Dr. C. H. VILAS’ 
EYE NOTES. 
Entered according to Act of Congress in the year 1878, by 
C. H. VILAS, M.D., 
In the Office of the Librarian of Congress, at Washington. 
These Eye Notes were prepared to assist in the study, and form the basis of the 
didactic lectures on the embraced subjects as given by the author at the Hahnemann 
Medical College and Hospital, Chicago. They are necessarily concise, condensed 
and elementary in their character, and are in no sense designed to take the place of, 
or in any way supersede the treatises on the subjects, but are intended to suggest the 
topics to be further studied, to pick out of the mass of writings the essential funda- 
mental pinciples and main diagnostic points, and to suggest the line of treatment. 
Their cordial reception, not only by students, but by practitioners, has seemed to be 
sufficient reason for a publication more general than was originally intended. 
The attempts to prepare an abbreviated materia medica must be always attended 
with hazard, and will doubtless be found incomplete. Additions of new remedies 
and well-authenticated symptoms will be made from time to time, and the whole 
enlarged and improved, may form the basis for a more pretentious work at some 
future time. But it is not to be expected that any one will always prescribe on local 
symptoms alone, but be guided by a more thorough knowledge of the remedies other- 
wise obtained. For their peculiar wording, the author is often alone respons- 
ible; but not only in them, but in the preparation of the diseases, all works accessible 
have been freely used. It is hoped this statement will serve as a full and courteous 
acknowledgement of the gr.eat assistance necessarily derived from many excellent 
publications. Dr. C. H. VILAS’ 
EYE NOTES 
Entered According to Act of Congress in the year 1878, by 
C. H. VILAS, M.D., 
In the Office of the Librarian of Congress, at Washington. Cl N NABARIS. i. “Pain from inner canthus of left eye across the eyebrows.” 
2. Ciliary neuralgia. 
CLEMATIS. I. “ Biting, burning pains in the eye.” 2. “ Burning in the eyes 
as ii fire were streaming out of them.” 3. “Burning, sticking pains in'the 
inner canthus ol the left eye.” 
COLOCYNTHIS. 1. “ Pains always relieved by pressure.” 2. “ Cutting pains 
in the eye.” 3. “ Lachrymation profuse and acrid.” 
CON IU M MAC. 1. Excessive photophobia, caused by superficial ulceration of 
the cornea. 2. Excessive photophobia, the terminal filaments of the ciliary and 
conjunctival nerves being exposed. 3. “ Weakness and dazzling of the eyes, 
with giddiness of the whole body.” 4. Inability to raise the eyelids. 5. Double 
vision. 
6. “A heat which is burning moves rapidly through the eye.” 7. Burning on 
the inner surface of the lids. 8. Induration of the lids. 9. Asthenopia. 
10 Hypersesthesia of the reitna. 
. 11. “ Inability to bear either light or heat.” 
CROTALUS HORRIDUS. 1. “ Hemorrhages into the retina.” 2. “Clears up 
the vision after attacks of keratitis.” 
CROTON TIC. 1. Superficial and deep ulcers of the cornea. 2. Pustules on 
the cornea. 3. Pustules on the conjunctiva. 4. Pustules on the lids. 5. Ec- 
zema of the lids. 
CYCLAMEN. 1. “ Muscae volitantes disappear.” 2. Flickering before the eyes. 
3. Strabismus convergens. 
DIGITALIS. 1. Relieves exophthalmic goitre, with severe heart symptoms. 
2. “ Tensive throbbing in left eye.” 
EUPHRASIA. 1. “ Redness and swelling of the margin of the lids.” 2. Burn- 
ing and swelling of the margin of the lids, with sensation of great dryness. 
3. “ Biting water runs from the eyes.” 4. Lids swollen and red. 5. Cornea 
covered with mucus. 
6. “ Burning in the eyes, with lachrymation.” 7. “ Lids red, swollen and cov- 
ered with a thick, yellow, acrid discharge.” 8. Catarrhal inflammations of the 
conjunctiva. 9. Strumous inflammations of the cornea. 10. Catarrhal inflam- 
mations from exposure to cold. 
11. “Yellow, muco-purulent, thick and excoriating discharge, making the lids 
sore.” 12. Opacities of the cornea from frequent attacks of inflammation. 
13. “ Blurring of the eyes, relieved by winking.” 
FERRUM. 1. Exophthalmic goitre. 
GELSEMIUM. 1. Paralysis of recti muscles. 2. Paralysis of external recti 
muscles. 3. “ Drooping of the eyelids.” 4. “ Eyelids half-closed, with apparent 
inability to move them.” 5. “ Great heaviness of the lids.” 
6. Diplopia. 7. “ Control over the upper eye-lid almost lost.” 8. Diseases 
of the uveal tract. 9. Serous exudations. 10. Detachment of the retina. 
11. “Snake before the eyes.” 12. “Constant inclination to squint.” 
13. “Inflammatory affections of retina and choroid.” 14. Paresis of the 
muscles. 
GRAPHITES. 1. “Dry scurfs on the cilia.” 2. “ Moist eczematous eruptions 
of the lids.” 3. Tarsal tumors. 4. External canthi fissured. 5. External 
canthi crack and bleed easily. 
6. Scrofulous ulcers and pustules. 7. Eyes and nose sore and surrounded by 
thick moist scabs. 8. Intense photophobia, with thin, acrid discharge from the 
nose. 9. “Very inflamed margins of the lids.” 10. Heat, dryness and pressure 
about the lids. 
11. “ Superficial ulcerations with vascularity of the cornea.” Dr. C. H. VILAS’ 
EYE NOTES 
F.ntered According to Act of Congress in the year 1878, by 
C. H. VILAS, M.D., 
Tn the Office of the Librarian of Congress, at Washington. BRYONIA ALB. i. Especially adapted to serous exudations. 2. “Choroiditis 
and irido-choroiditis.” 3 “Pains very severe; aggravated by motion of the 
eye-ball.” 4. Very sensitive pressive pain in the left eye-ball, especially violent 
on moving it. 5. Ciliary neuralgia, worse on motion of any kind. 
6. Diseases of the uveal tract. 7. Sclera highly inflamed. 
CACTUS GRAND. 1. Dimness of sight dependent on retinal and optic-nerve 
diseases. 2. Inflammation of optic nerve, when heart is diseased. 3. Great 
congestion of eye, with heart troubles. 4. Exophthalmic goitre. 
CAFFEIN. 1. Nen 'ous sleepless women, with eye troubles. 2. Particularly indi- 
cated for sleeplessness after operations. 3. Pains of glaucoma and iritis are 
alleviated. 
CALCAREA CARS. 1. Superficial inflammations caused by wet, or worse in 
damp weather. 2. “ Inflammations of margins of lids, loss of lashes, with thick 
purulent excoriating discharge, and burning, sticking pains.” 3. “ Blepharitis, 
with great itching in lids.” 4. “ Scrofulous inflammations of the conjunctiva 
and cornea.” 5. “ Nebulae of the cornea.” 
6. Constitutional symptoms are often the best guide. 7. Eye affections in pot- 
bellied children. 8. “ Entropion or ectropion in the beginning.” 9. Sees 
small things best. 10. Long-lasting supra-orbital neuralgia. 
11. Eyes inflamed and injected at every exposure to cold. 12. Scrofulous 
affections of the orbital bones. 13. Trachoma in tubercular subjects. 
CANTHARIS. 1. “Severe burning pains in the eye.” 2. “Eyes red and suf- 
fused with tears; burning in the lids.” 
CAUSTICUM. 1. Cataractous lenses. 2. Paralysis of the muscles, especially 
from taking cold. 3. “Sensation of heaviness in the upper lid; cannot be 
easily raised.” 4. “ Warts on the lids and brows.” 5. Blepharitis, “ especially 
if ameliorated in the fresh air.” 
6. “ Paralysis of the ciliary muscle.” 7. “ Paralysis due to rheumatism, or 
getting the feet wet.” 8. The upper lids fall down; are nearly paralyzed. 
CEDRON. 1. Ciliary neuralgia. 2. “ Pains severe, sharp and shooting.” 
3. “ Pains start over the eye, and extend along the branches of the supra-orbital 
nerve into the head.” 
CHAMOMILLA. 1. Child fretful, wants to be carried all the time, when troubled 
with eye complaints. 2. Especially adapted to superficial inflammations. 
3. Especially useful in eye complaints in fretful children, when they are teeth- 
ing, etc. 
CHINA. 1. Eye complaints aggravated by loss of blood. 2. Amblyopia due to 
venereal excesses. 3. Eye complaints when due to loss of animal fluids. 
4. Eye complaints, accompanied by great prostration of general system. 5. Eye 
complaints intermitting with other troubles. 
6. “ Sees better after sleeping.” 
CHININUM SULPHURICUM. 1. Intermittent strabismus. 2. Eye com- 
plaints with intermittent fever. 3. Paroxysmal eye complaints. 
CICUTA VIROSA. 1. “On attempting to stand, objects seem now to come 
nearer, and now to recede, causing a desire to hold on to something.” 2. Peri- 
odic and spasmodic strabismus. 3. “ Trembling and twitching of the lids.” 
CIMICIFUCA. 1. “Aching pain in both eye-balls.” 2. Heaviness of the eyes, 
as if caused by cold. 3. Stinging in the eyelids. 4. Pain in the centre of the 
eye-balls. 5. Pain in the eye extending to the top of the head. 
CINA. I. “Asthenopia, especially when due to some refractive anomaly.” 2. “ Stra- 
bismus, dependent on helminthiasis.” 3. “ Sickly look about the eyes, with 
paleness of face.” 4. Blackness before the eyes, with dizziness and faintness on 
rising; relieved on lying down. Dr. C. H. VILAS’ 
EYE NOTES. 
Entered According to Act of Congress in the year 1878, by 
C. H. VILAS, M.D., 
In the Office of the Librarian of Congress, at Washington. ARSENICUM, i. “Eyelids (Edematous, often completely closing the eyes.” 
2. “ Burning in the eyes, nose and mouth. 3. “ Corrosive tears, making the 
cheeks and eyelids sore.” 4. “ Feeling of sand in the eyes in the evening.” 
5. “ Severe and constant burning in the eyes.” 
6. Edges of lids very red. 7. “ Extreme redness of the inner surface of the 
lids.” 8. “ Continual trembling of the upper lids, with lachrymation.” 
9. “(Edematous eyelids, firmly and spasmodically closed.” 10. “ Dryness of 
eyelids as if the eye were rubbed by them, when reading by artificial light.” 
11. “Burning in margin of upper lids.” 12. “Conjunctiva minutely in- 
jected; diffused, pale redness.” 13. “ Yellowness of conjunctiva.” 14. “ Puls- 
ative throbbing in the eyes, and with every pulsation, a stitch; after midnight.” 
15. “Characteristic pains are often periodic.” 
16. Pains worse at night, with much thirst. 17. “ Excessive photophobia and 
lachrymation, with great prostration.” 18. “ Eye symptoms accompanied by 
great prostration and nervous irritability.” 19. Eczema of the lids. 20. “The 
pains are aggravated by light and by moving the eye.” 
21. Long known as an empirical remedy in neurotic diseases. 
ASAFCETIDA. 1. “Severe boring pain above the brows.” 2. “Deep-seated 
inflammation of the eyes attended by ciliary pains.” 3. “ The pains are usually 
throbbing, beating, boring or burning in character, either in the eye, over or 
around it.” 4. Syphilitic iritis, especially after the abuse of mercury. 
