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Homeopathy in Ophthalmology

Over the past 20 years, I have tried an integrated approach to the treatment of ophthalmic cases with my friend Dr. Ranjit Maniar who is a Consulting Ophthalmic Surgeon in Mumbai. I have also had the opportunity to present papers to members of the Bombay Ophthalmic Society at their scientific sessions, viz. “The Role of Homoeopathy in Ophthalmology” at K.E. M. Hospital, Mumbai (March 1996) and “Homoeopathy in Uveitis” at P. D. Hinduja Hospital, Mumbai, (July 1998). Many cured cases were discussed with the distinguished audience in both these sessions. I was also a faculty at an International Conference on Ophthalmology 'Eye Advance 2008' at Mumbai, India (August 2008).

The different types of ophthalmic conditions that I have successfully treated with homoeopathy are post- operative inflammations and ophthalmic infections, intra-ocular hemorrhages, post-traumatic conditions of the eyes, uveitis and of course common eye diseases like conjunctivitis and styes. Many cases of glaucoma, keratitis and corneal ulcers have also responded very well to homoeopathy.

Of the many ophthalmic cases referred to me for treatment, I have found that the most common condition that I am required to treat is uveitis. The patients with uveitis come with different presentations ranging from an acute state to a chronic state.

Uveitis is most commonly classified anatomically as anterior, intermediate, posterior, or diffuse. Anterior uveitis is localized primarily to the anterior segment of the eye and includes iritis and iridocyclitis. Intermediate uveitis, also called peripheral uveitis, is centered in the area immediately behind the iris and lens in the region of the ciliary body and pars plana, hence the alternate terms "cyclitis" and "pars planitis." Posterior uveitis signifies any of a number of forms of retinitis, choroiditis, or optic neuritis. Diffuse uveitis implies inflammation involving all parts of the eye, including anterior, intermediate, and posterior structures.

Many of the patients referred with chronic anterior uveitis have already had previous attacks of the disease in the past and it is known for this relapsing state. In anterior uveitis, most attacks last from a few days to weeks with treatment, but relapses are common. In posterior uveitis, the inflammation may last from months to years and may cause permanent vision damage, even with conventional (allopathic) treatment.

Causes of uveitis can include trauma, autoimmune disorders, infection, or exposure to toxins. However in many cases, the cause remains unknown. This wide range of causes also translates into the need for constitutional and miasmatic prescribing wherever necessary. The systemic symptoms as well as the complications underscore the need for an effective therapy that not only treats the disease but also prevents the recurrence and complications. Convenional (allopathic) therapy is not always able to achieve the expected results. This is where the homoeopathic medicine comes into the picture.

The patients referred for homoeopathic treatment are prescribed the indicated homoeopathic remedy after proper case taking, and the causation, mental symptoms, physical generals and the particular symptoms are all taken into consideration and given their due importance.

The patients who are on anti-inflammatory conventional (allopathic) drugs before referral for homoeopathic treatment are weaned off the medication within a maximum period of two weeks. Those who are on steroids are slowly tapered off the medication under the guidance of the ophthalmic surgeon. In most cases the patients are only on homoeopathic medicines within a period of 3-5 weeks of commencement of treatment.

The patient is referred back to the ophthalmic surgeon at regular intervals ranging from weekly (in cases of acute uveitis) to monthly (chronic uveitis) or as per the wishes of the ophthalmic surgeon. He would note his findings and refer the patient back with his evaluation of the patient’s progress.

The patient’s subjective symptoms as well as the ophthalmic surgeon’s findings are considered by me to plan the next prescription.

Below are a few cases of uveitis that have been treated with homoeopathy:

Case 1

Chief complaints:
Pain and severe photophobia in the rt. eye since 12 days. There is blurring of vision. Heaviness and dull pain in the rt. eye. The eye symptoms are < bright light3, < sun, > closing the eyes.
She also has a headache for the past 3 years esp. over the temples < before menses, > sleep3

Pain in both the shoulders since 2 weeks along with a general body ache < lifting slight weight.

