Glaucoma Health Dictionary

A plant alkaloid and the primary bioactive substance reducible from Pilocarpus spp. (Jaborandi leaves). It is an almost pure parasympathomimetic (cholinergic), inducing lowered blood pressure and stimulating glandular secretions...EVERYWHERE. It stimulates sweating as well, a sympathetic cholinergic response. Anyway, it is used in eye drops these days to contract the pupil, lower ocular fluid pressure and take some of the stress off glaucoma. The refined alkaloid is better in the eyes, but the dried leaves are the usual complex agents of herb use and have some therapeutic values in low doses. Good Lobelia or Asclepias will work similarly and are both safer, fresher and more predictable as botanicals.... pilocarpine

Acetazolamide is a sulphonamide drug which acts by inhibiting the ENZYME, carbonic anhydrase. This enzyme is of great importance in the production of acid and alkaline secretions in the body. Acetazolamide is sometimes used as a second-line drug for partial seizures in EPILEPSY. It also has a diuretic action (see DIURETICS) and is used to treat GLAUCOMA. The drug has a range of side-effects. Related agents include dorzolamide and brinzolamide, used as eye-drops in patients resistant to beta blockers or who have contraindications to them.... acetazolamide

The statutory de?nition – for the purposes of registration as a blind person under the National Assistance Act 1948 – is that the person is ‘so blind as to be unable to perform any work for which eyesight is essential’. Generally this is vision worse than 6/60 in the better eye, or with better acuity than this but where ‘the ?eld of vision is markedly contracted in the greater part of its extent’. Partial sight has no statutory de?nition, but there are o?cial guidelines for registering a person as partially sighted: generally these are a corrected visual acuity of 3/ 60 or less in the better eye with some contraction of the peripheral ?eld, or better with gross ?eld defects. In the UK more than 100,000 people are registered as legally blind and some 50,000 as partially sighted. The World Health Organisation has estimated that there are over 40 million binocularly blind people in the world. The causes of blindness vary with age and degree of development of the country. In western society the commonest causes are glaucoma, diabetic retinopathy, other retinal diseases and senile cataract. (See also VISION.)

Any blind person, or his or her relatives, can obtain help and advice from the Royal National Institute for the Blind (www.rnib.org.uk).

Night blindness An inability to see in the dark. It can be associated with retinitis pigmentosa or vitamin A de?ciency (see EYE, DISORDERS OF).... blindness

An osmotic diuretic (see DIURETICS) given by a slow intravenous infusion to reduce OEDEMA of the BRAIN or raised intraocular pressure in GLAUCOMA.... mannitol

A drug that curbs the action of an ENZYME in the blood controlling the production of carbonic acid or bicarbonate from CARBON DIOXIDE (CO2). Called carbonic anhydrase, the enzyme is present in ERYTHROCYTES and it has a key part in maintaining the acid-base balance in the blood. Inhibiting drugs include ACETAZOLAMIDE and DORZOLAMIDE, and these are used as weak DIURETICS to reduce the increased intraocular pressure in ocular hypertension or open-angle GLAUCOMA (see EYE, DISORDERS OF).... carbonic anhydrase inhibitor

A carbonic anhydrase-inhibitor drug restricted to use in patients with raised intraocular pressure in ocular hypertension or open-angle GLAUCOMA. It can be used alone or as an adjunct to a topical beta blocker (see BETA-ADRENOCEPTOR-BLOCKING DRUGS).... dorzolamide

Arcus senilis The white ring or crescent which tends to form at the edge of the cornea with age. It is uncommon in the young, when it may be associated with high levels of blood lipids (see LIPID).

Astigmatism (See ASTIGMATISM.)

Blepharitis A chronic in?ammation of the lid margins. SEBORRHOEA and staphylococcal infection are likely contributors. The eyes are typically intermittently red, sore and gritty over months or years. Treatment is di?cult and may fail. Measures to reduce debris on the lid margins, intermittent courses of topical antibiotics, steroids or systemic antibiotics may help the sufferer.