AURUM MET. 1. “ Constant feeling of sand in the eyes.” 2. “ Constant lach- 
rymation.” 3. Pressure in the eyes, as from a foreign body. 4. “ Burning, 
stitching, drawing, and itching in the inner canthus of the eyes.” 5. “ Half- 
sighteclness, as if the upper half of the vision were covered with a dark body; 
upper objects remain invisible.” 
6. “ Everything is seen double.” 7. “ Corneal ulcerations, and pannus-like 
thickening of the outer layer.” 8. “Infiltrated cornea and fine interstitial vas- 
cularity.” 9. Useful after the abuse of mercury. 10. “ Trachoma, with pan- 
nus.” 
11. “ Scrofulous ophthalmia, with ulcerations and vascularity of the cornea.” 
12. “ Pains dull or burning in character, compelling one to close the lids usually, 
worse in the morning, and ameliorated by the application of cold water.” 
13. Periostitis and caries of the orbits. 14. Especially useful in suspected 
syphilitic dyscrasia. 
BELLADONNA. 1. Lids puffy, red and congested. 2. Conjunctiva red and 
swollen. 3. Burning heat in the eyes. 4. Lachrymation, with great photopho- 
bia. 5. Haemorrhage and ecchymosis of the eye. 
6. “ Objects appear inverted.” 7. “ The eyes become distorted, with redness 
and swelling of the lids.” 8. Ilyperaemia of the optic nerve and retina, espe- 
cially when consequent on cerebral congestion. 9. Hyperaesthesia of the retina. 
10. Pains in the eyes from congestive headache. 
11. “Blepharitis, when lids are swollen and red.” 12. “Acute aggravations 
of chronic diseases.” 13. Photophobia. 14. Hyperaemia of the conjunctiva. 
15. Double vision. 
16. Conjunctiva intensely dry and brawny. 17. “ Motion of the eyes accom- 
panied by a sensation of dryness and stiffness.” 18. “ Inflammatory swellings 
of the lids and conjunctiva, with throbbing.” 19. Apoplexy of the retina. 
20. Alleviates the pains of glaucoma. 
21. “Removes deep-seated and obstinate haemorrhages into the eye.” 
22. “Dimness of vision from congestive headaches.” 23. “ Dilated pupils.” 
24. “ Sparks before the eyes.” 25. “ Halo around the flame, red predomin- 
ating.” 
26. Blindness after the suppression of rashes. 27. Blindness following severe 
congestive headaches after scarlet fever. Dr. C. H. VILAS’ 
EYE NOTES. 
' " . " ■ ■ . 
Entered According to Act of Congress in the year 1878, by 
C. H. VILAS, M.D., 
In the Office of the Librarian of Congress, at Washington. ACONITUM NAP. I. Inflammations which are very painful, with dryness, 
heat and burning. 2. “ Lids swollen, red and hard.” 3. The conjunctiva 
is intensely hyperaemic and chemosed. 4. Inflammatory conditions resulting 
from the irritation of foreign bodies. 5. Hyperaemia of the conjunctiva. 
6. Chemosis of the conjunctiva. 7. Violent acute inflammation of the deep 
structures of the eye-ball. 8. Ophthalmitis. 9. “ Eye-ball very sensitive to the 
touch.” 10. “ Intense burning heat in the eye-ball.” 
11. “ The eye-balls feel enlarged, as if coming out.” 12. “Vision as through 
a veil.” 13. “ Eyes dull, encircled by blue rings.” 14. Inflammation causes so 
much pain and fright that death is desired. 15. “ Slight irritation of the edges 
of the lids.” 
16. “Sensation as if the whole eye-ball would be pressed into the orbit.” 
17. Inflammatory symptoms, high strong pulse. 18. Acute aggravations of 
chronic troubles. 19. Ulcers of the cornea from traumatic causes. 
AGARICUS. 1. “ Twitchings of the lids.” 2. “ Twitchings of the ball, often 
very painful.” 3. “ Biting, itching and jerking above the brow.” 4. “ Sore- 
ness of the balls, with itching and twitching of the lids.” 5- “ Spasms of 
the ciliary muscle.” 
ALLIUM CEPA. 1. “ Excessive lachrymation.” 2. “Lachrymation with cory- 
za.” 3. “ Sensation as of something under the lids, which causes a gush of 
tears to wipe it out.” 
ALUMINA. 1. “Burning dryness in the eyes.” 2. Absence of lachrymation 
marked. 3. “ Chronic granular conjunctivitis.” 4. Paralysis of internal recti 
muscles. 5. “Burning in the lids,” and “absence of lachrymationare char- 
acteristics. 
6. Upper lids weak, and hang down as if paralyzed. 7. Cilia fall out easily. 
8. Pimples in the lids. 9. Sense of lameness in the upper lids. 10. Squinting 
of the eyes. 
AMYL NIT. 1. “Exophthalmic goitre.” 
APIS MEL. 1. “Lids much swollen, red and oedematous.” 2. “Swelling 
about the eyes.” 3. “ Burning, stinging and sensation of swelling around the 
eyes, and in the superciliary ridge.” 4. “Smarting and sensation of burning 
in the eyes, with bright redness of conjunctiva; very sensitive to light.” 
5. “ Burning in the margin of the lids, causing lachrymation.” 
6. “Eyes water and are painful when looking at anything light.” 7. “Upper 
lid swollen, hangs like a sack over the eye.” 8. “ Lachrymation profuse and 
hot, but not excoriating.” 9. “Absence of thirst very marked.” 
ARGENTUM NITRICUM. 1. “Conjunctivitis, abating in the cool and open 
air, intolerable in warm room.” 2. “ Infra-orbital neuralgia.” 3. “ Boring 
above the left eye.” 4. “ Canthi red as blood.” 5. “ Caruncula lachrymalis 
swollen.” 
6. “ Clusters of intensely red vessels extend from the inner canthus to the 
cornea.” 7. “ Increased secretion of tears.” 8. “ Itching of canthi.” 9 “The 
eyes are filled with mucus.” 10. “ Mucus in the eyes, drying upon the lashes 
and forming scurfs.” 
II. Conjunctiva of balls and lids as red as blood. 12. “ Bodies in the shape 
of serpents before the vision.” 13. “ Profuse muco-purulent discharge from the 
eye.” 14. “ Heat and pain in the ball.” 
ARNICA. 1. “ Haemorrhage and ecchymosis from blows, wounds, etc.” 2. “Sub- 
conjunctival ecchymosis.” 3. “ Dryness of margin of upper eyelids; sore and 
painful when moved.” 4. “ Retinal haemorrhages.” 5. Obscure troubles 
caused by injuries. Dr. C. H. VILAS’ 
EYE NOTES. 
tgSBgg 
Misessew 
Entered According to Act of Congress in the year r878, by 
C. H. VILAS, M.D., 
In the Office of the Librarian of Congress, at Washington. Synonym : Arthritic Ophthalmia. 
Divisions : Acute and Chronic. 
GLAUCOMA. 
CAUSES. Somewhat obscure: often caused by mental emotions, as prolonged 
grief, etc. Hereditary. Neuralgia of fifth nerve. Irritations of the ciliary nerves. 
Retinal hsemorrhage. 
SYMPTOMS. The symptoms of acute glaucoma are those of intense acute in- 
flammation. Generally preceded by what are known as prodromal symptoms as 
below, but greatly intensified; then bursts forth with addition of severe head- 
aches and terrible ciliary neuralgia; cloudiness of the aqueous and vitreous 
humors; dilitation and sluggishness of the pupil, which perhaps is filled with a 
greenish reflex; photophobia, lachrymation, and conjunctival congestion; often 
fever and vomiting; cornea clouded, iris jammed against it, the anterior cham- 
ber being obliterated ; tension increased until the eye may become as hard as 
stone : marked changes in the fundus, but generally not to be seen owing to 
condition of the refractive media. They are pulsation of the arteries; swollen, 
beaded appearance of the veins; slight retinal haemorrhages; peculiar cupping 
of optic disc. 
Chronic glaucoma (synonym, simple glaucoma), on the other hand is an insid- 
ious disease, stealing on unawares often. The prodromal symptoms are mild 
usually, and often needlessly overlooked, and disease steals on, to become 
hopelessly incurable, or burst into acute form. Its symptoms are increase of 
tension; mild hyperaemia and inflammation; the peculiar excavation of the 
optic nerve; and decrease of vision, with narrowing of visual field. Both 
forms, particularly the acute, are often mistaken for other diseases, as bilious 
fever, brain troubles, etc. 
Confirmed glaucoma (synonym, glaucoma absolutum), renders the globe hard 
as stone, pupil dilated, lens opaque, cornea dull and insensitive, anterior cham- 
ber shadow. 
Prodromal symptoms are rapid increase of any existing presbyopia; colored 
rings around a light; intermittent obscurations of sight; ciliary neuralgia; silght 
variable increase of intra-ocular tension; narrowing of visual field and dim- 
ness of vision. 
NOTE. Glau coma is one of the most dangerous and least generally understood dis- 
eases of the eye. Badly or neglectfully treated, results in certain blindness. 
Hypermetropic eyes most liable to it, generally attacking one and extending to 
the other. Intervals, or periods of remission may be days or years. When rapid, 
destroying sight in a few hours, or even in less time, it is called glaucoma ful- 
viinans (lightning glaucoma); when following ordinary inflammation or injuries 
of the eye, secondary glaucoma. Both eyes are usually affected, often first one 
and then the other. Females at and beyond the change of life are notably sus- 
ceptible. The cupping of the optic disc is peculiar and not easily confounded 
with either the physiological or atrophic cupping. Rapidly advancing presby- 
opia is suspicious. Treatment requires good judgment and experience. Rem- 
edies are often of great aid associated with proper local treatment. 
LOCAL TREATMENT. Paracentesis or iridectomy, according to severity 
and nature of attack. Until recently, great stress has been laid on the necessity 
for a broad iridectomy quite up to the ciliary margin, and explicit directions 
given for performing the same. Experienced judgment is the best guide as to 
the kind of iridectomy needed. If performed early, good results almost certain; 
tardy hesitating treatment generally punished with loss of vision. In early stages 
paracentesis properly performed, with proper remedies, is frequently all-sufficient. 
With caution, atropine, which see. 
GENERAL TREATMENT all important. See Principles of Ophthalmic 
Surgery. 
REMEDIES. Aconite, Belladonna, Bryonia alb., Colocynth, Cypripedin, Macro- 
tin, Mercurius, Prunus spin., Spigelia. Dr. C. H. VILAS’ 
EYE NOTES. 
a cAa ,5_ 
Entered According to Act of Congress in the year 1878, by 
C. H. VILAS, M.D., 
In the Office of the Librarian of Congress, at Washington. IRIDO-CYCLITIS. 
CHIEF CAUSES. Often primarily, cyclitis, but generally springs up in con- 
nection with iritis, or with choroiditis. Frequently arises from injuries, such as 
wounds in the ciliary region, dislocated lens, or foreign body in the eye. May 
also be sympathetic from the other eye. 
SYMPTOMS. Great tenderness on pressure over the ciliary region, with pain, is 
the main diagnostic symptom. This is not present in iritis. Accompanied by tur- 
bidity of the vitreous and aqueous humors; loss of accommodation; photophobia 
and lachrymation; impairment of vision; zone of vessels around the cornea; 
increase of tension. 
