by Ronald D. Whitmont, MD
Abstract: A 70-year-old-male with sudden onset of vitritis, iritis-panuveitis and retinal hemorrhage was successfully treated with the homeopathic medicine Belladonna after treatment failed with corticosteroid drops. The condition responded rapidly and permanently with progressive resolution following administration of a single dose of Belladonna 200c. Homeopathy helps speed resolution of many acute ophthalmic conditions, particularly when prescribed according to the doctrine of similars. (1)
Keywords: vitritis, iritis-panuveitis, retinal hemorrhage, homeopathic treatment of; Belladonna
The following case report is formatted according to CARE guidelines. (2)
Vitreitis or vitritis refers to inflammation of the vitreous body or vitreous humour of the eye. Panuveitis refers to inflammation of all layers, including the middle, or uvea of the eye, the iris, ciliary body and choroid.(3) Panuveitis can also affect the lens, retina, optic nerve, and vitreous fluid, causing reduced vision and blindness.(4) Signs and symptoms frequently include redness, pain, blurring, photophobia, decreased vision and floaters. Episodes can be brief or prolonged, and severe cases frequently relapse. Most cases are idiopathic, but inflammatory and infectious conditions elsewhere in the body may trigger it. Early treatment with anti-inflammatory and corticosteroid ophthalmic drops, systemic corticosteroid therapy and local injections are frequently recommended. Corticosteroids are the standard of care for most types of uveitis, including panuveitis and a chronic maintenance dose is frequently recommended.
The homeopathic treatment of these conditions relies on elucidating a careful history of the salient features (symptoms) and administering a single oral dose of the one medicine that most closely matches the totality of the symptoms according to the doctrine of similars. Different cases of uveitis or panuveitis may require the administration of a different (or the same) homeopathic medicine, depending upon the unique clinical presentation (and symptoms) expressed in each particular case. This principle of individual prescribing is fundamental to “classical homeopathy,” which has been in continuous use in the United States for nearly two centuries.
On January 1, 2018, a 70-year-old Caucasian male university professor developed blurry vision during an airplane flight home from vacation at high altitude. He initially thought his prescription eyeglasses were dirty and tried cleaning them several times, but to no avail. The following day he developed “thousands of floaters” in both eyes that appeared as black spots, dots, pinheads, and squiggles.
When he looked at sharp lines, they appeared “to squiggle.” These aberrations were worse when he looked at white backgrounds, particularly the snow. His symptoms were worse in bright light. He complained of muscular tension in his neck and shoulders which had been present for several months, and he occasionally took ibuprofen for symptoms of a rotator cuff injury for which he was considering surgery. He had seen his dentist one month earlier for a routine cleaning.
His ophthalmologist performed a thorough examination and told him he had “white blood cells in his eyes.” He was treated with Prednisone Forte 1% eye drops and referred immediately to a retinal specialist.
On January 3, 2018, fundoscopic and retinal evaluations revealed normal cup/disk ratio, normal disc, choroid, vessels, vitreous, periphery and retina bilaterally. There were moderate ‘dot blot’ hemorrhages bilaterally and retinoschisis (separation of layers of the retina) in the right eye only. No retinal breaks were detected.
Past medical history was remarkable for a history of atrial fibrillation, hypertension and hypercholesterolemia.
Medications included digoxin, metoprolol and simvastatin.
Diagnostic assessment: Moderate hemorrhages and uveitis.
He was referred to his cardiologist where transthoracic and transesophageal echocardiogram, EKG, blood cultures and Holter monitor were all normal.
He was referred to a rheumatologist where chest x-ray and blood work were unremarkable.
Follow-up: January 8, 2018,
After five days of local corticosteroid ophthalmic drops, ophthalmic examination revealed 1+ cells bilaterally in anterior chamber, and 2+ vitritis in right eye and 1+ in left.
Diagnostic assessment: moderate hemorrhage, iritis-panuveitis, moderate vitreous-uveitis, uveitis and vitreous-vitritis bilaterally.
The treatment options of oral steroids and vitreous biopsy were offered, but the patient refused. Since his visual symptoms were worsening he elected to discontinue the corticosteroid drops and made an appointment to see his homeopathic physician.
On January 10, 2018, he was evaluated in my office.
Clinical Findings: External examination of the eyes was unremarkable. A fundoscopic examination was not performed. The salient symptoms used to evaluate and select a homeopathic medicine included the following three rubrics.
Vision; BLACK, points
Vision; CLOUDY, vision
Vision; FLOATERS, muscae volitantes
The two top choices in this case were Gelsemium semperverins and Belladonna. These two outstanding medicines were carefully compared. Belladonna is known to be a medicine “par excellence” for inflammatory conditions throughout the body. Murphy’s Materia Medica lists its uses in “eye disorders” and photophobia.(5) One of its keynotes is “sudden onset.” Belladonna corresponds well to symptoms of high altitude sickness and has been used effectively
in many cases triggered by these conditions. This patient’s symptoms began while flying in an airplane cabin pressurized to 8,000 feet; before that he had been on vacation for several weeks at high altitude. Belladonna predominantly affects the right side of the body more severely than the left, which was the case in this patient. Many of the characteristic symptoms of Belladonna (throbbing pains, mydriasis, fever, etc.) were absent from this case, but this was not a contradiction for selection of this medicine since the key symptoms and predisposing factors were all present in this case.