Blepharospasm Involuntary closure of the eye. This may accompany irritation but may also occur without an apparent cause. It may be severe enough to interfere with vision. Treatment involves removing the source of irritation, if present. Severe and persistent cases may respond to injection of Botulinum toxin into the orbicularis muscle.

Cataract A term used to describe any opacity in the lens of the eye, from the smallest spot to total opaqueness. The prevalence of cataracts is age-related: 65 per cent of individuals in their sixth decade have some degree of lens opacity, while all those over 80 are affected. Cataracts are the most important cause of blindness worldwide. Symptoms will depend on whether one or both eyes are affected, as well as the position and density of the cataract(s). If only one eye is developing a cataract, it may be some time before the person notices it, though reading may be affected. Some people with cataracts become shortsighted, which in older people may paradoxically ‘improve’ their ability to read. Bright light may worsen vision in those with cataracts.

The extent of visual impairment depends on the nature of the cataracts, and the ?rst symptoms noticed by patients include di?culty in recognising faces and in reading, while problems watching television or driving, especially at night, are pointers to the condition. Cataracts are common but are not the only cause of deteriorating vision. Patients with cataracts should be able to point to the position of a light and their pupillary reactions should be normal. If a bright light is shone on the eye, the lens may appear brown or, in advanced cataracts, white (see diagram).

While increasing age is the commonest cause of cataract in the UK, patients with DIABETES MELLITUS, UVEITIS and a history of injury to the eye can also develop the disorder. Prolonged STEROID treatment can result in cataracts. Children may develop cataracts, and in them the condition is much more serious as vision may be irreversibly impaired because development of the brain’s ability to interpret visual signals is hindered. This may happen even if the cataracts are removed, so early referral for treatment is essential. One of the physical signs which doctors look for when they suspect cataract in adults as well as in children is the ‘red re?ex’. This is observable when an ophthalmoscopic examination of the eye is made (see OPHTHALMOSCOPE). Identi?cation of this red re?ex (a re?ection of light from the red surface of the retina –see EYE) is a key diagnostic sign in children, especially young ones.

There is no e?ective medical treatment for established cataracts. Surgery is necessary and the decision when to operate depends mainly on how the cataract(s) affect(s) the patient’s vision. Nowadays, surgery can be done at any time with limited risk. Most patients with a vision of 6/18 – 6/10 is the minimum standard for driving – or worse in both eyes should

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bene?t from surgery, though elderly people may tolerate visual acuity of 6/18 or worse, so surgery must be tailored to the individual’s needs. Younger people with a cataract will have more demanding visual requirements and so may opt for an ‘earlier’ operation. Most cataract surgery in Britain is now done under local anaesthetic and uses the ‘phaco-emulsi?cation’ method. A small hole is made in the anterior capsule of the lens after which the hard lens nucleus is liqui?ed ultrasonically. A replacement lens is inserted into the empty lens bag (see diagram). Patients usually return to their normal activities within a few days of the operation. A recent development under test in the USA for children requiring cataract operations is an intra-ocular ?exible implant whose magnifying power can be altered as a child develops, thus precluding the need for a series of corrective operations as happens now.

Chalazion A ?rm lump in the eyelid relating to a blocked meibomian gland, felt deep within the lid. Treatment is not always necessary; a proportion spontaneously resolve. There can be associated infection when the lid becomes red and painful requiring antibiotic treatment. If troublesome, the chalazion can be incised under local anaesthetic.

Conjunctivitis In?ammation of the conjunctiva (see EYE) which may affect one or both eyes. Typically the eye is red, itchy, sticky and gritty but is not usually painful. Redness is not always present. Conjunctivitis can occasionally be painful, particularly if there is an associated keratitis (see below) – for example, adenovirus infection, herpetic infection.