NOTE. Irido-cyclitis is an extremely dangerous and insidious disease. Often steals 
on quietly without subjective warning, and hence unnoticed until beyond hope. It 
often much resembles iritis, and is in consequence overlooked. An exudation is 
poured out which may be either serous, plastic or purulent. Either or both of 
the last two are the most destructive. Eye becomes hopelessly glued together or 
totally breaks down. When this condition is brought about by sympathetic 
ciliary nervous irritation from an injured companion eye, it is called “ sympa- 
thetic irido-cyclitis,” or “ sympathetic ophthalmia.” May come on immediately 
or after the lapse of years. Do not confound sympathetic irritation with sympa- 
thetic irido-cyclitis. The former may be present and quiet down, the latter 
extremely seldom if ever. The symptoms of sympathetic irritation are irritation 
and slight injection of the eye; neuralgic pain; slight photophobia and lachry- 
mation ; eye quickly fatigues at near or fine work. These may occur frequently 
and pass off with no organic lesions remaining. 
LOCAL TREATMENT. When primary, complete rest, protection, cold, heat, 
atropine, and remedies seemingly indicated may be tried, a careful watch being 
kept on companion eye for first symptoms of irritation. When sympathetic, the 
injured eye must be removed at once. There is danger and often a very great, 
but not necessarily destructive, risk of sympathetic ophthalmia taken, in not enu- 
cleating an eye seriously injured by disease or wound; but so long as there is 
sight in the injured eye, and no sympathetic irritation in the companion eye, it 
may be watched and allowed to remain. 
GENERAL TREATMENT. Good food and hygienic arrangements are all 
important. 
PUSTULAR KERATITIS. 
Synonyms: Herpes Ophthalmicus; Phlyctenular Keratitis. 
CHARACTERIZED by circumscribed inflammatory nodules in the superficial 
layers of the cornea, most often at the margin, singly or in groups. 
CHIEF CAUSES. Particularly associated with the weak, nervous and badly- 
nourished. Often epidemic. Seen in connection with the eruptions of herpes, 
eczema, etc., in the course of trifacial nerve. Irritations of ciliary nerves through 
the trifacial, or direct. Often associated with nasal catarrh. 
NOTE. Vesicles form on these nodules and burst, forming ulcers; or they may 
result directly from loss of tissue on the nodules. Photophobia and pain gen- 
erally very marked, former seemingly out of all proportion to the inflammation. 
Often combined with pustular conjunctivitis. Secretions from the eye acrid, 
irritating and burning the parts in contact. Disease apt to recur. 
LOCAL TREATMENT. Protective bandage and atropine. Proper and ju- 
dicious use of the finest powdered calomel, carefully dusted on, is often of the 
highest advantage. Absolute cleanliness of the lids and eye. 
REMEDIES. See Suppurative Keratitis. Dr. C. H. VILAS’ 
EYE NOTES. 
;J>ISE1SeK 
Entered According to Act of Congress in the year 1878, by 
C. H. VILAS, M.D., 
In the Office of the Librarian of Congress, at Washington. CATARRHAL CONJUNCTIVITIS. 
Synonym : Catarrhal Ophthalmia. 
CHIEF CAUSES. Exposure; the exanthematous diseases; injuries; bad 
hygiene ; consequent on other inflammations ; ametropia; foreign bodies ; con- 
tagion. Preceded by hypercemia. 
SYMPTOMS. Sensation of sand in the eye; smarting, itching and lachrymation ; 
increased vascularity; chemosis; sticking together of the lids, especially after 
sleeping; mucous or muco-purulent discharge, the latter collecting in, and 
known by, whitish flakes containing albumen, mucous and epithelial ceils. Lids 
grow red, swell and become stiff. Often numerous small haemorrhagic spots. 
NOTE. The classification of conjunctivitis is arbitrary: one form may run into 
another. All are infectious and contagious : the discharge from one form may 
produce its own kind, or that of another. May be endemic or epidemic. 
Caution.—Use extreme care as to cleanliness, isolation of all towels, basins, etc. 
LOCAL TREATMENT. Extreme cleanliness always. Cold applications in 
primary stages, with protection. Mild astringent lotions when necessary. Cor- 
neal and iritic complications may require atropine. 
CENERAL TREATMENT and constitutional must not be neglected. 
REMEDIES. Allium cepa, Apis mel., Argentum nit., Arsenicum, Belladonna, 
Euphrasia, Graphites, Hepar sulph., Merc sol., Nux vom., Pulsatilla, Rhus tox., 
Sulphur. 
PURULENT CONJUNCTIVITIS. 
Synonyms; Blenorrhcea; Military or Egyptian Ophthalmia. 
Varieties: Gonorrhoeal Conjunctivitis; Ophthalmia Neonatorum. 
CHIEF CAUSES. Same as catarrhal variety. 
SYMPTOMS. Same as catarrhal, but greatly intensified. Discharge purulent, 
thick and highly contagious. Often great chemosis. 
NOTE. The classification is arbitrary. Read carefully Note under catarrhal va- 
riety. Great danger of cornea becoming involved, causing ulceration, sloughing 
and not infrequently loss of the eye. Study the corneal dangers and their treat- 
ment. Gonorrhoeal conjunctivitis is usually very severe and shows great 
tendency to constitutional symptoms, which often are extremely severe. Oph- 
thalmia neonatorum may be very mild or very severe. 
LOCAL TREATMENT. No disease requires greater judgment or more careful 
diagnosis in this matter. Extreme cleanliness always. When discharge has not 
set in, conjunctiva being tense, hot and dry, use soothing applications, such as 
atropine, and feel the way carefully. When discharge is fully established, an 
astringent lotion every few hours; or it may be necessary to paint inner surface 
of lids once or twice daily with a strong solution of silver nitrate (which see) 
or other similar remedy. If cornea becomes cloudy, atropine must be used. 
Canthoplasty, if lids press too closely on the globe. Seal up the non-affected 
eye, if necessary; in any event use the greatest caution that the disease be not 
communicated to it. Cool, or even iced, applications may be demanded in 
severe cases. 
CENERAL TREATMENT. This disease often greatly drains the system; 
gonorrhoeal variety particularly so. Keep strength up. Disinfect the room. 
REMEDIES. Aconite, Apis mel., Argentum nit., Calcarea carb., Chamomilla, 
Hepar sulph., Mercurius, Nitric acid, Pulsatilla, Rhus tox. Dr. C. H. VILAS’ 
EYE NOTES. 
Entered According to Act of Congress in the year 1878, by 
C. H. VILAS, M.D., 
In the Office of the Librarian of Congress, at Washington. KERATITIS. 
Synonyms: Corneitis; Inflammation of the Cornea. 
CHIEF CAUSES. Inflammation of adjacent parts; bad nutrition; constitutional 
disease; injuries; exposure. 
SYMPTOMS more or less attendant on all varieties: 
1. Ciliary irritation. 
2. Rosy zone of vessels around corneal margin, with conjunctival congestion. 
3. Contraction of pupil. 
4. Pain. 
5. Photophobia and lachrymation. 
6. Impaired vision. 
Classification arbitrary, but for convenience divided into 
1. Vascular. 
2. Pustular, (synonyms: phlyctenular; herpes of the cornea). 
3. Suppurative. 
4. Interstitial, (synonyms: parenchymatous; diffuse). 
NOTE. Keratitis may involve whole or part of the cornea, and is named according 
to the predominant kind of inflammation present. 
Opacities are frequently result of keratitis. Are superficial and deep; former 
affecting epithelium—generally curable ; latter affecting parenchyma—seldom 
curable. Faint superficial opacity called a neubla—sometimes a macula when 
more like a spot; deeper, denser one, a leucoma, but when combined with pro- 
lapse and adhesion of iris, a leucoma adherens. 
Caution.—Use no nitrate of silver or other irritants or preparations of lead in 
acute keratitis. 
Opacity may be so situated as to be no hindrance to vision, or may 
shut out vision wholly or in part. May cause cross-eye, nystagmus, etc. If 
unsightly, may be stained with india-ink, but operation dangerous, unless 
thoroughly conversant with eye diseases. Cloudiness of cornea may be due to 
glaucoma, serous iritis, irido-choroiditis, or other disease, cornea being second- 
arily implicated, and real cause overlooked. A common error, involving loss of 
sight in many cases. 
Cornea becomes turbid, swollen and thinned; may burst and contents pro- 
lapse, forming a staphyloma. Corneal curvature thus becomes astigmatic, and 
vision damaged or destroyed. Hence the caution to prevent intra-ocular pressure 
by bandage or iridectomy. 
A staphyloma may necessitate the removal of the eye, for fear of sympathetic 
ophthalmia of the companion eye. Some prefer to excise the anterior portion 
of the globe, evacuate the contents, and bringing together the remnants form a 
good stump for the wearing of an artificial eye. This latter operation, however, 
is not free from the danger of sympathetic trouble, and may cause it. 
Old chronic indolent ulcers, showing little disposition to heal, may sometimes 
be advantageously gently touched with weak silver nitrate to stimulate them. 
Superficial opacities will generally get well independently of remedial aid, but 
are accelerated by the proper remedy. Local irritants judiciously used will also 
hasten the tissue changes, but must be cautiously used, if at all. 
PANNUS is a superficial non-inflammatory vascular opacity of the cornea. Term 
often applied to acute and chronic vascular keratitis, new tissue still being in 
process of formation. Disease tedious in its course, complete cure seldom. 
Caused by granular conjunctivitis, inverted lashes or other irritating substances. 
Requires thorough knowledge and careful study to cure. Canthoplasty often ad- 
visable. Hot and cold applications, syndectomy and remedies should be care- 
fully studied and tried previous to any of the severer means. Inoculation of pur- 
lent matter is a final resort. This artificial disease is then allowed to run its 
course unchecked, and not unfrequently is followed by the most brilliant results. Dr. C. H. VILAS’ 
EYE NOTES. 
2 
Entered according to Act of Congress in the year 1878, by 
C. H. VILAS, M.D., 
In the Office of the Librarian of Congress, at Washington. 
These Eye Notes were prepared to assist in the study, and form the basis of the 
didactic lectures on the embraced subjects as given by the author at the Hahnemann 
Medical College and Hospital, Chicago. They are necessarily concise, condensed 
and elementary in their character, and are in no sense designed to take the place of, 
or in any way supersede the treatises on the subjects, but are intended to suggest the 
topics to be further studied, to pick out of the mass of writings the essential funda- 
mental pinciples and main diagnostic points, and to suggest the line of treatment. 
Their cordial reception, not only by students, but by practitioners, has seemed to be 
sufficient reason for a publication more general than was originally intended. 
The attempts to prepare an abbreviated materia medica must be always attended 
with hazard, and will doubtless be found incomplete. Additions of new remedies 
and well-authenticated symptoms will be made from time to time, and the whole 
enlarged and improved, may form the basis for a more pretentious work at some 
future time. But it is not to be expected that any one will always prescribe on local 
symptoms alone, but be guided by a more thorough knowledge of the remedies other- 
wise obtained. For their peculiar wording, the author is often alone respons- 
ible; but not only in them, but in the preparation of the diseases, all works accessible 
have been freely used. It is hoped this statement will serve as a full and courteous 
acknowledgement of the great assistance necessarily derived from many excellent, 
publications. Dr. C. H. VILAS’ 
EYE NOTES. 
