It has been said that one should be a good general man in order to be a
competent specialist. This is especially true in regard to ophthalmic
therapeutics. Many systemic diseases have eye symptoms and pathology.
The same blood and lymph that nourishes and bathes different parts
of the body, also circulates in the structures of the eye. In the
examination of the eye, heredity, occupation and environment are to be
taken into consideration. Osteopathic lesions may exist from falls,
strains, twists, blows, colds and exposure and impair the integrity
of the metabolic processes of the eye through the nerve connections
and blood supply and lay the foundation for a great variety of eye
diseases. With these lesions existing about the neck and upper dorsal,
it is only required to have some insignificant local irritant to start
symptoms and cause pathology apparently out of all proportion to the
etiology. It is important then that one understand the nerve centers
and reflexes and the osteopathic logic underlying these conditions or
else he must frequently work without a satisfactory explanation of the
etiology and consequently be more or less unscientific in his treatment.
The eye examination should consist of the case history, the family
history, inspection, osteopathic examination, especially from the
fourth dorsal vertebra to the occiput and especial examination of the
eye by inspection and other methods.
=1. The Case History.=—Thoroughness of the doctor, or the lack of it,
will be readily displayed at this point. Every little thing, as far
as possible, that has a bearing on the case should be observed and
uncovered in the case history. The physician should want to know every
fact that helps him to better understand his case. Patience in hearing
the history will often be of great assistance. It gives light on the
physical and mental condition of the patient. Much can be gained by
being careful and attentive. Notice carefully what he emphasizes and
what he thinks is the most important. Inquire in regard to headaches,
nervous symptoms, previous eye trouble and past illnesses. Get a
venereal history if present, as many eye diseases are complicated or
caused by syphilis or gonorrhea.
=2. The Family History.=—Inquire as to blindness in the family and
about the age it occurred, if any. Get a venereal history if possible.
=3. Inspection.=—Much inspection can go on while the history is being
taken. Observe the countenance, whether there is strabismus or frowning
due to eye strain, photophobia as suggested by the effort to avoid the
light; note symmetry. Look closely at the lashes, lids, conjunctiva,
cornea and iris. Note any scales or crusts on the lids at the root of
the lashes. Turn the lids for further inspection. Note the size and
relation of the eyes. Exophthalmos may be due to an enlarged globe
in high myopia, to Graves’ disease, orbital tumor and paralysis of
the extrinsic muscles, or staphyloma. In blepharospasm there may be a
corneal ulcer or a rupture of the eyeball. An exact examination must
be made at the first visit in order for a diagnosis to institute the
best treatment possible. Study the conjunctival sac for congestions,
hypertrophy, swelling, tumors, foreign bodies, trachoma bodies and
secretions. In all forms of conjunctivitis the congestion is most
marked in the fornix and decreases toward the sclerocorneal junction.
In iritis and cyclitis there is a circumcorneal injection, a pink or
red color radiating from the cornea. Note any corneal pathology in the
way of ulcers or abrasions and foreign bodies. Compare the tension of
the eyes.
=4. The Osteopathic Examination of the Eye.=—This heading is put
here in order to show what osteopathy has to offer that is distinct
as belonging to our system and not practiced by any other school.
Osteopathic research so far has shown that osteopathic science has much
to offer on etiology and diagnosis and treatment in eye diseases. The
case history, family history and inspection should require but a few
minutes but they are essential to a proper examination and may aid us
in what to expect osteopathically. Weak nerves will cause asthenopia.
A broken arch, an innominate lesion or a slipped axis may cause weak
nerves. The osteopathic eye examination then should consider the whole
mechanism of the body. In case glasses are being worn for asthenopia
they may readily be made unnecessary by osteopathic treatment in
the correction of the lesions and building up the system. Some time
ago some parents sent their daughter to me to have her eyes fitted
for glasses. They stated that she had been to different doctors and
opticians and no one had ever given satisfaction. They said she was all
right every other way if her eyes were properly fitted with glasses.
They did not want her examined or treated otherwise because she would
be well every other way with correct glasses. Her vision was right
eye 5-20, left eye 5-15 or about one fourth vision in each eye. A
plus .87 diopter sphere combined with a plus 3 diopter cylinder in
axis 90 gave her perfectly normal 5-5 vision in each eye. This gave
her perfect satisfaction until she started to school in September,
a couple of months later. Before the end of the first month she was
having trouble with her eyes and was again sent to me by her parents.
Her vision was reduced to 6-15 in each eye with her glasses on. She
wondered and no doubt the parents did, if it was not another case of a
misfit in glasses similar to all her previous experiences. This time I
insisted upon a thorough physical examination against all protest. The
following lesions were discovered: the left innominate was up and back
or tilted posteriorly, first lumbar anterior and to the right, sixth
and first dorsals to the right. The case was not refracted again. I
took particular care the first time and I was quite sure the refractive
error was corrected. It was all explained to the parents and regular
osteopathic treatment was begun. In less than a month practically
every lesion was corrected, her vision returned to normal and she also
was cured of an annoying backache with which she had been bothered
for years. Her nerves were depleted a great deal. She got benefit in
ways that she had not dreamed of. This approach to the eye is not
considered by physicians in general, even the oculists. I have had
about ten special courses in medical colleges and hospitals on the eye,
ear, nose and throat, and I have never heard anything mentioned that
would indicate any ideas of the logic involved in this case. Surely
osteopathy has much to offer in eye troubles that is new and unique.
The osteopathic examination of the eye then should begin with the
feet, going then to the innominates, lumbar, dorsal, ribs and cervical
regions. Oculists are too prone to rely upon crutches (glasses) in the
treatment of asthenopia.
It is easy for the osteopath to conceive how lesions of the upper
dorsal and cervical regions may occur and disturb the nerve and blood
supply to the eye. This is why asthenopia appears so frequently with
ordinary use of the eyes, even without abuse or refractive errors.