The cause can be infective (bacteria, viruses or CHLAMYDIA), chemical (e.g. acids, alkalis) or allergic (e.g. in hay fever). Conjunctivitis may also be caused by contact lenses, and preservatives or even the drugs in eye drops may cause conjunctival in?ammation. Conjunctivitis may addtionally occur in association with other illnesses – for example, upper-respiratory-tract infection, Stevens-Johnson syndrome (see ERYTHEMA – erythema multiforme) or REITER’S SYNDROME. The treatment depends on the cause. In many patients acute conjunctivitis is self-limiting.

Dacryocystitis In?ammation of the lacrimal sac. This may present acutely as a red, painful swelling between the nose and the lower lid. An abscess may form which points through the skin and which may need to be drained by incision. Systemic antibiotics may be necessary. Chronic dacryocystitis may occur with recurrent discharge from the openings of the tear ducts and recurrent swelling of the lacrimal sac. Obstruction of the tear duct is accompanied by watering of the eye. If the symptoms are troublesome, the patient’s tear passageways need to be surgically reconstructed.

Ectropion The lid margin is everted – usually the lower lid. Ectropion is most commonly associated with ageing, when the tissues of the lid become lax. It can also be caused by shortening of the skin of the lids such as happens with scarring or mechanical factors – for example, a tumour pulling the skin of the lower lid downwards. Ectropion tends to cause watering and an unsightly appearance. The treatment is surgical.

Entropion The lid margin is inverted – usually the lower lid. Entropion is most commonly associated with ageing, when the tissues of the lid become lax. It can also be caused by shortening of the inner surfaces of the lids due to scarring – for example, TRACHOMA or chemical burns. The inwardly directed lashes cause irritation and can abrade the cornea. The treatment is surgical.

Episcleritis In?ammation of the EPISCLERA. There is usually no apparent cause. The in?ammation may be di?use or localised and may affect one or both eyes. It sometimes recurs. The affected area is usually red and moderately painful. Episcleritis is generally not thought to be as painful as scleritis and does not lead to the same complications. Treatment is generally directed at improving the patient’s symptoms. The in?ammation may respond to NON-STEROIDAL ANTI-INFLAMMATORY DRUGS (NSAIDS) or topical CORTICOSTEROIDS.

Errors of refraction (Ametropia.) These will occur when the focusing power of the lens and cornea does not match the length of the eye, so that rays of light parallel to the visual axis are not focused at the fovea centralis (see EYE). There are three types of refractive error: HYPERMETROPIA or long-sightedness. The refractive power of the eye is too weak, or the eye is too short so that rays of light are brought to a focus at a point behind the retina. Longsighted people can see well in the distance but generally require glasses with convex lenses for reading. Uncorrected long sight can lead to headaches and intermittent blurring of vision following prolonged close work (i.e. eye strain). As a result of ageing, the eye becomes gradually long-sighted, resulting in many people needing reading glasses in later life: this normal process is known as presbyopia. A particular form of long-sightedness occurs after cataract extraction (see above). MYOPIA(Short sight or near sight.) Rays of light are brought to a focus in front of the retina because the refractive power of the eye is too great or the eye is too short. Short-sighted people can see close to but need spectacles with concave lenses in order to see in the distance. ASTIGMATISMThe refractive power of the eye is not the same in each meridian. Some rays of light may be focused in front of the retina while others are focused on or behind the retina. Astigmatism can accompany hypermetropia or myopia. It may be corrected by cylindrical lenses: these consist of a slice from the side of a cylinder (i.e. curved in one meridian and ?at in the meridian at right-angles to it).

Keratitis In?ammation of the cornea in response to a variety of insults – viral, bacterial, chemical, radiation, or mechanical trauma. Keratitis may be super?cial or involve the deeper layers, the latter being generally more serious. The eye is usually red, painful and photophobic. Treatment is directed at the cause.

Nystagmus Involuntary rhythmic oscillation of one or both eyes. There are several causes including nervous disorders, vestibular disorders, eye disorders and certain drugs including alcohol.

