Diabetes Mellitus is a challenging disease and complications
are vulnerable. Here the author presents a article with a case for inspiration
on diabetic retinopathy , which can be supported with homoeopathic remedies.
This article is authoured by Dr Rajeev Chaudari and co authored by Dr.
Mohan singh . They practice at Badun, Uttar pradesh, India.
Diabetic Retinopathy is a major cause for loss of vision
and tends to be particularly severe in type 1 diabetes. The degree of
retinopathy is highly correlated with both duration of diabetes and poor
blood glucose control. It can be classified as:
Nonproliferative retinopathy develops first and produces increased capillary
permeability, micro aneurysms, hemorrhages, exudates, and macular edema.
Macular edema causes vision loss if untreated.
Proliferative retinopathy is characterized by abnormal new vessel formation
(neovascularization), which occurs on the vitreous surface of the retina
and may extend into the vitreous cavity and cause vitreous haemorrhages.
Vision loss with proliferative retinopathy may be severe.
Symptoms, Signs, and Diagnosis of Nonproliferative Retinopathy- Vision
symptoms are rare in the early stages; as retinopathy progresses, macular
edema may cause decreased visual acuity. In late stages, cystic changes
from chronic macular edema and macular ischemia from capillary occlusive
disease may develop.
The first signs are often venous dilation and small red
dots (capillary micro aneurysms) seen on funduscopy in the posterior retinal
pole. Later cotton-wool spots (soft exudates). Cotton wool spots are areas
of micro infarction that lead to retinal opaccification.
Proliferative Retinopathy- Symptoms include blurred vision and black spots
or flashing lights in the field of vision. Vitreous hemorrhage or retinal
detachment may occur, leading to sudden severe vision loss. It is diagnosed
when fine preretinal capillaries are observed on the optic nerve or retinal
surface. Retinal haemorrhage may develop in the vitreous cavity when these
abnormal vessels are damaged. In extreme cases, retinal detachment may
occur with white preretinal membranes forming over the retinal surface.
Detachment and contraction of the vitreous gel contribute to retinal detachment
by pulling the retina anteriorly from its attachments over the major vessels.
Control of diabetes and BP is important; intensive control of blood glucose
can delay onset and slow progression of retinopathy.Homoeopathy can play
a great role in the treatment of retinopathy either proliferative or nonproliferative.
Homoeopathic literature is full of drugs capable of reducing macular edema
and may provide better visual improvement. But with the possible exceptions
of vitreous haemorrhage and retinal detachment, lost vision is seldom
recovered, but still Homoeopathic drugs are there to prevent further loss.
With careful selection of Homoeopathic drugs one can diminish or eliminate
proliferative retinopathy and neovascularization and decrease the risk
of neovascular glaucoma. It is important to note that constitutional medicines
selected on the basis of mental generals and causations are capable of
showing good results. It is also quite useful in patients in whom surgery
is deferred especially patients with hypertension, very old age, severe
diabetes etc. Homoeopathic drugs like Arnica, Physostigma, Sanicula, Phosphorous,
Lachesis, Bothrops, and Cineraria are effective in the treatment of proliferative
and nonproliferative retinopathy.
A 61 years old male having family history of diabetes was suffering from
recurrent headache and gradual loss of vision since 3 years. Funduscopy
dated 12/05/06 showed capillary micro aneurysms more in left eye and Fluorescein
Angiography dated 25/05/06 confirmed retinopathy with loss of vision.
The patient was called for case taking on 10/06/06. The case was repertorised
and the symptoms selected were:
Ailments from care worries, ailments from fright, dreams of falling, blood,
body parts pinched, fear of dark, frightened easily, desire for company,
consolation ameliorate, sympathetic, angered easily, desire for salty
thing, blurred vision, heaviness in eye, headache. Increased thirst with
dryness of mouth.
The case was repertorised on the basis of mental symptoms and Phosphorus
was selected for prescription.
1st Prescription 10.06.06
Phosphorus 1000/single dose was given followed by Placebo for 2 weeks.
Follow up 1 25.06.06
No dreams were repeated, tendency to anger was as such, vision was stable
but patient reported recurrent headache especially during eyestrain. Sangunaria
30 BD was prescribed for 2 weeks. No high potency was repeated.
Follow up 2 13.07.06
No dreams were repeated, tendency to anger was reduced, vision was stable
and headache was not reported. Placebo was given for 4 weeks.
Follow up 3 27.08.06
Dreams of falling was repeated, tendency to anger was reduced, and thirst
was normal, vision was stable, no headache was reported but smarting pain
was reported in both eyes. Phosphorus 1000/single dose was repeated followed
by external use of Cineraria Maritima 2-2 Drops B.D. for 4 weeks.
Follow up 3 08.10.06
No dreams were repeated, vision was stable, no headache and pain in eyes
was reported, Placebo was given for 4 week.
Follow up 4 11.11.06
No dreams were repeated, vision was stable, no headache and pain in eyes
was reported. Placebo was repeated for 4 weeks. Patient was advised to
go for Funduscopy.
Follow up 5 0.12.06
Funduscopy dated 18/12/06 showed marked improvement in capillary microaneurysms.
Dreams of falling repeated with dreams of dead relatives. Phosphorus 1000/single
dose was repeated followed by Placebo for 2 weeks. The case continues
Lids agglutinated in morning. Lachrymation in cold open air or cold application.
Eyes burn, exuding a sticky fluid. Dandruff of eyebrows. Sight dim. Cornea
Blood eyes with burning. Glaucoma. Contraction of pupils. Profuse lachymation.
Increasing myopia. Eyelids tense, Night-blindness, Photophobia. Muscae
volitantes, flashes of light. Increasing myopia. Vision trembling.
Eyeballs feel large, stiff, Choroiditis. Fatigue of eye and head even
without much use of eyes. Edema of lids and about eyes. Glaucoma. Cataract.
Vitreous opacities. Atrophy of optic nerve. Black points seem to float
before the eyes. Green halo about the candlelight. Letters appear red.
Thrombosis of retinal vessels and degenerative changes in retina. Retinal
trouble with the lights and hallucination of vision.
Defective visions after diphtheria, sensation as of eyes were drawn together
by cords, which were tied in a knot at root of nose. Blindness with lung
or heart disorders. Eyes watery from pain. Intra-ocular haemorrhages.
Feels as if eyes were forced out on pressing the throat. Dim sight. Conjuctivitis
with measles. The eyes water all the time. Acrid lachrymation, bland coryza.
Thick, acrid, yellow discharge from the eyes. Profuse hot or acrid tears
worse open air, Pressive, cutting pains in the eyes. Sticky mucus on cornea,
must wink to remove it. Pressure in eyes. Little blister on cornea. Cataract
with watery eyes. Opacities of cornea after injury. Chronic sore eyes.
Bloodshot. Retinal haemorrhage. Black eye. Bruised, sore feeling in eyes
after close work. Must keep eyes open. Dizzy on closing them. Feel tired
and weary after sight seeing, moving pictures, etc. Photophobia. High
objects appear to lean forward and about to fall.