Life Situation and Mind:
Presently she is anxious about the eye complaints. Likes company and mixes easily with others.
Sensitive to insults, rudeness à brooding
> consolation
She has become irritable lately and snaps at everyone.
Patient as a Person:
Appetite: good
Desires: sweets3, spicy3, warm food, tea
Aversion: nil
Thirst: 10-12 glasses of cold water per day
Sweat: in summer
Stools: hard
Urine: normal
Hot patient
Gyn. & Obst. History:
Before Menses: headache, weakness
Past History:
Typhoid and chicken pox in childhood.
Viral conjunctivitis and keratitis of both eyes- 2003
Acute Gastroenteritis- 2004

Family History:
Father- HT
Brother- Asthma, eczema, obsessive compulsive disorder

Examination findings:
Eyes (Externally)- congested
Rt. eye- Iritis

Diagnosis: Acute iridocyclitis

Treatment: Bryonia 200 tds x 2 weeks

Follow up:
12-10-2005: Asymptomatic. No pain, photophobia, redness of the eye.
Treatment- SL tds x 4 weeks.
10-11-2005: Asymptomatic. No visual complaints. (S/B Ophthalmic surgeon
on 2210-2005: Vision both eyes- 6/6, Iridicyclitis settled.)
Treatment- ct all tds x 4 weeks.

Case 2
Chief complaints:
H/O injury to the rt. eye leading to an intra ocular foreign body- 2 years ago. He was operated upon and the foreign body was removed and Silicon oil was inserted in Nov. 2002.
On 1-3-2004 the silicon oil was removed and AC IOL was implanted.
At present complains of vitreous floaters in the rt. eye.
Life Situation and Mind:
His father irons clothes.
The patient left studies because he had a series of school changes as the family was frequently shifting to different cities. He wants to study but is hesitant because he left school about 4 years ago.
He fears darkness.
Dislikes being alone.
He feels sad and weeps if someone dies in the family.
Does not readily show his anger.

Patient as a Person:
Desires: vegetables, spicy food
Aversion: sweets
Thirst: normal
Sweat: scanty
Chilly patient
Addictions/Habits: tea

Past History:
Malaria- 1 year ago

Family History:
Father- Cx spondylosis, Pleural effusion (20 years ago)
Mother- cholera- twice
Sister- Cx lymph nodes

Examination findings:
Vision: Rt. eye- 6/9; Lt. eye- 6/6
IOP- 12.2 (both eyes)
Slit lamp- vitreous floaters ++

Diagnosis: Rt. vitreous floaters with sec. glaucoma and recurrent vitreitis

Treatment: Arnica 200 tds x 2 weeks

Follow up:
06-09-2004: Pt. absent. Vision improved. Treatment- ct all x 2 weeks.
23-09-2004: Pt. absent. Floaters reduced. Treatment- ct all x 2 weeks.
15-10-2004: Pt. absent. Vision improved. Treatment- ct all x 7 days.
21-10-2004: Anterior Chamber wash was done on 18-10-2004. The vision became blurred and hazy after that. Vision Rt. eye: FC à 6/60.
Treatment- ct all x 7 days.
27-10-2004: S/B Dr. Maniar today: Vision: Rt. eye- 6/9; Lt. eye- 6/6, IOP- 17.3; Slit lamp- AC clear, vitreous floaters +, pupils reacting, IOL in place. Treatment- ct all x 7 days.
09-11-2004: Floaters >>. Treatment- SL tds x 2 weeks
11-02-2005: S/B Dr. Maniar today: Vision: Rt. eye- 6/12; Lt. eye- 6/6, IOP- 17.3; Slit lamp- AC clear, vitreous floaters +, pupils reacting, IOL in place.
Treatment- SL tds x 2 weeks then Arnica 200 tds x 2 weeks.

The patient was followed up on 17-3-2005, 12-4-2005, 5-7-2005, 30-7-2005 and 1-9-2005 when he was given SL. The vitreous floaters had reduced and he was asymptomatic. He was under observation to see if he gets a relapse of the vitreitis.

Case 3
Chief complaints:
Foggy vision in the Rt. eye since Feb. 2003. Was in London at that time and was treated with steroid injections and tablets. She felt better from April to June 2003, but the symptoms returned again.
In Dec. 2003, she had black patches in front of her vision in the Lt. eye with a sensation of a ball in the eye. The objects appear smaller and the vision is hazy- as if looking through smoke.
She also has a non-healing ulcer in the nostrils after a septoplasty in 1979-1980. The wound has never healed and there is a scab formation. She aslo has a tendency to sinusitis.

Pain in both the shoulders since 2 weeks along with a general body ache < lifting slight weight.