Ophthalmia In?ammation of the eye, especially the conjunctiva (see conjunctivitis, above). Ophthalmia neonatorum is a type of conjunctivitis that occurs in newborn babies. They catch the disease when passing through an infected birth canal during their mother’s labour (see PREGNANCY AND LABOUR). CHLAMYDIA and GONORRHOEA are the two most common infections. Treatment is e?ective with antibiotics: untreated, the infection may cause permanent eye damage.

Pinguecula A benign degenerative change in the connective tissue at the nasal or temporal limbus (see EYE). This is visible as a small, ?attened, yellow-white lump adjacent to the cornea.

Pterygium Overgrowth of the conjunctival tissues at the limbus on to the cornea (see EYE). This usually occurs on the nasal side and is associated with exposure to sunlight. The pterygium is surgically removed for cosmetic reasons or if it is thought to be advancing towards the visual axis.

Ptosis Drooping of the upper lid. May occur because of a defect in the muscles which raise the lid (levator complex), sometimes the result of ageing or trauma. Other causes include HORNER’S SYNDROME, third cranial nerve PALSY, MYASTHENIA GRAVIS, and DYSTROPHIA MYOTONICA. The cause needs to be determined and treated if possible. The treatment for a severely drooping lid is surgical, but other measures can be used to prop up the lid with varying success.

Retina, disorders of The retina can be damaged by disease that affects the retina alone, or by diseases affecting the whole body.

Retinopathy is a term used to denote an abnormality of the retina without specifying a cause. Some retinal disorders are discussed below. DIABETIC RETINOPATHY Retinal disease occurring in patients with DIABETES MELLITUS. It is the commonest cause of blind registration in Great Britain of people between the ages of 20 and 65. Diabetic retinopathy can be divided into several types. The two main causes of blindness are those that follow: ?rst, development of new blood vessels from the retina, with resultant complications and, second, those following ‘water logging’ (oedema) of the macula. Treatment is by maintaining rigid control of blood-sugar levels combined with laser treatment for certain forms of the disease – in particular to get rid of new blood vessels. HYPERTENSIVE RETINOPATHY Retinal disease secondary to the development of high blood pressure. Treatment involves control of the blood pressure (see HYPERTENSION). SICKLE CELL RETINOPATHY People with sickle cell disease (see under ANAEYIA) can develop a number of retinal problems including new blood vessels from the retina. RETINOPATHY OF PREMATURITY (ROP) Previously called retrolental ?broplasia (RLF), this is a disorder affecting low-birth-weight premature babies exposed to oxygen. Essentially, new blood vessels develop which cause extensive traction on the retina with resultant retinal detachment and poor vision. RETINAL ARTERY OCCLUSION; RETINAL VEIN OCCLUSION These result in damage to those areas of retina supplied by the affected blood vessel: the blood vessels become blocked. If the peripheral retina is damaged the patient may be completely symptom-free, although areas of blindness may be detected on examination of ?eld of vision. If the macula is involved, visual loss may be sudden, profound and permanent. There is no e?ective treatment once visual loss has occurred. SENILE MACULAR DEGENERATION (‘Senile’ indicates age of onset and has no bearing on mental state.) This is the leading cause of blindness in the elderly in the western world. The average age of onset is 65 years. Patients initially notice a disturbance of their vision which gradually progresses over months or years. They lose the ability to recognise ?ne detail; for example, they cannot read ?ne print, sew, or recognise people’s faces. They always retain the ability to recognise large objects such as doors and chairs, and are therefore able to get around and about reasonably well. There is no e?ective treatment in the majority of cases. RETINITIS PIGMENTOSAA group of rare, inherited diseases characterised by the development of night blindness and tunnel vision. Symptoms start in childhood and are progressive. Many patients retain good visual acuity, although their peripheral vision is limited. One of the characteristic ?ndings on examination is collections of pigment in the retina which have a characteristic shape and are therefore known as ‘bone spicules’. There is no e?ective treatment. RETINAL DETACHMENTusually occurs due to the development of a hole in the retina. Holes can occur as a result of degeneration of the retina, traction on the retina by the vitreous, or injury. Fluid from the vitreous passes through the hole causing a split within the retina; the inner part of the retina becomes detached from the outer part, the latter remaining in contact with the choroid. Detached retina loses its ability to detect light, with consequent impairment of vision. Retinal detachments are more common in the short-sighted, in the elderly or following cataract extraction. Symptoms include spots before the eyes (?oaters), ?ashing lights and a shadow over the eye with progressive loss of vision. Treatment by laser is very e?ective if caught early, at the stage when a hole has developed in the retina but before the retina has become detached. The edges of the hole can be ‘spot welded’ to the underlying choroid. Once a detachment has occurred, laser therapy cannot be used; the retina has to be repositioned. This is usually done by indenting the wall of the eye from the outside to meet the retina, then making the retina stick to the wall of the eye by inducing in?ammation in the wall (by freezing it). The outcome of surgery depends largely on the extent of the detachment and its duration. Complicated forms of detachment can occur due to diabetic eye disease, injury or tumour. Each requires a specialised form of treatment.