' jP , * 
Entered According to Act of Congress in the year 1878, by 
C. H. VILAS, M.D., 
In the Office of the Librarian of Congress, at Washington. STRYCHNIA. I. Atrophy of the optic nerve. 2. Twitchings of the lids. 
3. Twitchings of the ball. 4. Spasms of the muscles. 5. Paralysis of external 
rectus. 
6. Dilatation of the pupil from spinal irritation. 
SULPHUR. 1. Pustular Keratitis. 2. Pustular conjunctivitis. 3 Troubles due 
to scrofula or blood-taint. 4. Pains are like pins sticking in the eye. 5. “ Pains 
like a glass splinter in the eye.” 
6. Eye complaints from suppressed eruptions. 7. Ulcers and abscesses of the 
cornea. 8. Pterygium. 9. “ Child dislikes to have its eyes washed or bathed.” 
10. Chronic cases complicated with other troubles. 
11. Hereditary complaints. 12. Synechise may yield under its use. 13. “Tears 
which feel greasy are secreted.” 14. “ Gaslights seen are surrounded by a 
halo.” 
THUJA OCCID. 1. “Warts on the lids.” 2. Condylomatous excrescences. 
3. Tarsal tumors. 4. “ Cures obstinate styes, when other remedies have failed.” 
5. “ Episcleritis.” 
6. Especially indicated in syphilitic iritis. 7. Syphilitic condylomata. 
ZINCUM MET. 1. “Pterygium, with great pressure across the root of the 
nose.” 2. “ Syphilitic iritis, with dull pain in the brows.” Dr. C. H. VILAS’ 
EYE NOTES 
Entered According to Act of Congress in the year 1878, by 
C. H. VILAS, M.D., 
In the Office of the Librarian of Congress, at Washington. PULSATILLA. i. In its selection bear in mind the general characteristics, “ mild, 
tearful,” etc. 2. Tarsal tumors. 3. Mucocele. 4. Inflammation of the mei- 
bomian and sebaceous glands. 5. Styes on the lids. 
6. Aborts styes when forming. 7. Specially adapted to inflammations of lach- 
rymal sac. 8. Discharges are generally profuse and bland. 9. Inflammation 
of cornea and conjunctiva, particularly superficial, when found on characteristic 
patient. 10. Eye diseases due to disordered digestion. 
11. “Eye-complaints consequent on faulty menstruation.” 12. “Conjunc- 
tivitis consequent on suppressed gonorrhoea.” 13. Eye diseases better in the 
open air. 
RHUS TOX. 1. Orbital cellulitis. 2. Great swelling of the lids, closing the 
eye. 3. Paralysis due to getting the feet wet, cold, etc. 4. Erysipelas of the 
lids. 5. “ Lids swollen, tightly closed, and looking as though varnished.” 
6. Pains worse at night and relieved by warm applications. 7. “ Suppurative 
inflammation of the uveal tract after cataract extraction.” 8. Ulcers and pus- 
tules of the cornea, accompanied by characteristic eruption on the face. 
9. Eye diseases resulting from exposure to cold, wet, etc. 10. Especially 
indicated in rheumatic subjects. 
11. “ Lids red, swollen, hot and oedematous, tears gushing out on opening 
them.” 12. Enlargement of meibomian glands, with falling out of the cilia. 
R U TA C RAV. 1. Highly recommended for asthenopia not due to anomalous 
refraction and accommodation. 2. “ Blurring of vision, letters seem to run to- 
gether.” 3. Aching in and over the eyes; eyes feel like balls of fire. 4. “Am- 
blyopia due to unknown causes.” 
SECALE. 1. “ Paralysis of the ciliary muscle.” 2. “ Paresis of the ciliary mus- 
cle.” 3. “Asthenopia due to weakness of the ciliary muscle.” 
SENEGA. 1. “ Promotes absorption of lens fragments after cataract operations.” 
2. Catarrhal conjunctivitis. 3. Weakness of the muscles. 
SEPIA. 1. Eye troubles dependent on uterine complaints. 2. Aggravation of 
symptoms in the morning and evening; better in the middle of the day. 3. Eye 
troubles associated with uterine diseases. 4. Hepatic troubles sometimes asso- 
ciated with eye complaints. 
SILICEA. 1. Especially indicated in diseases which linger with seemingly no 
reason. 2. Promotes tendency to absorption. 3. Especially indicated in mu- 
cocele. 4. “ Sensation of a splinter in the eye.” 5. Especially indicated in 
inflammation of the lachrymal sac. 
6. Dry scurf clings to the cilia. 7. “ Small round ulcers which have a ten- 
dency to perforate.” 8. Indolent, quiet ulcers with no marked symptoms. 
9. Ulcers which the patient has not noticed; no troublesome symptoms apparent. 
10. Valuable in removing superficial opacities from the cornea. 
SPIGELIA. 1. Ciliary neuralgia. 2. Ciliary neuralgia, particularly when the pains 
seem to start from the centre of the ball, radiate in different directions, with 
aggravation about 2 A. M. 3. “ Constant sticking pain in the ball.” 4. Pains 
sharp and sticking, as with a poniard. 5. “Unendurable pressive pain in the 
ball.” 
6. Pains of rheumatic and arthritic eye complaints. 7. Falling of the 
upper eye-lid. 8. Intolerable pain in the superciliary ridge. 9. Severe, press- 
ing, jerking pains in the eye. 10. “When moving the muscles of the face, sen- 
sation as if the skull would burst.” 
SPONGIA. 1. “ Exophthalmic goitre.” 
STAPHYSACRIA. 1. Styes on the lids. 2. Tumors of the lids. 3. “ Bursting 
pain in the eye-ball, temple and side of face, worse from evening to morning 
and upon using the eyes.” 4. “ Pains due to syphilis.” Dr. C. H. VILAS’ 
EYE NOTES. 
. . al| 
Entered According to Act of Congress in the year 1878, by 
C. H. VILAS, M.D., 
In the Office of the Librarian of Congress, at Washington. LYCOPODIUM. i. Arrests cataract due to dyspeptic troubles. 2. Of great 
value in eye troubles due to faulty digestion, such as styes, etc. 3. Optic nerve 
troubles are relieved. 4’. Highly recommended for night blindness. 
MACROTIN. 1. Highly recommended in hyperesthesia of the retina. 
MACNESIA CARB. 1. Recommended for the removal of cataract. 
MERCURIUS PERCIP. RUBER. 1. “Cornea superficially ulcerated with 
bright red vessels.” 2. Bright red swellings of the conjunctiva, with granula- 
tions. 3. Intense pannus with redness, photophobia and thick discharge. 
4. “ Eyes burn and are inflamed.” 
MERCURIUS SOL. 1. Long known as a remedy for iritis. 2. “ Sharp acrid 
discharges, making the cheek sore.” 3. Symptoms all aggravated from looking 
into a fire. 4. Worse at night, and by artificial light. 5. Eye diseases depend- 
ent on hereditary syphilis. 
6. Eye diseases caused by working over the fire, accompanied by hereditary 
taints. 7. “ Thin acrid discharges,” and “ worse at night” are characteristics. 
8. Excoriations of the nostrils, night sweats, etc., frequently accompany eye 
troubles. 
MERCURIUS COR. 1. Long known as a great absorbent. 2. Serous exuda- 
tions are absorbed. 3. Diseases of the uveal tract are well met. 4. Often works 
when other preparations of mercury will not. 5. Particularly valuable in syph- 
ilitic troubles. 
6. Has characteristics of mere. sol. 7. “ Retinitis albuminurica.” 8. “Ker- 
ato-iritis.” 9. “ Blepharitis, with swollen lids, red, excoriated by acrid lachry- 
mation.” 10. Iritis, especially when dependent on syphilis. 
11. Eye complaints associated with enlarged glands. 
MERCURIUS PROT. 1. Diphtheritic conjunctivitis. 2. Ey.e-complaints ac- 
companied by a thick, yellow coating at the base of the tongue. 
NATRUM MURIATICUM. 1. Useful after the abuse of caustics. 2. “Mus- 
cular asthenopia, with drawing stiff sensation in the muscles of the eyes upon 
moving them.” 3. “ Entropion from abuse of caustics.” 4. Itching of the 
inner canthus. 5. Irritability of the margins of the lids, with redness. 
6. Catarrhal affections of the lids. 
NITRIC ACID. 1. Especially useful after the abuse of mercury. 2. Diseases 
of the eye due to syphilis. 3. “ Scrofulous ophthalmia.” 4. “ Gonorrhoeal 
ophthalmia.” 5. “ Eyelids swollen, hard and livid, with a copious yellow dis- 
charge running down the cheeks.” 
NUX VOMICA. 1. Atrophy of the optic nerve. 2. “ Blurring of sight from 
over-heating.” 3. “ Useful where patient has been much drugged previous to 
eye attacks.” 4. Often indicated from over-drugging in old-school practice. 
5. Eye troubles, especially amblyopia, caused by the abuse of stimulants. 
6. Ciliary blepharitis, with morning aggravation. 7. Nervous irritations. 
8. Specially adapted to the colored race. 9. Retinal hyperaesthesia. 
PHOSPHORUS. 1. Amaurosis, paralysis or paresis of muscles due to sexual 
excesses. 2. Dimness of vision due to sexual weakness. 3. Muscular asthen- 
opia. 4. Diseases of retina and choroid. 5. “Photopsias and chromopsias of 
various forms and colors.” 
PHYSOSTICMA VENENOSUM. 1. Twitching of the lids. 2. “ Irritation 
of the fundus of the eye due to myopia.” 3. Irritation of the fundus of the 
eye due to posterior staphyloma. 4. Spasm of the accommodation. 
PRUNUS SPINOSA. 1. Ciliary neuralgia, pains not well marked. 2. Sharp 
piercing pains, sometimes commencing behind the ears, and shooting forward 
toward the eye. 3. Pain as if the ball were wrenched or crushed. 4. Arrests 
deep-seated inflammation of sclera and choroid. Dr. C. H. VILAS’ 
EYE NOTES 
Entered According to Act of Congress in the year 1878, by 
C. H. VILAS, M.D., 
I11 the Office of the Librarian of Congress, at Washington. HEPAR SULPHUR, i. Ulcerations of the cornea. 2. Sloughing of the cor- 
nea. 3. Absorbs pus in the anterior chamber. 4. Obscuration of vision while 
reading. 5. “Acute phlegmonous inflammation of the lids, with tendency to sup- 
puration.” 
6. Suppurative keratitis. 7. “ Pains are aggravated by cold and relieved 
by warmth.” 8. Lids very sensitive to touch, with throbbing, achir%, stinging 
pain. 9. Great tendency to suppuration. 10. “ Redness and swelling of upper 
lid, with pain.” 
11. Abscesses of the lids. 12. Abscesses of the cornea. 13. Mucocele. 
14. Orbital cellulitis after suppuration has set in. 15. Pustular conjunctivitis of 
strumous origin. 
16. “ Eczema of the lids, large heavy scabs form after sleeping.” 17. Lids 
swollen, spasmodically closed and very sensitive to the touch. 18. Ulcerations 
of external parts of the eye, which bleed easily and are very sensitive to the 
touch. 19. Photophobia is usually a prominent symptom. 20. “Lids red, swol- 
len and bleed easily on opening.” 
