Dry eye disease and Homeopathy
With the progression of technology and digitalization, lifestyle diseases are gradually increasing and hampering the health quality of life. Among the various diseases caused by this modern lifestyle, dry eye disease (DED) is becoming significant. Though dry eye seem to be a very common eye symptom, it’s not that simple. DED is due to insufficiency of lubrication and moisture on the eye surface. A recent observational study evaluated by ocular surface disease index questionnaire showed that the prevalence of DED was 32%. Among them 9.9% had mild DED; 61.2% had moderate DED; and 28.9% had severe DED of age group of 21-40 years.[1],[2] This study also indicates that male sex, urban region, and desk job were associated with increased risk of DED. Hours of visual display terminal (VDT) usage multiplies the risk of DED. Severe DED patients had 4 hour or more of VDT usage.
Signs and symptoms, causes, risk factors and diagnosis[3],[4]
Symptoms of dry eyes include, burning sensation in eyes, itchy of eyes, aching sensations, heavy, fatigued eyes, soreness, foreign body sensation, dryness, redness of eyes, photophobia (light sensitivity), blurred vision, etc. The characteristics of the causative factors, such as air travel, sitting near an air conditioner vent, low humidity, and prolonged visual efforts such as reading, watching TV, smartphone or computer use are helpful in diagnosing dry eye as it aggravates by these factors. Medical history plays major role as secondary DED may develop due to menopause, sjögren syndrome, rheumatoid arthritis, systemic lupus erythematosus, scleroderma, dermatitis, rhinitis, bronchial asthma, antihistamines, diuretics, hormones and hormonal antagonists, antidepressants, cardiac antiarrhythmic drugs, Parkinson disease, Bell’s palsy, trigeminal neuralgia, lymphoma, sarcoidosis, etc. VDT use, smoking, and contact lens use are also associated with increased odds of developing DED. Symptom-based assessment is the key component of clinical diagnosis of DED due to the inability of any single diagnostic test or set of diagnostic tests to confirm or rule out the condition. Tear break-up time (TBUT) test, Ocular surface dye staining test, and Schirmer test are some of the common tests performed for the assessment of DED.
Etiological risk factors in Dry Eye Disease[5]
| Level of Evidence | ||
| Mostly consistent | Suggestive | Unclear |
| • Older age
· Vitamin A deficiency · Postmenopausal estrogen therapy · Low dietary intake of Omega-3 fatty acids · Medications Antihistaminics · LASIK and refractive excimer · laser surgery · Radiation therapy · Hematopoietic stem cell transplantation · Hepatitis infection
|
· Asian ethnicity
· Medications: Tricyclic antidepressants, Diuretics, Beta-blockers, Serotonin uptake inhibitors · Diabetes mellitus · HIV/HTLV 1 infection · Systemic chemotherapy · Large incision ECCE and PK · Retinoid: Isotretinoin · Low humidity environments · Sarcoidosis |
· Cigarette smoking
· Hispanic ethnicity · Medications: Anticholinergics, Anxiolytics, Antipsychotics · Alcohol use · Menopause · Botulinum toxin injection · Acne · Oral contraceptives
|
Managing dry eye
During dry weather frequently closing of eyes for a few minutes minimizes the evaporation of tears. Blinking repeatedly for a few seconds or closing the eye for a few seconds may help to spread tears. Avoiding direct hair dryers, car heaters, air conditioners or fans toward eyes will also be helpful. It is suggested to view a computer when the eyes are looking downward. Optimal 15 to 20 degrees below eye level (about 4 or 5 inches) as measured from the center of the screen and 20 to 28 inches distance from the eyes is recommended.
Homeopathic remedy for management of DED[6],[7],[8],[9]
There are several homeopathic medicines for the management of DED. The commonly indicated remedies obtained after repertorisation with RADAR are represented below with their indications.
Aconitum napellus
Eyes feel dry and hot as if sand in the eyes. Eyelids turn red, hard, and swollen. Complaints begin from exposure to dry, cold winds, reflection from snow, after extraction of cinders and other foreign bodies. Physical and mental restlessness, fright, is the most characteristic manifestation of Aconite. Acute, sudden, and violent invasion of the symptoms. In true sclerotis, acute stage, with contracted pupils, sticking or tearing pains, photophobia, a blue circle around cornea and violent aching in balls. Itching, smarting, and burning in eyes, worse in evening.
