Etiological factors:
A scotoma can result from a retinal, choroid, or optic nerve disorder. It can be classified as absolute, relative, or scintillating. An absolute scotoma refers to the total inability to see all sizes of test objects used in mapping the visual field. A relative scotoma, in contrast, refers to the ability to see only large test objects. A scintillating scotoma refers to the flashes or bursts of light commonly seen during a migraine headache.
Chorioretinitis:
Inflammation of the choroid and retina produces a para central scotoma. Ophthalmoscopic examination reveals clouding and cells in the vitreous, sub retinal hemorrhage, and neo vascularization. The patient may have photophobia along with blurred vision.
Glaucoma:
Prolonged elevation of IOP can cause an arcuate scotoma. Poorly controlled glaucoma can also cause cupping of the optic disk, loss of peripheral vision, and reduced visual acuity. The patient may also see rainbow-colored halos around lights.
Migraine headache:
Transient scintillating scotomas, usually bilateral and often homonymous, can occur during a classic migraine aura. Besides pain, characteristic associated symptoms include paresthesia of the lips, face, or hands; slight confusion; dizziness; and photophobia.
Optic neuritis:
Inflammation, degeneration, or demyelination of the optic nerve produces a central, circular, or centrocecal scotoma. The scotoma may be unilateral with involvement of one nerve, or bilateral with involvement of both nerves. It can vary in size, density, and symmetry. The patient may report severe visual loss or blurring, lasting up to 3 weeks, and pain especially with eye movement. Common ophthalmoscopic findings include hyperemia of the optic disk, retinal vein distention, blurred disk margins, and filling of the physiologic cup.
Retinal pigmentary degenerations:
These disorders cause premature retinal cell changes leading to cell death. One disorder, retinitis pigmentosa, initially involves loss of peripheral rods; the resulting annular scotoma progresses concentrically until only a central field of vision (tunnel vision) remains. The earliest symptom impaired night vision appears during adolescence. Associated signs include narrowing of the retinal blood vessels and pallor of the optic disk. Eventually, with invasion of the macula, blindness may occur.
Homoeopathic approach:
Graphites:
Phlyctenular ophthalmia.
It is one of our best remedies in vesicles on the cornea and ulceration in scrofulous children; there is intense burning, lachrymation; the canthi crack and bleed.
Scrofulous ophthalmia with tendency to wild hairs.
It is a specific in blepharitis than any other.
Graphites is the great remedy in "gummed up, photophobia eyes." and it is most useful in blepharitis, especially in eczematous subjects or following measles.
Ammoniacum :
This remedy stands between Belladonna and Ruta in asthenopia; the eyes smart and burn, especially when used at night by light.
Asarum:
Eyes feel stiff and burn or feel cold, better when in cold air, or bathed in cold water, worse in the sunlight.
Ruta:
Is also a most a valuable remedy for affections of the eyes from overwork, where every tissue of the eye is irritable.
Eyes burn, feel hot like balls of fire.
Onosmodium:
It is a very useful remedy in eye strain, with dull, heavy , sore, aching eyes.
No inflammatory troubles but patient is troubled with headaches and weakness.
The remedy gives prompt relief to many annoying symptoms.
Hyperaemic conditions from continuous fine work, as in seamstresses.
Also to be remembered in cataract. Objects look yellow.
Natrum muriaticum:
A fine remedy in asthenopia, there is weakness of the internal recti, the eyes feel stiff while moving them, letters run together.
It is also a valuable remedy in scrofulous ophthalmia with acrid tears and spasmodic closure of lids, in ulcers with inflamed eyes agglutinated in the morning, and in fistula lachrymalis.
It suits scrofulous children having eruptions on border of hairy scalp.
Arsenicum:
Here the great characteristic is burning, as if from fire, burning discharges relieved by warmth, intermittent pains, ulcerations of cornea, running a rapid course with a high degree of inflammation.
It is useful in obstinate cases of ophthalmia of he strumous variety when other remedies fail.
Useful in glaucoma with periodical exacerbation of the pain which is intense and burning.
Nitric acid :
It is often indispensable in ophthalmia neonatorum, but its main use is in superficial ulcers of the cornea with splinter-like pains.
It is also considered to be one of our best remedies in corneal opacities.