Life Situation and Mind:
She is a Chartered Accountant and was working with a company before she left for London.
She has been ambitious about her studies and career since childhood. She won’t give up too easily.
She wants things in order. Everything must be in its proper place.
She is hot tempered and is angry at trifles. She screams and shouts from anger. She cannot bear to be cheated.
She likes to help others and goes out of her way to make people comfortable.
She is religious and has a lot of faith in God.
She fears being alone; darkness
Sleep:
Often disturbed from worries about family matters. Fears ghosts when in bed.

Patient as a Person:
Appetite: Good
Desires: nil
Aversion: sweets
Thirst: normal
Sweat: scanty
Stools: normal
Urine: normal
Chilly patient
Gyn. & Obst. History:
Before Menses: headache, weakness
During Menses: nothing particular
After Menses: feels fresh and nice
Leucorrhoea: yellowish white < Menses B2 and A
Pregnancies: 2 FTNDs
Abortions: nil
Contraceptives: IUCD
Past History:
Chicken pox, Mumps and Measles in childhood
Tosillectomy- 12 years age, Nasal septoplasty- 30 years age

Family History:
Father- CVA
Mother- HT, Hysterectomy (adherent placenta)
Son- Albinism

Examination findings:
BP: 140/84 mm Hg.
Treatment: Phosphorus 200 tds x 2 weeks

Follow up:
27-04-2004: Strain in Lt. eye >>. Rt. eye still feels strained. Redness of both eyes in the morning on waking. Objects appear smaller.
Treatment- SL tds x 2 weeks.
12-05-2004: Lt. eye vision >. Rt. eye still dim. Redness of the eyes >. Steroids were reduced by the ophthalmic surgeon.
Treatment- Phos 200 tds x 2 weeks and SL tds x 2 weeks.
10-06-2004: Vision improved in both eyes. Mild pain around rt. eye. Floaters+ Treatment- Phos 200 tds x 1 week and SL tds x 1 week
24-06-2004: Eyes >3. No redness in the morning. Lt. eye feels ‘relaxed’. Rt. eye- floaters +. (S/B Opthalmic surgeon on 26-5-2004: FFA was done- no evidence of active inflammation; Resolving choroiditis in Lt. eye and ant. Uveitis in rt. eye)
Treatment- Phos 200 tds x 2 weeks and SL tds x 2 weeks.
13-07-2004: Dark spot in front of vision in the rt. eye in the periphery of vision.
Blurred vision in the rt. eye and pain in the supra ciliary region. (S/B Ophthalmic surgeon: Healed choroiditis in lt. eye and Uveitis in Rt. eye.)
Treatment- Phos 1M tds x 2 weeks and SL tds x 2 weeks.
10-08-2004: (S/B Ophthalmic surgeon on 4-8-2004: both eyes quiet. Steroids tapered further.) Pain in Rt. eye >. Floaters reduced. Scabs in nostril > 90%.
Treatment- Phos 1M tds x 2 weeks and SL tds x 2 weeks.
This patient has been followed up till 29-9-2005 and has been given Phos 1M on 23-9-2004, 25-11- 2004,17-2-2005 for a period of 1 week with SL being given the rest of the time.

She was last seen at the L.V. Prasad eye hospital at Hyderabad on 10-5-2005 and was found to be clinically normal in both the eyes. All the allopathic medicines had gradually been discontinued by this time.

Case 4
Chief complaints:
There is dim vision in the Rt. Eye since January 1992. She had redness of the eye followed by gradual loss of the vision.
She can see only from the left eye.
She was treated with local and systemic steroids without any improvement and was then referred for homoeopathic treatment.
She also has cough with yellowish expectoration since three years which is < winter, < afternoon (after eating). She has been started on Tab. Isonex by her doctor for the cough (TB).
Life Situation and Mind:
Mild personality.
Very fearful. Fear of darkness3. Fear of being alone3. She has a fear of ghosts and feels that ghosts might creep out of the dark areas of the house.
Hence she wants company, especially at night.
Sleep: Poor. Scared at night. Gets sleep at 2-3 am.
Patient as a Person:
Appetite: OK
Desires: Spicy
Aversion: --
Thirst: Increased. Wants cold water.
Sweat: normal
Stools: Takes Isabgul (husk preparation) to get proper bowel movements.
Urine: D:N::4:2-3
Chilly patient
Past History:
Nothing particular

Family History:
Nothing particular

Examination findings: (S/B Dr. Maniar on 28-2-1995)
Vision: Rt. Eye- F.C. upto 2 feet
Fundus: Ant. vitreous haze with vitreous floaters