Belladonna
Throbbing pain deep in eyes on lying down. Eyes feel swollen and protruding, staring, brilliant. Photophobia from the artificial light. Chronic keratitis, when suddenly eye becomes intensely congested, with heat, pains often sharp, shooting through ball to back of head. Rheumatic iritis in early stages.
Clematis erecta
Iritis with heat in eyes and sensitive to air must close them in cold air. Burning heat and dryness in eyes as if fire was streaming from them.Complaints from bright sunlight.Smarting of eye worse on closing them and on reopening them.Kerato-iritis, particularly of the ulcerative type.
Arsenicum album
Burning pain in eyes relieved by washing with warm water. Acrid lachrymation from the eyes.Lids red, ulcerated, scabby, scaly, and granulated. Aching, burning, and shooting pains in the eyes, worse by light, as also by the movement of the eyes, accompanied sometimes with a necessity to lie down or with anguish which does not permit to rest in bed. Agglutination of eyelids. Burning pains over orbit, worse at night, with profuse acrid lachrymation during Keratoiritis. Extreme redness of inner surface of eyelids, with an uneasy sensation rather than pain, often obliging one to rub the eyes.Great restlessness and anxiety.
Nux vomica
Smarting dry sensation in inner canthi. Orbital twitching radiating towards the occiput, Optic neuritis.Pressive and tensive pains in eyes, worse on opening them, and looking into the air.Burning itching, or sharp drawing pains, or sensation of excoriation in lids and in margins worse in morning on being touched.Blurring of sight caused by overheating. Dryness of eye with severe pain in eyes during night, with conjunctival injection, brought on by overuse, especially by artificial light.
Lycopodium
Right eye is generally affected. Flickering and black spots before the eyes.Dim, hot eyes. The eyes are wide open, insensible to light, fixed. Dryness of eyes, in evening.Sparks before the eyes, especially in the dark.Drawing pain in the cervical muscles. Eye symptoms may accompanied with flatulence and heartburn, worse at afternoon especially 4-8 P.M.
Phosphorus
The occiput and nape of the neck are painful and very stiff. This pain extends till coccyx. Sleeplessness due to overuse of computers. Slightest noise disturbs. Paralytic weakness in the small of the back and extremities with tremor from prolonged sitting. Patient may have logging of cold food, ice cream, excessive salt, and thirst for cold water.
Rhustoxicodendron
It is indicated for burning in eyes; sudden pain behind eyes as if brain were torn to pieces, the eyes red, agglutinated with matter, in morning, cervical and shoulder pains, etc. Dryness of eye worse at night with great restlessness better by motion.
Argentum nitricum
Acute granular conjunctivitis, conjunctiva intensely pink or scarlet, discharge profuse, inclined to be mucopurulent. Blepharitis if lids are very red, thick and swollen, especially if complicated with granulations. Photophobia worse in the warm room.Aching tired feeling in eyes, better closing or pressing upon them. Very impulsive wants to do things in a hurry. Pain from brain to eyes during iritis.
Pulstillanigricans
Itching and burning in eyes. Profuse lachrymation and secretion of mucus. Lids inflamed, agglutinated. Dryness of eyes and lids, with sensation as if darkened by mucus, which ought to be wiped away. It seems dark before eyes in morning, on rising from bed. Loss of vision at night, as if eyes were tightly bound by a cloth, with menstrual disturbances.Iritis with dry burning heat in and about eye. Burning, itching in eyes, provokes rubbing and scratching relieve by washing with cold water, cold application, and open air. In general patient is thirstless, mild, and weeping disposition.
Cinchona officinalis
Dryness of eyes may associated with excessive pain in eye as if knife was thrust between orbit and ball and moved about in orbital cavity as if to scoop out eye, from 8 A. M. till 2 or 3 P. M. Iritis from loss of blood, after confinement. Inflammation and itching of eyes and eyelids in persons debilitated by loss of animal fluids.Pressive smarting pain in eyes as from salt ; she must constantly rub them. Eye complaints may be associated with excessive flatulence and dyspepsia. Offensive flatulence.