21. “ Boring pain in roof of orbits.” 22. The lids are stuck together in the 
morning. 23. Pressive pain in the eyes and through the head. 
HYDRASTIS CAN. 1. Lids completely stuck together. 2. Burning sensation 
in lachrymal duct. 
HYOSCYAMUS NICER. 1. Distortion of the eyes; squinting. 2. Small 
objects seem very large. 3. It seems as though a veil were before the eyes. 
4. “ Deceptive vision, the flame of the light seems smaller, that of another 
larger; though both are of equal size.” 5. Extreme dilatation of the pupils, 
which are insensible to the light. 
ICNATIA AMARA. 1. “ Zig-zag and serpentine flickering white light at one 
side of the field of vision.” 2. “ In the evening on reading, it seems dim before 
the eye, as from tears to wipe away, but there are none.” 3. Glaucomatous 
neuroses dependent on grief. 4. Emotional eye diseases. 5. “ The blue veins 
in the upper lid are often a good guide.” 
KALI BICHROMICUM. 1. “Ulcers and pustules on the cornea, with sur- 
rounding indolent inflammation.” 2. The corneal troubles are dormant, pre- 
senting little or no redness or photophobia. 3. Secretions are of a stringy char- 
acter. 4. Inflammations, with yellow discharge and morning agglutination. 
5. Violent shooting pains from the root of the nose along the left orbital arch to 
the external angle of the eye. 
6. Opacities of the cornea. 
KALI JOD. 1. Pustules on the conjunctiva. 2. Pustules on the cornea. 3. Clears 
up corneal opacities. 4. Syphilitic iritis after the use or abuse of mercury. 
5. Paralysis of muscles dependent on syphilis. 
6. Obscure troubles of the eye dependent on syphilis. 7. Internal eye in 
flammation consequent on syphilis. 8. Long known as an important remedy in 
choroiditis, and acute or chronic irido-choroiditis. 9. “Vision dim and foggy.” 
LACHESIS. 1. “ Retinitis apoplectica.” 2. “ Hastens absorption of blood into the 
retina.” 3. “ Much black flickering before the eyes.” 4. Stitches as from 
knives in the eye, coming from the head. 5. “ Inflammations of the eye, with 
raging, dull, stitching, tearing, jerking pains in the teeth, extending through the 
upper jaw to the ear.” 
6. Terrible pains in the eye, with sharp pains in the teeth and upper jaw, the 
patient complaining of suffocative feelings. 7. Pains rapidly change from the 
eye to other parts of the body and back again. 8. Scrofulous keratitis, worse 
in the morning and after sleeping. 9. Eye complaints worse after sleeping. 
LILIUM TIC. 1. Weakness of ciliary muscle. 2. “Weak vision due to anom- 
alous accommodation and refraction.” 3. Increase of hypermetropia, 
4. “Asthenopia due to ametropia.” Dr. C. EE VILAS’ 
EYE NOTES 
* " ' * • ' t •’ 
Entered According to Act of Congress in the year 1878, by 
C. H. VILAS, M.D., 
In the Office of the Librarian of Congress, at Washington. GRANULAR CONJUNCTIVITIS. 
Synonyms: Trachoma; Granular Lids; Ophthalmia Granulosa. 
CHIEF CAUSES. Catarrhal and Purulent Conjunctivitis. Filth, impure air, 
and defective hygiene generally. Contagion. 
SYMPTOMS. Locally this trouble is characterized by hypersemia, swelling, and 
a peculiar roughness of the palpebral conjunctiva. These changes may be 
noticed as diffuse, vascular excrescences in the conjunctival tissue, resembling 
roundish granules; or as hypertrophied papillae. Former called “ granular trach- 
oma latter, “papillary trachoma;” occurring together, as they most often do, 
“ mixed trachoma.” There may be a discharge, at first thin and watery, grad- 
ually becoming thicker and of a muco-purulent character; or the disease may 
steal on so insidiously as to be established before really suspected. In latter 
case patient generally previously complains of the lids sticking together in the 
morning, with some roughness. When either acute, or established, the eyes 
are very irritable, accompanied by a sensation of sand, especially under the 
upper lid, and they become red and watery on attempting to use them. After a 
short time the lids become puffy, more or less flabby, and limp. 
Nearly always, however, general complaints accompany, or have originated 
this trouble. Particularly associated with the badly nourished ; with high free 
livers, who crowd their stomachs, drink hot, stimulating drinks, remain in smoky 
rooms, or heated, close atmosphere, and take insufficient exercise. 
All symptoms vary greatly in severity according to the nature of the attack. 
NOTE. Granular conjunctivitis is contagious : often highly so. Caution—Isolate 
all towels, utensils, etc. Shows great tendency to relapses, acute exacerbations 
being common. Often complicated with other diseases. The greatest Ganger 
lies in the injury to the cornea. The rough, sand-paper-like lids irritate the 
cornea, promoting vascularity and pannus, or it may ulcerate. Conjunctiva may 
become chronically dry (xerophthalmia), lids be drawn inwards at the margin 
(entropion), lashes turn in (trichiasis), or lid or lids become firmly adherent to 
the globe (symblepharon). Either of the latter more likely to be the result of 
injudicious treatment, however. Mind apt to partake of the bodily weakness in 
old advanced cases, and patient become addicted to lazy, indolent habits. 
LOCAL TREATMENT is all important. Injudiciously done, it does harm 
rather than good. In severe cases astringents are necessary, caustics seldom 
are. Primary cases and exacerbations are better met by remedies. Ice-bags in 
severe, acute attacks, or exacerbations of old chronic ones are highly recom- 
mended. Crayon of copper sulphate is to be used only by the most experienced, 
if at all. Tannic acid, six to ten grains, and glycerine, one ounce, also highly 
recommended. Silver nitrate, which see, properly used, is the most reliable 
irritant, however. 
CENERAL TREATMENT. Removal of all exciting causes; cold-water 
general bathing, with friction; good food, air, and exercise, and healthy, useful 
employment are all essential. 
REMEDIES. Aconite, Alumina, Argentum nit., Arsenicum alb., Aurum, Bella- 
donna, Euphrasia, Mercurius, Natrum mur., Nux vomica, Pulsatilla, Sulphur. 
PUSTULAR CONJUNCTIVITIS. 
Synonyms : Herpes Ophthalmicus; Phlyctenular Conjunctivitis. 
CHARACTERIZED by small, yellowish-red nodules on the conjunctiva ; often 
associated with, and in many respects similar to, pustular keratitis, which see. 
TREATMENT. Same as indicated under Pustular Keratitis. 
REMEDIES. See Suppurative Keratitis. Dr. C. H. VILAS’ 
EYE NOTES. 
Disease^ 
Entered According to Act of Congress in the year 1878, by 
C. H. VILAS, M.D., 
In the Office of the Librarian of Congress, at Washington. SUPPURATIVE KERATITIS. 
CHARACTERIZED by the inflammatory infiltration becoming changed into 
pus, and appearing as a yellow opacity in the corneal tissue. It may be lim- 
ited, or the entire cornea become a yellow necrosed mass. 
CHIEF CAUSES are the same as in the other forms. Corneal incisions in the 
old or feeble. Often following in corneal cataract operations, especially when the 
cornea has been bruised. Severe forms of conjunctivitis. Paralysis of fifth 
pair of nerves, rendering cornea anaesthetic, and retarding nutrition. 
NOTE. An abscess is suppuration enclosed by corneal tissue; an ulcer is formed 
by an abscess opening. Ulcers also occur superficially without previous abscess, 
and vary in form, size and depth. Keratocele (hernia of the cornea) is formed 
by ulcer penetrating to third lamina (Descemet’s membrane) of the cornea, when 
latter bulges forward filled with aqueous humor from intra-ocular pressure, and 
generally perforates. 
When pus sinks between the plates of the cornea, it is called onyx (or 
unguis); when found in the anterior chamber, hypopion. Both may exist at 
same time. May absorb, or require to be evacuated. 
Ulcers may close up, leaving only slight superficial opacities or no result of 
inflammation, or may burst through suddenly carrying with the rush of humor 
the iris, which becoming entangled in the wound in the process of healing forms 
an anterior synechia; or if opening be large, iris may bulge through and adher- 
ing around its margin form a staphyloma. Either of these accidents, and 
especially the last, are dangerous in that they may lead up to sympathetic irido- 
cyclitis, which see. The relation of the parts becomes greatly changed also, 
even though temporarily, in these accidents; and when, if such happens, they 
return to their positions, they may be greatly damaged. Anterior lens capsule 
may be cataractous. 
When the suppuration be attended with little or no irritation and no vessels, it 
is especially dangerous, the cornea rapidly dying. Prognosis more or less favor- 
able, according as ulcer is superficial or deep-seated. 
LOCAL TREATMENT. In beginning atropine and rest. Later, and not too 
late, reduce the intra-ocular tension by paracentesis or iridectomy. Large 
ulcers should not be allowed to burst, but paracentesis be performed through 
their base. Pus need not be evacuated except in hypopion, seldom then. Rem- 
edies will control these troubles. Saemische’s operation. Protective bandage in 
the neuro-paralytic form. 
CENERAL TREATMENT is all-important. Disease produces great drain 
on the system. Careful diet and all tonic influences. 
REMEDIES. Aconite, Apis mel., Argentum nit., Arnica, Arsenicum alb., Aurum 
met., Calcarea carb., China, Conium mac., Euphrasia, Graphites, Ilepar sulph., 
Kali bichrom., Merc, sol., Merc, clulc., Merc, prot., Natrum mur., Nux vom., 
Rhus tox., Silicea, Sulphur. 
VASCULAR KERATITIS. 
CHARACTERIZED bv gray opacity of, and development of vessels on the 
roughened surface of the cornea. 
NOTE. The loss of the epithelium, which may ensue, causes great pain from the 
exposure of the nerves. 
LOCAL TREATMENT. Protection and rest of eyes, and atropine. Perhaps 
cold applications. Canthoplasty sometimes necessary. 
REMEDIES. See Suppurative Keratitis. Dr. C. H. VILAS’ 
EYE NOTES. 
Entered According to Act of Congress in the year 1878, by 
C. H. VILAS, M.D., 
In the Office of the Librarian of Congress, at Washington. INTERSTITIAL KERATITIS. 
Synonyms : Diffuse Keratitis. Parenchymatous Keratitis. 
CHARACTERIZED by moderate infiltration of the cornea with an opaque 
grayish or yellowish-white product, generally beginning at the margin and ad- 
vancing toward the centre, causing swelling and diffuse cloudiness. Infiltration 
shows little inclination to break down, and usually collects in extensive, cloudy 
and distinctly-marked spots. These opacities may vary all the way from slight 
diffuse cloudiness to density, the cornea then looking like ground glass. 
NOTE. The surface may, but usually does not, retain its smooth appearance. 
Epithelium generally lost, vessels appearing on the surface. Often found with 
hereditary syphilis, when there are also present the peculiar notched teeth, upper 
central incisors, permanent set, and the peculiar physiognomy. Disease apt to be 
very tedious, but may recover. Cornea in rare cases is so covered with vessels 
as to look red, like an extravasation of blood. 
LOCAL TREATMENT. Atropine at times does well, other times seems to 
injure; much benefit often from daturine, when atropine does not do well. Pro- 
tection and rest of eyes. 
REMEDIES. See Suppurative Keratitis. 