Investigations: Blood sugar: (F)-82, (PP)- 92; Mantoux test: - ve

Diagnosis: Rt. Eye vitreitis

Treatment: Phos 200 tds x 7 days

Follow up:
10-03-1995: No redness of eye. Dimness of vision >.
Treatment- ct all x 7 days.
17-03-1995: (S/B Dr. Maniar: Vision – 6/60; Fundus- ant. haze +, floaters +) Treatment- ct all x 7 days.
24-03-1995: Vision improved.
Treatment- SL tds x 14 days
10-04-1995: (S/B Dr. Maniar: Vision – 6/36; Fundus- ant. haze +, floaters +) Treatment- ct all x 14 days.
24-04-1995: Haziness of vision >. Can see objects clearly. Floaters >.
Treatment- ct all x 14 days.
08-05-1995: Vision again dim since 3 days. Floaters +
Treatment- Phos 200 tds x 7 days, then SL tds x 7 days.
23-05-1995: Vision improved once again. Haziness > ++; Floaters > + Treatment- ct all x 14 days.
05-06-1995: (S/B Dr. Maniar: Vision – 6/9; Fundus- clear, floaters- nil) Treatment- SL tds x 14 days.
05-07-1995: (S/B Dr. Maniar: Vision – 6/9; Fundus- clear, floaters- nil; IOP- normal). Treatment- SL tds x 14 days.

Case 5
Chief complaints:
The patient developed sudden black spots in the Rt. Eye in front of his vision about 2 months ago.
Blurring of vision and ultimately complete loss of vision followed this. He cannot make out details of the objects. There is also a stiffness of the Rt. Eye in the morning on waking. He is a welder by profession and is exposed to very bright light.
He also complains of gases and flatulent distension of the lower abdomen, which is < eating pulses and > passing flatus.

Life Situation and Mind:
He is married and has 3 sons and 2 daughters.
He joined a religious group 24 years ago and since then he has stopped eating non-vegetarian food and now helps in the local temple.
He has been working as a welder for the past 40 years but is not treated well by his boss.
He is mild and does not retaliate if insulted, though he feels hurt and sometimes gets a desire to hit the other person. He will weep if insulted.
No tensions or fears.

Patient as a Person:
Skin: Vitiligo on hands and feet
Appetite: Poor
Desires: Sweets3, Salt, Milk
Aversion: Spicy
Thirst: Increased. Mixes fridge and pot water
Sweat: Profuse, no stains/ odours
Stools: Daily but hard and unsatisfactory
Urine: D:N::4-5:2-3. No straining

Past History:
Rt. Herniorrhaphy, Rt. Hydrocele (RCTVH done)

Family History:
Nothin g significant

Examination findings: Rt. Eye: Vitreous haze ++, Vision- FC (finger counting), IOP- Normal

Investigations: (7-5-1990)
Blood Sugar: (F)- 93 mg%; (PP)-127 mg%
RBC- 4.3, Hb- 13, TC- 12,200, N/60, L/24, E/6; ESR- 15mm

Diagnosis: Rt. vitreitis

Treatment: Lycopodium 200 tds x 7 days

Follow up:
28-05-1996: Vision SQ. Treatment- ct all x 7 days.
04-06-1996: Vision- can detect light; flatulent distension >.
Treatment- ct all x 7 days.
12-04-1996: Vision improving, no gases. Treatment- SL tds x 14 days.
26-04-1996: (S/B Dr. Maniar: Vision- Rt. Eye- 6/60, IOP- normal.)
Pt. complains of smoky vision; but can appreciate shapes.
Treatment- ct all x 14 days.
11-05-1996: Vision- slightly better. Gases again +
Treatment- Lyco 200 tds x 7 days then SL tds x 7 days.
25-05-1996: (S/B Dr. Maniar: Vision- 6/24, Media clearer, Very few floaters seen, IOP- normal.) Symptomatically >
Treatment- SL tds x 14 days.
11-06-1996: Vision improved. Can read letters on TV clearly. Haziness of vision reduced ++. Gases and abdominal distension >
Treatment- ct all x 14 days. 26-06-1996: (S/B Dr. Maniar: Vision- 6/12, Media clear, floaters reduced IOP- normal.) Pt. again complains of gases and distension of the lower abdomen after eating pulses. Vision is better and haziness has reduced almost completely. Treatment- Lyco 200 tds x 7 days then SL tds x 7 days. 26-07-1996: Vision improved. No haziness of vision. No gases. (S/B Dr. Maniar: Vision- 6/9, Media clear, floaters nil, IOP- normal. Has recommended new glasses.) Treatment- SL tds x 1 month.