Scleritis In?ammation of the sclera (see EYE). This can be localised or di?use, can affect the anterior or the posterior sclera, and can affect one or both eyes. The affected eye is usually red and painful. Scleritis can lead to thinning and even perforation of the sclera, sometimes with little sign of in?ammation. Posterior scleritis in particular may cause impaired vision and require emergency treatment. There is often no apparent cause, but there are some associated conditions – for example, RHEUMATOID ARTHRITIS, GOUT, and an autoimmune disease affecting the nasal passages and lungs called Wegener’s granulomatosis. Treatment depends on severity but may involve NON-STEROIDAL ANTI-INFLAMMATORY DRUGS (NSAIDS), topical CORTICOSTEROIDS or systemic immunosuppressive drugs.

Stye Infection of a lash follicle. This presents as a painful small red lump at the lid margin. It often resolves spontaneously but may require antibiotic treatment if it persists or recurs.

Sub-conjunctival haemorrhage Haemorrhage between the conjunctiva and the underlying episclera. It is painless. There is usually no apparent cause and it resolves spontaneously.

Trichiasis Inward misdirection of the lashes. Trichiasis occurs due to in?ammation of or trauma to the lid margin. Treatment involves removal of the patient’s lashes. Regrowth may be prevented by electrolysis, by CRYOTHERAPY to the lid margin, or by surgery.

For the subject of arti?cial eyes, see under PROSTHESIS; also GLAUCOMA, SQUINT and UVEITIS.... eye, disorders of

The operation by which a hole is made in the iris of the EYE – as, for example, in the treatment of GLAUCOMA or as part of CATARACT surgery.... iridectomy

An analogue of prostaglandin (see PROSTAGLANDINS), used to treat open-angled GLAUCOMA and raised intra-ocular pressure in the EYE. Delivered as an eye drop, the drug is used in patients who cannot tolerate, or who fail to respond to, other treatments.... latanoprost

A drug that stimulates the PARASYMPATHETIC NERVOUS SYSTEM. The actions of such drugs resemble those of ACETYLCHOLINE. Those cholinergic actions include stimulation of musculoskeletal muscle, reduction in the heart rate, greater tension in involuntary (or smooth) muscle, increasing glandular secretions such as saliva, and constriction of the pupil of the EYE. MYASTHENIA GRAVIS, GLAUCOMA, certain disorders of the cardiovascular system, and intestinal or bladder malfunction are among the conditions for which cholinergic drugs are prescribed.... parasympathomimetic

A hormone, also called epinephrine, released by the adrenal glands in response to signals from the sympathetic autonomic nervous system. These signals are triggered by stress, exercise, or by an emotion such as fear.

Adrenaline increases the speed and force of the heartbeat. It widens the airways to improve breathing and narrows blood vessels in the skin and intestine so that an increased flow of blood reaches the muscles.