DIPHTHERITIC CONJUNCTIVITIS. 
CHIEF CAUSES. Occurs in course of diphtheria, and results from same causes 
as do the other forms. 
SYMPTOMS. A yellow, tough and firm product of inflammation, collects in the 
tissue of the conjunctiva and on its surface, from which it may often be torn off- 
like a thick lining of the lids. There are usually the symptoms of intense in- 
flammation in the first stages, with great tenderness to the touch, the lids being 
hardened by fibrinous infiltration. Symptoms vary much in nature according to 
the severity of the case, but generally are severe at first; the lids grow soft as 
the disease advances, and pus supervenes. 
NOTE. This disease is extremely rare in the United States. Lids are often rigid 
and seemingly fibrinous in the other varieties, and errors in diagnosis made. 
Found mainly on the Continent. Cornea apt to suffer severely, and the lids to 
become cicatrized. Constitutional symptoms usually marked. 
TREATMENT. The treatment is not very satisfactory. Locally ice compresses 
in first stages, and the treatment of purulent conjunctivitis when pus sets in. 
Support the strength. 
PTERYGIUM. 
CHIEF CAUSES. Exposure to hot winds, to the winds of the sea, of the prai- 
ries, etc. Chronic inflammations. 
SYMPTOMS. A triangular vascular ridge of hypertrophied conjunctival and sub- 
conjunctival tissue, usually on the nasal side of the eye, base towards the can- 
thus, apex adjacent to, or more or less on the cornea. 
LOCAL TREATMENT. If remedies are unavailing and it persistently en- 
croaches on the cornea, excision, ligation or transplantation. 
REMEDIES. Argentum nit., Arsenicum alb., Calc, carb., Sulphur, Zincum. Dr. C. H. VILAS’ 
EYE NOTES 
i^H 
Entered According to Act of Congress in the year 1878, by 
C. H. VILAS, M.D., 
In the Office of the Librarian of Congress, at Washington. IRITIS, 
Synonym : Inflammation of the Iris. 
CHIEF CAUSES. Exposure, rheumatism, syphilis, injuries and extension of 
inflammation from other parts. 
SYMPTOMS more or less attendant on all varieties. 
1. Changes in color and texture of the iris (light iris becomes greenish; dark, 
brownish-red.) 
2. Alteration in form and mobility of the pupil; iris sluggish. 
3. Suffusion of conjunctiva : and zone of vessels around corneo-scleral junction, 
(which may be red, blue or brown.) 
4. Pain, variable, (may be absent). 
5. Photophobia and lachrymation. 
6. Vision always impaired, (should be accurately tested). 
Classification arbitrary, but for convenience divided into 
1. Simple or plastic, characterized by plastic exudation. Synechise may be 
found after atropine is used, if not before. 
2. Serous, characterized by hyper-secretion of the aqueous humor. Less ten- 
dency to synechise. Tension increased. Pupil dilated. 
3. Parenchymatous or suppurative, characterized by well-defined nodular mas- 
ses, which are reddish-brown at first, then yellowish. They are absorbed, 
or suppurate causing hypopion, (pus in the anterior chamber.) 
NOTE. Neither syphilitic, rheumatic or gonorrhoeal iritis have distinctive forms, 
though the former is often parenchymatous. When the circumference of the 
pupil is wholly adherent to the anterior capsule of the lens, the condition is 
called exclusion of the pupil; when area of pupil is encroached on by exuda- 
tion, called occlusion of pupil. Contraction of field of vision is due to me- 
chanical obstruction. Adhesions of iris to lens capsule or cornea are called 
posterior or anterior synechias, respectively. The various forms are often far 
from distinct: each may run into or be combined with another form. 
Serous iritis is an insidious disease, the symptoms are often quite dull, and the 
disease creeps on unawares. 
LOCAL TREATMENT. In all forms, perfect rest of the iris and eye. Best se- 
cured by atropine and the protective bandage. A drop of a solution of the former, 
of the strength of from two to four grains to the ounce should be instilled at 
intervals of a few minutes until dilatation of pupil is secured, and then several 
times a day. It may even be necessary to use solutions of atropine of strength 
of six to eight grains to the ounce, but with great caution. Full dilatation of the 
pupil is best guide, and in most cases, essential to success. Atropine should be 
continued some days after all inflammation has apparently subsided. In serous 
iritis, a paracentesis of the cornea should be early performed, unless atropine and 
hot applications relieve early. Great harm is often done to the delicate parts of 
the eye by dilatory treatment. Hypopion is well met by remedies, and seldom 
requires to be evacuated. In the parenchymatous form, anterior synechise may 
form and require to be broken up. Corelysis properly done is sometimes the best 
operation; improperly done often sets up violent internal eye inflammations. 
Iridectomy is often a necessity in serous iritis of a severe type; may be required 
in severe parenchymatous iritis due to syphilis; extremely seldom required in 
the plastic form if properly treated in the beginning. Old, badly-treated, 
chronic cases may require it. Sometimes when there is great intra-ocular pres- 
sure, atropine will not work until the pressure be relieved by paracentesis or 
otherwise. 
Caution. Use no nitrate of silver in iritis. 
GENERAL TREATMENT. Quiet the pain. Keep down complications. 
Induce sleep. 
REMEDIES. Aconite, Arsenicum, Asafoetida, Aurum, Bryonia, Cannabis, Clema- 
tis, Gelsemium, Hepar sul., Kali iod., Mercurius, Rhus tox., Spigelia, Thuja. Dr. C. EL VILAS’ 
EYE NOTES. 
COMPLETE IN THREE PARTS. 
3 
Entered according to Act of Congress in the year 1878, by 
C. H. VILAS, M.D., 
In the Office of the Librarian of Congress, at Washington. 
These Notes were prepared to assist in the study, and form the basis of the 
didactic lectures on the embraced subjects as given by the author at the Hahnemann 
Medical College and Hospital, Chicago. They are necessarily concise, condensed 
and elementary in their character, and are intended to pick out of the mass of 
writings the essential fundamental principles and diagnostic points, and to suggest the 
treatment. 
The attempts to prepare an abbreviated materia medica must be always attended 
with hazard, and will doubtless be found incomplete. Additions of new remedies 
and well-authenticated symptoms will be made from time to time, and the whole 
enlarged and improved, may form the basis for a mere pretentious work at some 
future time. But it is not to be expected that any one will always prescribe on local 
symptoms alone, but be guided by a more thorough knowledge of the remedies other- 
wise obtained. For their peculiar wording, the author is often alone responsible; 
but not only in them, but in the preparation of the diseases, all works accessible have 
been freely used. It is hoped this statement will serve as a full and courteous 
acknowledgement of the assistance necessarily derived from many excellent publica- 
tions. 
To facilitate a ready distinction between the Eye- and the Ear-Notes, the latter are 
printed on colored paper. Dr. C. H. VILAS’ 
EYE NOTES 
rnmmm 
Entered According to Act of Congress in the year 1878, by 
C. H. VILAS, M.D., 
In the Office of the Librarian of Congress, at Washington. LOCAL APPLICATIONS. 
SILVER NITRATE (Synonym: Nitrate of Silver), is an invaluable local as 
well as general remedy in eye complaints. It is readily neutralized in all 
strengths by a saturated solution of sodium chloride (common table-salt). The 
chlorine of the sodium unites with the silver forming silver chloride, which is 
insoluble, and consequently innocuous, in the tears. Used as follows: 
Ophthalmia Neonatorum. A strength of one or two grains to the ounce of pure 
distilled water should be used, a drop into the thoroughly-cleansed eye once or 
twice a day. Combined with it internally, 6x or 30X trituration preferred, it 
will prove an unfailing remedy. 
Granular Conjunctivitis. It may be necessary to use it. Preferably, paint 
on the everted upper lid a solution of five grains to the ounce of distilled water, 
quickly neutralizing it with sodium chloride, as above. To be seldom repeated. 
Bear in mind that it is not thus used for its caustic effect, but as an irritant and 
stimulant to promote absorption, and used excessively in quantity or frequency, it 
does harm. Let the improvement go on to completion before another applica- 
tion is made, previous to which gently remove the eschar. 
Purulent Conjunctivitis. Strength of three to ten grains to the ounce, ac- 
cording to severity of case. Many use a solution of two to six grains to the 
ounce of distilled water, and put a drop in the eye three or four times a day. 
Solutions of five grains and upwards are preferably painted on the everted upper 
lid, and neutralized or not, according to experienced judgment. It should never 
be used until the discharge has set in, or it will be highly injurious. Having used 
it, wait until the deposit which forms on the conjunctiva has disappeared and 
the discharge has become re-established before again using it. If this rule be 
attended to, there will be little danger from its use. 
COPPER SULPHATE, ZINC SULPHATE AND ZINC CHLORIDE 
are also much used in mild forms of conjunctivitis. Properly used, there is often 
much benefit. Injudiciously used, there is occasionally considerable harm. One 
or two grains of either of the former, or a half grain to one grain of the latter, to 
the ounce of distilled water, is of the ordinary strength. Their strength may be 
increased if necessary. 
HYOSCYAMINE, the alkaloid of hyoscyamus niger, is a mydriatic sometimes 
used. It can often be borne when atropine cannot. Under its use the 
pupil will dilate more rapidly and remain longer dilated than under atropine, 
and of not less maximum degree; but it is much more expensive, more difficult 
to procure and does not keep as well. 
DUBOISINE, the active principle of duboisia myoporoides, is much similar to 
atropine in its general action, though far more powerful. It dilates the pupil and 
paralyzes the ciliary muscle more rapidly and efficiently than atropine; has no 
unpleasant action on the conjunctiva, but frequently produces the most distress- 
ing vertigo. Its high price renders it only a substitute where atropine distresses. 
DAT URINE, the alkaloid of datura stramonium, is also sometimes used as a 
mydriatic. It can be borne when atropine can not, and may thus be sometimes 
useful. 
CALABAR BEAN, an extract of the product of physostigma venenosum, is the 
myositic generally used in ophthalmic practice. Its active alkaloid, eserine (or 
physostigmine,) is also much used. A drop of a solution of four grains of the 
alcoholic extract of the former to an ounce of distilled water, or a little of 
the alcoholic extract, is put into the eye. Its effect is rapid, but soon passes off, 
or is easily overcome by atropine. 
Caution.—Beware of spurious or imitation alkaloids of all these substances. Dr. C. H. VILAS’ 
EYE NOTES 
IfNiSSSit 
Entered According to Act of Congress in the year 1878, by 
C. H. VILAS, M.D., 
In the Office of the Librarian of Congress, at Washington. DISEASES OF THE LIDS. 
ECTROPION is an eversion of the lid, exposing the conjunctival surface. En- 
tropion is an inversion of the lid, by which the edge of the lid or the covering 
integument is in contact with the globe. Ptosis is a drooping of the upper lid, 
either wholly or in part; may be caused by paralysis of third nerve, injury of 
levator muscle, or swelling and increased weight of the lid from inflammation. 
Trichiasis is an inversion of the cilia, so that they rub on the globe. Distichi- 
asis is a similar affection, except that there appears to be a double row of cilia. 
NOTE. The lids are subject to the same diseases as the other parts of the general 
integument, such as eczema, cancer, erysipelas, ecchymosis, abscess, acne, warts, 
naevi, etc., and require same treatment as when occurring in other parts, except 
that it must always be borne in mind that the danger from resultant cicatrices 
and inflammatory action generally is very great, and often entails irremediable 
injury which, from similar inflammation, could elsewhere be disregarded. 