References
[1]Titiyal JS, Falera RC, Kaur M, Sharma V, Sharma N. Prevalence and risk factors of dry eye disease in North India: Ocular surface disease index-based cross-sectional hospital study. Indian J Ophthalmol 2018;66:207-11
[2]Noopur Gupta, I Prasad, R Jain, P D’Souza, Estimating the prevalence of dry eye among Indian patients attending a tertiary ophthalmology clinic, Pathogens and Global Health 104(3):247-55 · Apri
[3]Dr.LalitVerma, ALL INDIA OPHTHALMOLOGICAL SOCIETY, Honorary General Secretary, AIOS, Room No. 111 (OPD Block), 1st Floor, Dr. R.P. Centre, A.I.I.M.S., Ansari Nagar, New Delhi 110029 (India)
[4]Optometry Council of India, 5 & 6 Vasu Complex, RMV 2nd Stage, New BEL Road, Bangalore – 560054. Karnataka, India
[5] Begley CG, Chalmers RL, Abetz L, et al. The relationship between habitual patient-reported symptoms and clinical signs among patients with dry eye of varying severity. Invest Ophthalmol Vis Sci 2003; 44: 4753-61.
[6]HERING’S GUIDING SYMPTOMS of our Materia Medica By Calvin B. Knerr, M. D. B Jain Publishers Pvt Ltd;New Delhi
[7]F. Schroyens, Synthesis Treasure Edition 2009V, RadarOpus 1.33 (Homeopathic Software), Archibel S.A. Rue Fontaine St. Pierre 1E, Zoning Industriel de la Fagne, 5330 Assesse, Belgium.
[8]W. Boericke, New Manual of Homeopathic Materia Medica& Repertory [with Relationship of Remedies], Second Re-Augmented & Revised Edition Based on Ninth Edition, Reprint Edition 2002, B. Jain Publishers, New Delhi.
[9]J. H. Clarke, Dictionary of Practical Materia Medica, Reprint Edition 1992, B. Jain Publishers, New Delhi.
[1]Titiyal JS, Falera RC, Kaur M, Sharma V, Sharma N. Prevalence and risk factors of dry eye disease in North India: Ocular surface disease index-based cross-sectional hospital study. Indian J Ophthalmol 2018;66:207-11
[1]Noopur Gupta, I Prasad, R Jain, P D’Souza, Estimating the prevalence of dry eye among Indian patients attending a tertiary ophthalmology clinic, Pathogens and Global Health 104(3):247-55 · Apri
[1]Dr.LalitVerma, ALL INDIA OPHTHALMOLOGICAL SOCIETY, Honorary General Secretary, AIOS, Room No. 111 (OPD Block), 1st Floor, Dr. R.P. Centre, A.I.I.M.S., Ansari Nagar, New Delhi 110029 (India)
[1]Optometry Council of India, 5 & 6 Vasu Complex, RMV 2nd Stage, New BEL Road, Bangalore – 560054. Karnataka, India
[1] Begley CG, Chalmers RL, Abetz L, et al. The relationship between habitual patient-reported symptoms and clinical signs among patients with dry eye of varying severity. Invest Ophthalmol Vis Sci 2003; 44: 4753-61.
[1]HERING’S GUIDING SYMPTOMS of our Materia Medica By Calvin B. Knerr, M. D. B Jain Publishers Pvt Ltd;New Delhi
[1]F. Schroyens, Synthesis Treasure Edition 2009V, RadarOpus 1.33 (Homeopathic Software), Archibel S.A. Rue Fontaine St. Pierre 1E, Zoning Industriel de la Fagne, 5330 Assesse, Belgium.
[1]W. Boericke, New Manual of Homeopathic Materia Medica& Repertory [with Relationship of Remedies], Second Re-Augmented & Revised Edition Based on Ninth Edition, Reprint Edition 2002, B. Jain Publishers, New Delhi.
[1]J. H. Clarke, Dictionary of Practical Materia Medica, Reprint Edition 1992, B. Jain Publishers, New Delhi.