Synthetic adrenaline is sometimes given by injection as an emergency treatment for cardiac arrest or anaphylactic shock.

Adrenaline eye drops may be used to treat glaucoma, but regular use can cause a burning pain in the eye.... adrenaline

A large, prominent eyeball in an infant as a result of increased

pressure inside the eyeball due to congenital glaucoma.

Treatment of the condition usually involves surgery to reduce the pressure, otherwise the child’s sight is progressively damaged.... buphthalmos

Also known as eserine. An alkaloid (see ALKALOIDS) obtained from Calabar bean, the seed of Physostigma venenosum, a climbing plant of West Africa. Its action depends on the presence of two alkaloids, the one known as physostigmine or eserine, the other as calabarine, the former of these being much the more important.

Action Physostigmine produces the same e?ect as stimulation of the PARASYMPATHETIC NERVOUS SYSTEM: i.e. it constricts the pupil of the eye, stimulates the gut, increases the secretion of saliva, stimulates the bladder, and increases the irritability of voluntary muscle. In poisonous doses it brings on a general paralysis.

Uses It is used in medicine in the form of eye drops or ointment to treat GLAUCOMA.... physostigmine

A beta-blocker drug used to treat hypertension and angina pectoris.

Timolol may also be given after a myocardial infarction.

It is used as eye-drops to treat glaucoma.

Possible side effects, such as cold hands and feet, are typical of other beta-blockers.

Eye-drops may cause irritation, blurred vision, and headache.... timolol

A surgical procedure to control glaucoma by allowing the fluid from the front chamber of the eye to drain out under the conjunctiva.... trabeculectomy

Loss of the peripheral visual field to the extent that only objects straight ahead can be seen clearly. Tunnel vision is most commonly caused by chronic glaucoma. Retinitis pigmentosa is another possible cause.... tunnel vision

The total area in which visual perception is possible while a person is looking straight ahead.

The visual fields normally extend outwards over an angle of about 90 degrees on either side of the midline of the face, but are more restricted above and below, especially if the eyes are deep-set or the eyebrows are prominent.

The visual fields of the 2 eyes overlap to a large extent, giving binocular vision.

Partial loss of the visual field may occur in glaucoma or stroke.... visual field

Lindl.

Synonym: A. belladonna auct. non L.

Family: Solanaceae.

Habitat: Kashmir and Himachal Pradesh up to 2,500 m.

English: Indian Belladonna, Indian Atropa.

Ayurvedic: Suuchi.

Unani: Luffaah, Luffaah-Barri, Yabaruj, Shaabiraj.

Action: Highly poisonous; sedative, narcotic, anodyne, nervine, antispasmodic (used in paralysis); parkinsonism; encephalitis; carcinoma; spastic dysmenorrhoea; whooping cough, spasmodic asthma; colic of intestines, gall bladder or kidney, spasm of bladder and ureters; contraindicated in enlarged prostate.

Key application: In spasm and colic-like pain in the areas of the gastrointestinal tract and bile ducts. (German Commission E, The British Herbal Pharmacopoeia.) It is contraindicated in tachycardiac arrhythmias, prostate adenoma, glaucoma, acute oedema of lungs.

A. belladonna L. (European sp. Belladonna, Deadly Nightshade) is cultivated in Kashmir and Himachal Pradesh.

The herb contains tropane (tropine) or solanaceous alkaloids (up to 0.6%), including hyoscamine and atropine; flavonoids; coumarins; volatile bases (nicotine).

Tropane alkaloids inhibit the para- sympathetic nervous system, which controls involuntary bodily activities; reduces saliva, gastric, intestinal and bronchial secretions, and also the activity of urinary tubules. Tropane alkaloids also increase the heart rate and dilate the pupils. These alkaloids are used as an additive to compound formulations for bronchitis, asthma, whooping cough, gastrointestinal hy- permotility, dysmenorrhoea, nocturnal enuresis and fatigue syndrome.

Atropine provides relief in parkin- sonism and neurovegetative dystonia.