TREATMENT. For the radical cure of these deformities, when present in an 
aggravated degree, an operation is necessary as a rule. Many cases of minor 
degree, and sometimes of a more serious character, are cured by the appropriate 
remedy combined with simpler treatment, however. Temporary relief from the 
latter two may be had by pulling out—epilation—the offending lashes. 
Require an exhaustive knowledge of their causes, etc. 
BLEPHARITIS CILIARIS. 
Synonyms: Blepharitis marginalis; Tinea Tarsi; Ophthalmia Tarsi; Lippitudo; 
Inflammation of the Edge of the Lid. 
CHIEF CAUSES. Exposure to irritating influences; general debility; filth; 
anomalous refraction; occurs during course of other inflammations. 
SYMPTOMS. If seen early, edge of lid is hyperaemic; soon becomes swollen, 
shiny and smooth. Little pustules appear about the roots of the lashes, leaving 
often small ulcerations and fissures. The discharges aggregate into small yel- 
low scabs, sticking the lashes together. 
NOTE. This is frequently an obstinate and recurrent disease. If it progresses to a 
great extent, the lashes often fall out and leave the lid bald—madarosis—which 
becomes hard and calloused—tylosis. 
LOCAL TREATMENT. Absolute cleanliness of the edge of the lid. The 
scabs should be gently soaked off (not torn off) with warm water, or warm milk 
and water, several times daily, and a little pure cosmoline rubbed on the cleansed 
and dried margin. A silver nitrate solution may be advantageously used. If 
at fault, it is all-essential to correct the refraction by suitable lenses. 
REMEDIES. Aconite, Alumina, Apis mel., Arsenicum, Graphites, Hepar sulph., 
Mercurius, Natrum mur., Pulsatilla, Silicea, Sulphur. 
HORDEOLUM. Synonym, Stye. Is a boil affecting connective tissue near the 
margin of the lid. Treatment consists in proper remedy internally—pulsatilla or 
staphysagria usually—but if not seen in time, encourage suppuration with hot 
fomentations externally, silicea internally, and evacuate the resultant pus. 
CHALAZION. A tumor usually about the size of a pea, caused by obstruction of 
the orifice of a sebaceous gland and consequent retention of secretion. Located 
in cartilage, nearest conjunctival covering, skin over same freely movable and 
natural in color. Usually several at a time or recurrent. Filled with pus or 
fatty material, according as inflammation has or has not set in. Treatment con- 
sists in evacuating contents and causing the sac to adhere by artificially excited 
inflammation. 
TUMORS. Dr. C. H. VILAS’ 
EYE NOTES 
Entered According to Act of Congress in the year 1878, by 
C. H. VILAS, M.D., 
In the Office of the Librarian of Congress, at Washington. LOCAL APPLICATIONS. 
ATROPINE, the alkaloid of atropa belladonna, is the principal mydriatic used 
in ophthalmic practice. It is insoluble in water, and if ordered must be cut 
by an acid. Hence we use atropia sulphate, or atropine treated by sulphuric 
acid, which is freely soluble in water. It is important that it be well prepared 
or there will be attributed to the atropia unfavorable results due to other causes. 
Pure, neutral atropia sulphate has the following advantages, when rightly 
used: 
1. It diminishes the intra-ocular tension. 
2. It draws back the iris, and 
(a) prevents adhesions to the anterior capsule of the lens ; 
(b) prevents adhesions to the posterior layer of the cornea; 
(e) tears away adhesions when formed ; 
(d) prevents its prolapse; 
(e) not infrequently restores it when prolapsed; 
(/) compels it to rest; 
(p) diminishes its congestion. 
3. It diminishes the congestion of the ciliary body. 
4. It compels the ciliary muscle to rest. 
5. It lessens ciliary neuralgia. 
6. It acts as a local anaesthetic during its passage through the cornea, allaying 
irritation. 
It also has disadvantages, as follows: 
1. Severe irritation of the conjunctiva with an eczematous condition of the 
lids, has been caused by its use. 
2. Its use is contra-indicated when the posterior uveal tract is affected or likely 
to be. 
3. By its use acute glaucoma has been hastened in eyes already attacked, by 
reason of which, the advantage above numbered 1 has been doubted in 
some cases. 
4. Its use may cause detachment of the retina. 
5. Paralysis of the fibres of the iris may be caused by prolonged use of a 
solution. 
6. Poisoning by the solution running from the conjunctival sac into the throat 
through the lachrymal canaliculi may occur; or it may even be absorbed 
to this extent. 
7. Some persons show a constitutional antipathy to its use in other ways than 
mentioned. 
Its strength may be varied according to the necessities of the case. Being an 
active poison great care is essential. One-half a grain of atropia sulphate to an 
ounce of distilled water is sufficient to dilate the pupil for examination of an 
healthy eye, but when inflammation is present, solutions of two to eight grains to 
the ounce are required—one drop from a drop-tube, to be placed in the eye, the 
lower lid being slightly everted. 
THE ANTIDOTE to atropine is preferably a strong decoction of coffee, which 
in cases requiring a more powerful antidote is best alternated with hot vinegar. 
When an immediate antidote is required, however, a hypodermic injection of 
morphia is essential, and excels all others. 
COSMOLINE is valuable in all cases of ciliary blepharitis, preventing the form- 
ation of new scales, acting as a demulcent, and perhaps through absorption ex- 
ercising some medicinal influence over the progress of the disease. It is to be 
preferred pure and uncombined with carbolic acid or any thing else. Vaseline, 
cloverine, etc., are names of substitutes said to be similar in preparation. Dr. C. H. VILAS’ 
EYE NOTES. 
fcilpp# 
Entered According to Act of Congress in the year 1878, by 
C. H. VILAS, M.D., 
In the Office of the Librarian of Congress, at Washington. DACRYO-CYSTITIS. 
Synonyms: Abscess of the Sac; Acute Inflammation of the Lachrymal Sac. 
CHIEF CAUSES. Chronic disease of tear passages; nasal catarrh; con- 
junctivitis; injury; exposure. 
SYMPTOMS. Tenderness, redness and puffy swelling over the region of the 
sac and lids, accompanied by great pain. When disease is not arrested the 
abscess bursts through the skin. 
NOTE. The abscess should not be allowed to burst externally, as this forms a 
fistula lachrymalis, which is otten exceedingly difficult to cure. When such 
happens, the natural course of the discharge being established, we must heal the 
fistula by stimulating its edges; if they have become covered with skin, pare the 
edges and unite with a stitch. 
LOCAL TREATMENT. Open up the canaliculus to let pus out that way, and 
keep it open with probes. If the skin over the abscess is in imminent danger of 
bursting it is better to open the abscess with a knife than allow it to burst; then 
apply hot lotions and encourage suppuration. As soon as possible heal up the 
fistula and get the pus through the opened canaliculus. Ice-water lotions and 
indicated remedy will often cut short an attack if used in the beginning. 
REMEDIES. See Blenorrhcea of the Sac. 
BLENORRHCEA OF THE SAC. 
Synonyms : Mucocele; Chronic Inflammation of the Lachrymal Sac. 
CHIEF CAUSES. Same as Dacryo-cystitis. Faulty position of the puncta. 
SYMPTOMS. Constant irritability and watering of the eye; variable swelling 
of the sac which, on pressure, discharges pus. 
NOTE. Mucocele has associated with it many troubles, which are also sometimes 
independent. Strictures of the lachrymal duct are very common, and must be 
cured by operation or treatment before this affection can be overcome. This 
trouble is generally of tedious recovery, and if mal-treated seldom gets well. 
In exceptional cases, after all other treatment has failed, the sac must be 
obliterated. Inasmuch as syphilis plays an important part in all lachrymal 
troubles, its presence must be suspected. 
LOCAL TREATMENT. First, the passages must be opened and kept free by 
probing or otherwise. In this great delicacy must be observed. Great harm 
usually is done from too much force and senseless wrenching. Astringent 
injections may then be made with benefit. 
REMEDIES. Aconite, Argentum nit., Euphrasia, Hepar sul., Pulsatilla, Silicea. 
IRI DO-CHOROIDITIS. 
CAUSE. Extension of inflammation from the iris, and vice versa. 
SYMPTOMS. Those of iritis mainly, but exaggerated in degree. The vitreous 
becomes clouded, and there is contraction of the field of vision not explained 
by iritis. 
NOTE. Is most frequent result of previous oft-recurring iritis, where the chambers 
of the eye have become separated (exclusion, or occlusion of the pupil) 
or the iris is dragged on by synechise. Eye often lost by the disease, and sympa- 
thetic ophthalmia may result and the companion eye be endangered or lost. 
LOCAL TREATMENT. Occurring with iritis requires same treatment as that 
disease. Iridectomy most valuable .remedy for severe cases. Corelysis. 
REMEDIES. See Iritis and Choroiditis. Dr. C. H. VILAS’ 
EYE NOTES. 
’W* 
Entered According to Act of Congress in the year 1878, by 
C. H. VILAS, M.D., 
In the Office of the Librarian of Congress, at Washington. REFRACTION AND ACCOMMODATION (3). 
HYPERMETROPIA. 
Synonyms: Over-sight; H. 
DEFINITION. When the accommodation is at rest, and parallel rays of light 
entering the eye are focussed behind the retina, the condition is called hyper- 
metropia. Convergent rays are focussed upon the retina. 
CAUSES. Optic axis too short; senile changes in the eye ; aphakia, or absence of 
the lens. Too low refractive power. May be congenital and hereditary. 
NOTE. In hypermetropia the eye cannot see distant objects without using a cer- 
tain amount of the accommodation, or what is the same thing, a convex lens; 
in emmetropia no accommodation is used for distant objects, the refraction alone 
sufficing. This abnormal use of the accommodation overtasks the eye, causing 
spasm of the ciliary muscle, strabismus, etc. Latent H, or HI, is that which 
is habitually concealed and only revealed by the use of a strong mydriatic; 
manifest H, or Hm, is that which is present without the use of a mydriatic. 
The latter is represented by the strongest convex lens through which the patient 
sees distant objects most acutely; the total H, by the strongest convex lens 
through which the patient sees distant objects most acutely after a strong mydri- 
atic has acted; the difference between the two represents the latent. 
Of late years H has been greatly elucidated, and strabismus, blepharitis, 
many so-called scrofulous troubles, etc., been found to originate therein. 
H is divided into three kinds: facultative, that in which patient sees near 
and far objects clearly with or without convex lenses; relative, in which patient 
sees near and far objects clearly, but only by converging visual lines to points 
nearer than the objects, giving the eyes a periodic squint; absolute, in which 
neither near or far objects can be seen clearly without convex lenses. 
(In examining patients, it should be borne in mind that the two eyes will 
often be found to differ greatly, either in grade or kind of defect. One eye may 
be M and the other H, or one eye E and the other H or M, forming anisome- 
tropia, or one highly myopic and the other slightly, anisometropic myopia; or 
similarly hypermetropic, anisometropic hypertnetropia ; or one with Amh and the 
other M + Am; or Ahm and Amh, etc., etc.) 
H may be diagnosed, by the ophthalmoscope, with which the details of the 
fundus may be seen some distance away; carrying the ophthalmoscope to one 
side the fundus moves in the same direction. On nearer approach a convex 
glass will be required to get a clear erect image. By indirect method, the details 
of the fundus look larger than in an emmetropic eye. 
