer fundus another separate bulging detachment of the retina could be plainly seen.
The right eye was highly myopic, with a myopic arching around the disk, and the entire fundus was mottled with small choroidal pigmentation spots, clearly of long standing.
The nature of his trouble was explained to him. He was kept quiet, and all forms of tobacco and stimulants were forbidden. He was placed on kali hyd. 3d, three times daily. In one week’s time a remarkable change for the better had taken place. The detachment was much reduced. The wavy retinal vessels were seen climbing over its edges. The optic disk was visible. In two days more he could count fingers with the left eye at two feet. The improvement continued. On June 24 vision of the left eye was 15/200; right eye, 15/100. He thenwent home for a few days; the kali hyd. being kept up. July 13 he returned, saying that the improvement had gone on by slow degrees, until, suddenly, the vision of the left eye was again lost, on July 12. He was then placed on 5–grain doses of kali iod. 3d, three times daily, which was followed by very slow improvement, so that in three weeks he could again count fingers with the left eye at two feet, and the detachment, which had resumed its former dimensions, was somewhat reduced. I then went back to kali hyd. 3d, three times daily, which was again followed by improvement for some months after his return home. This, with some intercurrent medication, was kept up from time to time for a year, gradual improvement being reported until the sight of both eyes seemed about as it was in former years.
May 3, 1899, fourteen years after his first visit, he again came to me, reporting that his eyes had gotten along very well, with no particular trouble until in 1897, when he took a severe cold, which settled in his left eye, which became badly inflamed. He went to St. Louis, but did not find me, as it was during my summer vacation. Returning home, he consulted Dr. Knapp of Vincennes, Ind., who advised the removal of the left eye, as it seemed hopelessly involved by that time. This was done, and he progressed nicely, the vision of the right eye remaining about the same, though occasionally its vision seemed not quite so clear.
This was the situation until two weeks before his visit, when the sight of the eye began to grow dimmer. There was no pain present at any time, but vision gradually grew worse and worse.
Examination: V. R. = 8/200; where it had before been 15/100. Ophthalmoscope revealed some increase of the old choroidal atrophic mottling, with a red blurry optic disk.
He was placed on gels. θ, three times daily, for a few days, with evident improvement of the optic nerve congestion. He was then given kali hyd. 3d, four times daily. He returned home in a week, keeping up the same remedy. In three weeks he returned to me again, when examination showed decided improvement; with — 13 Ds., V. = 15/100 once more; still keeping up the kali hyd. 3d.; thus having been brought back to the condition which followed the treatment in 1885, and which had remained instatu quofor fourteen years.
Detachment of the retina is always a serious condition. It is not an unfrequent complication in high degrees ofmyopia. In three hundred cases collected in Horner’s clinic, 48 per cent. were in myopic eyes. Its progress is generally unfavorable. It is usually treated by perfect quiet, rest of patients, after confining them to bed for some weeks, giving infusions of jaborandi and hypodermics of pilocarpin mur. Puncture through the sclera at the points of detachment, allowing escape of the fluid, has been advocated and performed by various well-known authorities, but has not been successful enough to ensure its general adoption. In rare cases spontaneous recovery has been observed, but I cannot think that the case here presented belongs to this class, for the original attack was in 1885, and was of such a degree that the vision of the left eye was reduced to mere perception of light in the outer upper field of vision. Under kali hyd. 3d, remarkable changes and rapid improvement took place. A relapse followed on his return home, after a couple of weeks. This again yielded to the same treatment, the vision of the left eye regained what it had lost, and remained in this condition for twelve years, when a severe general inflammation of the left eye necessitated its removal. Then, in a couple of years, the vision of the right eye became suddenly involved. Rapid improvement again followed the same remedy, and it was restored to its original condition. Hence, I cannot regard the improvement as either spontaneous or a coincidence, but think I am justified in attributing it to the direct result of the remedy given.
In the old school iodide of potash, in large and repeated doses, is a very common remedy in all intraocular diseases, and the more obscure the case, the more frequently and persistently it is used. Some cases are benefited by it, others not. The points I wish to make are, first to demonstrate the homeopathic possibilities of treatment in this serious disease; that when you have a homeopathic kali hydriodicum case, kali hyd. will probably help it, whether you give it in the third trituration or in more appreciable doses. In the case here reported kali hyd. 3d was certainly more potent than the 5–grain doses used for one week and then changed to the 3d trituration again.