The keynotes and materia medica of Gelsemium were reviewed in detail, but did not correlate as closely as those of Belladonna.
The patient was advised to temporarily discontinue simvastatin. Although statins have been associated with reduced incidence of uveitis, (6) they are associated with a large number of other ocular side effects.(7) He was also advised to discontinue ibuprofen due to its immunosuppressive effects and the possibility that it might interfere with his innate immune recovery.(8) He was advised to hold off on restarting the corticosteroid eye drops. He was advised to have his digoxin level checked.
Plan: Belladonna 200c, one dry dose.
The following day, on January 11, 2018, he noted “marked improvement” in his vision.
On January 15, 2018, an ophthalmologic examination revealed trace cells in anterior chambers, and improvement of “Roth spots.”
On February 8, 2018, he returned to my office feeling “much better” with continual improvement in his eyesight. He continued to see “a few” black spots when he looked at a grey background, sky, or any bright solid background. He described a sensation of “gauze,” “like a greyish cloud” that was translucent and transparent over his vision, which was improving with time.
His shoulder and arm had both improved so dramatically that he had cancelled his upcoming rotator cuff surgery.
Plan: He was treated with a single dose of placebo.
Follow-up ophthalmologic evaluation on February 21, 2018, revealed complete resolution of inflammation in both eyes. His ophthalmologist remarked that the improvement was “miraculous” and suggested the possibility of writing an article for the ophthalmologic community.
On June 12, 2018, he returned to my office. His most recent visit to ophthalmology revealed that his eyes were “clear.” His only remaining symptom was the sensation of an “out of focus hair” falling across his face. He was given one more dose of placebo.
On September 17, 2018, I called him to check-in. He told me that his vision was now fine and that he had not experienced any further aggravations. He occasionally had the experience of a “hair” in front of his vision, but it usually passed quickly.
I have treated numerous ophthalmic conditions with varying levels of pathology over the last 29 years of clinical practice. Each case is individualized based on the characteristic symptoms that are present.
Classical homeopathic prescribing addresses every case as a distinctive constellation of signs and symptoms that has a unique solution. In this system, symptoms are weighed more heavily than the diagnosis, which is frequently, as it was in this case, not even included in the hierarchy of rubric analysis. The highest priority of analysis is to capture both the gestalt as well as the “strange, rare and peculiar” symptoms that are present and make each case unique.
Rapid resolution of symptoms in this particular case was reflected in the resolution of inflammation and the return to normal functioning, which both began soon after administration of homeopathic treatment. Once resolution begins, there is usually no need to repeat the medicine, and as many experts have suggested, premature repetition can hinder recovery or interfere with improvement. Bearing this in mind, placebo treatments were utilized once it became clear that the condition was improving, and only time was needed to complete the cure. If progress had flagged or if the condition had deteriorated, then a repetition of the medicine would have been appropriate.
It is also remarkable (but not unusual) that this patient’s other clinical condition, a long-standing rotator cuff injury, also improved simultaneously with treatment. Homeopathy is an holistic system of medicine and compatibility with the entire organism is one of the preconditions of responsible medicine selection. The simultaneous improvement of many symptoms in different organ systems appears to be the rule, rather than the exception, of classically prescribed homeopathic medicines.
Homeopathy, as opposed to conventional strategies, tends to be associated with systemic health improvement as a “side effect”of holistic treatment. This case demonstrates the elegance of that approach in this case of ophthalmic pathology, and strongly suggests the need for greater utilization of this methodology in the public health sector.
“While flying home from a holiday on the first of the year, I noticed a few moments where my vision was disturbed–as though my glasses needed cleaning. I then cleaned my glasses and went on reading. The next morning, while walking my dogs on a snowy path in the Hudson Valley, I immediately saw, against the white of the snow, thousands of black spots in front of my eyes. I made an appointment with an ophthalmologist in New York City for the next day.
By the time I went to the ophthalmologist’s office, my vision had deteriorated. There were sometimes fields of cloudiness that would pass in front of my eyes. The ophthalmologist saw, on my retinas, multiple red spots with white centers. He was concerned because the onset was so rapid and the symptoms appeared bilaterally. He set up an appointment with a partner in his practice who was a retinal infection specialist for the following week. In the meantime, he sent me, that day, to my cardiologist (I’ve had atrial fibrillation for about 20 years).
I then began a series of tests over the next week to try to determine the systemic issue. I had five rounds of blood work, a stress echocardiogram, x-rays. I also visited a rheumatologist. There were no issues.
After two visits to the ophthalmologist and no headway toward determining the cause of the infection, I visited Dr. Ronald Whitmont. He prescribed Belladonna 200. Within two days my vision began to clear. When I made my weekly visit to the ophthalmologist’s the following week, he expressed surprise at looking at that day’s imaging of my retinas. The condition showed remarkable improvement. By the following week’s appointment the condition had essentially cleared. I’ve made monthly visits to the ophthalmologist since then. The situation seems to have been resolved.”
Informed consent: The patient gave verbal informed consent to have his case written and published.
About the author: Ronald D. Whitmont, MD, is Board Certified by the American Board of Internal Medicine and is a Founding Diplomate of the American Board of Holistic Medicine. He is immediate past president of the American Institute of Homeopathy and Clinical Assistant Professor of Family and Community Medicine at New York Medical College. Dr. Whitmont maintains a private practice of classical homeopathy in New York City and Rhinebeck, New York. He can be reached at www.homeopathicmd.com.
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