TREATMENT. Correct the refraction by suitable convex spherical lenses. 
PRESBYOPIA. 
DEFINITION. Presbyopia is the term applied to the diminished range of accom- 
modation consequent on age. It consists in a recession of the near point. 
CAUSES. Still in dispute. Increasing hardness of lens. Perhaps flattening of 
the cornea. 
NOTE. The recession of the near point begins in youth in all eyes and gradually 
advances, but does not become inconvenient until about the fortieth year. First 
noticed by inability to see small objects as near as formerly; they must be put 
farther away, especially in the evening. It should be remembered that distant 
vision remains unimpaired. Hypermetropic eyes are affected earlier; myopic 
later, and occasionally not at all. It is wrong to delay the use of lenses when 
needed ; they should be given as soon as the affection becomes inconvenient. 
TREATMENT. Correct the presbyopia by convex spherical lenses. 
Synonyms: Far-sight; Old sight; Pr. Dr. C. H. VILAS’ 
EYE NOTES. 
Entered According to Act of Congress in the year 1878, by 
C. H. VILAS, M.D., 
In the Office of the Librarian of Congress, at Washington. REFRACTION AND ACCOMMODATION (3). 
HYPERMETROPIA. 
Synonyms: Over-sight; H. 
DEFINITION. When the accommodation is at rest, and parallel rays of light 
entering the eye are focussed behind the retina, the condition is called hyper- 
metropia. Convergent rays are focussed upon the retina. 
CAUSES. Optic axis too short; senile changes in the eye ; aphakia, or absence of 
the lens. Too low refractive power. May be congenital and hereditary. 
NOTE. In hypermetropia the eye cannot see distant objects without using a cer- 
tain amount of the accommodation, or what is the same thing, a convex lens; 
in emmetropia no accommodation is used for distant objects, the refraction alone 
sufficing. This abnormal use of the accommodation overtasks the eye, causing 
spasm of the ciliary muscle, strabismus, etc. Latent H, or HI, is that which 
is habitually concealed and only revealed by the use of a strong mydriatic; 
manifest H, or Hm, is that which is present without the use of a mydriatic. 
The latter is represented by the strongest convex lens through which the patient 
sees distant objects most acutely; the total H, by the strongest convex lens 
through which the patient sees distant objects most acutely after a strong mydri- 
atic has acted; the difference between the two represents the latent. 
Of late years H has been greatly elucidated, and strabismus, blepharitis, 
many so-called scrofulous troubles, etc., been found to originate therein. 
H is divided into three kinds: facultative, that in which patient sees near 
and far objects clearly with or without convex lenses; relative, in which patient 
sees near and far objects clearly, but only by converging visual lines to points 
nearer than the objects, giving the eyes a periodic squint; absolute, in which 
neither near or far objects can be seen clearly without convex lenses. 
(In examining patients, it should be borne in mind that the two eyes will 
often be found to differ greatly, either in grade or kind of defect. One eye may 
be M and the other H, or one eye E and the other H or M, forming anisome- 
tropia, or one highly myopic and the other slightly, anisometropic myopia; or 
similarly hypermetropic, anisometropic hypermetropia ; or one with Amh and the 
other M +Am; or Ahm and Amh, etc., etc.) 
H may be diagnosed, by the ophthalmoscope, with which the details of the 
fundus may be seen some distance away; carrying the ophthalmoscope to one 
side the fundus moves in the same direction. On nearer approach a convex 
glass will be required to get a clear erect image. By indirect method, the details 
of the fundus look larger than in an emmetropic eye. 
TREATMENT. Correct the refraction by suitable convex spherical lenses. 
Synonyms: Far-sight; Old sight; Pr. 
DEFINITION. Presbyopia is the term applied to the diminished range of accom- 
modation consequent on age. It consists in a recession of the near point. 
CAUSES. Still in dispute. Increasing hardness of lens. Perhaps flattening of 
the cornea. 
NOTE. The recession of the near point begins in youth in all eyes and gradually 
advances, but does not become inconvenient until about the fortieth year. First 
noticed by inability to see small objects as near as formerly; they must be put 
farther away, especially in the evening. It should be remembered that distant 
vision remains unimpaired. Hypermetropic eyes are affected earlier; myopic 
later, and occasionally not at all. It is wrong to delay the use of lenses when 
needed; they should be given as soon as the affection becomes inconvenient. 
TREATMENT. Correct the presbyopia by convex spherical lenses. 
PRESBYOPIA. Dr. C. H. VILAS’ 
EYE NOTES. 
Entered According to Act of Congress in the year 1878, by 
C. H. VILAS, M.D., 
In the Office of the Librarian of Congress, at Washington. REFRACTION AND ACCOMMODATION (2). 
Synonyms: Hypometropia; Brachymetropia; Short-sight; M. 
MYOPIA. 
DEFINITION. When the accommodation is at rest, and parallel rays of light 
entering the eye are focussed in front of the retina, the condition is called 
myopia. Divergent rays are focussed upon the retina. 
CAUSES. Optic axis too long; too high refractive power. Often hereditary or 
congenital. Anything that favors congestion of the globe, as straining the eyes 
at fine work; reading by too dim a light; reading in a recumbent posture; 
stooping over at the desk, etc. 
NOTE. In myopia the far point lies nearer the eye than in emmetropia. 
A myopic eye is often considered as necessarily of strong sight, and hence not 
regarded as unsound. This is erroneous. While a stationary myopia of low 
degree may not necessarily be a serious matter, it must always be regarded as 
liable at any time to become progressive; a progressive myopia of high or low 
degree is a serious matter. One of high degree, accompanied by posterior 
staphyloma, is dangerous to vision in advanced life, always affecting the vision 
more or less; one of high degree accompanied by posterior staphyloma (syno- 
nyms; myopic arc; myopic crescent) and attendant atrophy of the optic 
nerve, not infrequently ends in blindness. The latter grades are nearly always 
attended by asthenopia, much irritation, and amblyopia. 
Myopia is often confounded with spasm of the ciliary muscle, and the latter 
diagnosed as myopia. Spasm of the ciliary muscle is curable by medicines; 
myopia is not. The two may be associated; the spasm may be overlooked and 
an improvement of the myopia supposed to be accomplished. 
Myopia may be diagnosed by the ophthalmoscope, in which case the details 
of the fundus can be seen by direct method a short distance away; carrying the 
ophthalmoscope to one side, the fundus is seen to move in the opposite direction. 
On nearer approach a concave glass will be required to get a clear erect image. 
By the indirect method the details of the fundus seem smaller than in an 
emmetropic eye. 
The distance of the far point determines the degree of myopia. A patient 
who does not see clearly beyond 32 inches is said to have M 1-32; beyond 
12 inches, M 1-12, etc. 
A stationary myopia through youth has a compensation in that presbyopia does 
not affect it until the error due to myopia is overcome by the senile change. 
TREATMENT. The myopia must be neutralized by concave spherical lenses; 
generally the weakest that can be worn. Other associated troubles to be treated 
as indicated. 
LENSES. 
DEFINITION. The term lens is now given to all transparent masses terminating 
at least on one side by a spherical, cylindrical, or prismatic surface. 
NOTE. In ophthalmic practice two forms of lenses are used, spherical and 
cylindrical. A spherical lens is a segment of a sphere ; a cylindrical, the seg- 
ment of a cylinder. A third form is sometimes used called a prismatic lens. 
There are six kinds of spherical lenses used, plano-convex, bi-convex, positive 
or concavo-convex meniscus, plano-concave, bi-concave and negative or con- 
vexo-concave meniscus. Convex lenses are called positive and designated by 
the sign + ; concave lenses are called minus and designated by the sign —. 
When not otherwise expressed a bi-convex lens is understood to be meant. All 
spectacles for the aid of the eye are composed of some of the various forms of 
lenses. A thorough knowledge of their uses and component materials is all- 
essential to their successful adaptation. Erroneously adapted they injure and 
not infrequently destroy sight. Dr. C. H. VILAS’ 
EYE NOTES. 
MMf 
Entered According to Act of Congress in the year 1878, by 
C. H. VILAS, M.D., 
In the Office of the Librarian of Congress, at Washington. REFRACTION AND ACCOMMODATION (I). 
ELEMENTARY DEFINITIONS. 
By the refraction is understood the faculty the eye possesses of focussing cer- 
tain rays of light upon the retina; this is due to the shape of the globe and the 
refracting media, and is independent of the accommodative apparatus. 
By the accommodation is understood the voluntary action whereby the eye 
becomes adjusted for vision of points nearer than is possible under refraction 
alone. 
The exact method of accommodation is not fully settled. The most learned 
theories are those of Dudgeon and Helmholtz. 
In viewing any point beyond about eighteen feet, the refraction alone is used, 
and the accommodation (or the eye sometimes) is said to be at rest; points 
nearer require the aid of the accommodation. Any object situated more than 
eighteen feet distant from the eye is said to be at an infinite distance; nearer, at 
a finite distance. 
Emmetropia (synonym E) is a synonym for perfect refraction, that state in 
which parallel rays are brought to a focus upon the retina when the accommo- 
dation is at rest; ametropia for imperfect refraction, and embraces astigmatism, 
myopia, hypermetropia, and by some presbyopia, all of which see. 
Asthenopia (synonym As) is a synonym for weakness of the sight. 
An accurate knowledge of the principles of light, physical and physiological 
optics, embracing an intimate familiarity with the dioptrics of the eye, its 
excellencies and defects, (the latter requiring a complete knowledge of the 
higher mathematics) is absolutely essential for a thorough comprehension of the 
subject. A simple outline only can be presented, such as is necessary for an 
understanding of the main practical points. 
ASTIGMATISM. 
Synonyms : Irregular sight; A. 
DEFINITION. Astigmatism is that state of refraction, when the eye being at rest, 
rays of light emanating from a point are not re-united at a point. 
CAUSES. Asymmetry of refracting surfaces, whence no image is correctly formed 
on the retina. May be congenital or not, generally is; when not, is due to 
results of inflammation of cornea, defective union of cornea after cataract opera- 
tions, etc. Often hereditary. 
SYIVIPTOMS. Subjective, generally that the eye sees more than one image, and 
those distorted in shape and position. Objectively, with ophthalmoscope, dis- 
tortion of the fundus; with oblique illumination, irregular corneal reflections 
and changes of curvature. 
NOTE. Th & principal meridians are those of greatest and least curvature; different 
focal lengths of principal meridians cause regular astigmatism; differences of 
refraction in same meridian cause irregular astigmatism, which is incurable by 
glasses, though improved by stenopaic apparatus occasionally. 
REGULAR ASTIGMATISM is called simple when one principal meridian is 
emmetropic and the other ametropic, as simple myopic A (synonym Am); simple 
hypermetropic A (synonym Ah); compound, when both are hypermetropic or 
myopic, but defect greater in one than the other, as compound myopic A (syno- 
nym M+Am); compound hypermetropic A, (synonym H+Ah); mixed, when 
one principal meridian is hypermetropic, the other myopic, as mixed A with 
predominant myopia (synonym Amh); or mixed A with predominant hyper- 
metropia (synonym Ahm). 
TREATMENT consists in the adaptation of proper cylindrical lenses; must 
often be combined with spherical, and sometimes with prismatic, lenses.