Case 6
Chief complaints:
This patient had a Rt. Cataract surgery on 8-4-1994 and developed a blurring of vision after that. She was diagnosed as suffering from Vitreitis of the Rt. Eye and treated with local steroid and atropine drops. She was also given a retro bulbar injection of steroids.
Since she was not responding well to this treatment, she was referred for homoeopathic treatment.

Life Situation and Mind:
She has been irritable recently. She has a weeping tendency. She likes company.

Patient as a Person:
Appetite: Reduced since 1 month
Desires: Spicy3
Aversion: nothing particular
Thirst: Increased. Drinks extremely cold water
Tongue: clean
Sweat: in summer. Stains yellow. Odour +
Stools: 2 /day
Chilly patient

Gyn. & Obst. History: Menopausal since 11 years
Past History: nothing particular

Family History: nothing particular

Examination findings:
Rt. Eye- vision: finger counting; vitreous haze ++
Treatment: Arnica 200 tds x 14 days

Follow up:
17-06-1994: Vision still blurred. Treatment- Phos 200 tds x 14 days followed by SL tds x 7 days.
14-07-1994: Vision improved from FC to 6/12 with glasses. Pain Rt. Eye.
Photophobia. S/B Dr. Maniar: Congestion ++. Rt. Sup. Temporal
branch arterial occlusion. Treatment- Bell 200 tds x 14 days.
03-08-1994: Vision OK. Objects appear larger. Occasional chest pain that lasts for a few minutes. S/B Dr. Maniar: Fundus- Vitreitis +, Rt.
Eye- 6/24, IP- normal. Treatment- Phos 200 tds x 14 days.
05-09-1994: (S/B Dr. Maniar on 1-9-1994: Vision- 6/12; Fundus- clear; IOP- normal.) Retrosternal burning, 1-2 hours after eating. Pain in the eye since 2 days. Treatment- SL tds x 14 days.
26-10-1994: (S/B Dr. Maniar on 18-10-1994: Rt. Eye- no ciliary flush; Vision- 6/12; Fundus- clear; IOP- normal.) Presently complains of pain in the eye. Retrosternal burning < after eating.
Treatment- Phos 1M (I) dose and SL tds x 14 days.
Treatment- Phos 1M tds x 2 weeks and SL tds x 2 weeks.

Comments about the above cases:
Arnica is the drug that I frequently use to begin the treatment of uveitis caused by trauma. In most of the cases, the trauma is surgery on the eye for cataract. In spite of the fact that surgical trauma is more of an incision (clean cut wounds) and is not due to blunt injuries, Arnica is very useful.

In Allen’s Keynotes, the first line of the ‘eye remedy’, Euphrasia reads “Bad effects from falls, contusions or mechanical injuries of external parts [Arn.]” However, when I gave Euphrasia to many of the patients who had earlier come with the history of cataract surgery or other trauma to the eye, it did not bring about any positive change. Hence, Arnica was next given to the patients- with wonderful results. I have found that in uncomplicated cases (patients with no other constitutional symptoms), Arnica is the sole remedy to treat the inflammation and restore the vision.

There is not much scope for the use of rare remedies in the treatment of uveitis, mainly because it is a result of some immune mechanism and needs internal constitutional treatment.

Many of the patients with vision of only Finger Counting (FC) before treatment have had their sight restored after giving the indicated homoeopathic medicine and the acuity of vision in such cases has improved to 6/12 and even 6/9.

Most of the other patients have had their vision restored to 6/9 or 6/6 from a poor visual acuity of 6/60 or 6/36 after homoeopathic treatment.

Patients who have a history of recurrent attacks of uveitis are followed up on a long-term basis in spite of the fact that the acute exacerbation is rapidly controlled by the homoeopathic medicines. Such patients have not had a recurrence even 2 years after stopping treatment.

I have found that the average time taken for the inflammation in the eye to subside completely is about 5-6 weeks. The ophthalmic surgeon documents this improvement. All the inflammatory signs and exudates usually disappear within this period.

Patients with simple inflammation of the uveal tract, the so-called rheumatic iritis, usually had a clear vision within 2 weeks of beginning treatment.