The root is the most poisonous, the leaves and flowers less, and the berries the least. (Francis Brinker.)

Dosage: Leaf, root—30-60 mg powder. (CCRAS.)... atropa acuminata royle ex

Linn. var.

rapa (L.) Hartm.

Family: Cruciferae; Brassicaceae.

Habitat: Cultivated as an oil-yielding crop.

English: Field Mustard, Turnip Rape.

Ayurvedic: Sarshapa, Siddhaartha.

Unani: Sarson.

Siddha/Tamil: Kadugu.

Action: Stimulant, diuretic, emetic, rubefacient, counter-irritant. Used externally for bronchitis and rheumatic pains (increases flow of blood to a specific area). Powdered seeds are used as a tea for colds, influenza and fever.

The seeds contain glycosinolates (the derivatives are responsible for tox- icity). The concentration of the major glucosinolate, gluco-napin, varies from 0.64 to 1.8% in the oil-free meal of Indian brassicas. The glucosinolates in rapeseed meal split upon enzymatic hydrolysis to produce glucose, potassium, hydrogen sulphate and a sulphur- containing compound which undergoes intramolecular rearrangement to give rise to the antinutritional factors, isothiocyanates or thiocyanates.

The volatile oil of mustard is given internally in colic; in overdoses it is highly poisonous and produces gastro- enteric inflammations. It is employed externally as a liniment for rheumatic pains.

Adulteration of mustard oil with argemone oil (Argemone mexicana is frequently found growing in brassica fields), by accident or by design, has led to the widespread epidemics of dropsy and glaucoma due to an alkaloid sanguinarine.

Black mustard contains sinigrin, which on hydrolysis by enzyme my- rosin, produces allyisothiocynate; the white mustard contains sinalbin, which produces p-hydroxybenzyl isothiocy- nate. Mucilage contains sinapine.

Dosage: Seed—500 mg to 1 g paste. (API Vol. III.)... brassica campestris

A drug which stimulates the parasympathetic nervous system, for example, for relieving GLAUCOMA and retention of urine due to ATONY.... carbachol

Also called beta blockers, these drugs interrupt the transmission of neuronal messages via the body’s adrenergic receptor sites. In the HEART these are called beta1 (cardioselective) receptors. Another type – beta2 (non-cardioselective) receptors – is sited in the airways, blood vessels, and organs such as the eye, liver and pancreas. Cardioselective beta blockers act primarily on beta1 receptors, whereas non-cardioselective drugs act on both varieties, beta1 and beta2. (The neurotransmissions interrupted at the beta-receptor sites through the body by the beta blockers are initiated in the ADRENAL GLANDS: this is why these drugs are sometimes described as beta-adrenergic-blocking agents.)

They work by blocking the stimulation of beta adrenergic receptors by the neurotransmitters adrenaline and noradrenaline, which are produced at the nerve endings of that part of the SYMPATHETIC NERVOUS SYSTEM – the autonomous (involuntary) network

– which facilitates the body’s reaction to anxiety, stress and exercise – the ‘fear and ?ight’ response.

Beta1 blockers reduce the frequency and force of the heartbeat; beta2 blockers prevent vasodilation (increase in the diameter of blood vessels), thus in?uencing the patient’s blood pressure. Beta1 blockers also affect blood pressure, but the mechanism of their action is unclear. They can reduce to normal an abnormally fast heart rate so the power of the heart can be concomitantly controlled: this reduces the oxygen requirements of the heart with an advantageous knock-on e?ect on the respiratory system. These are valuable therapeutic effects in patients with ANGINA or who have had a myocardial infarction (heart attack – see HEART, DISEASES OF), or who suffer from HYPERTENSION. Beta2 blockers reduce tremors in muscles elsewhere in the body which are a feature of anxiety or the result of thyrotoxicosis (an overactive thyroid gland – see under THYROID GLAND, DISEASES OF). Noncardioselective blockers also reduce the abnormal pressure caused by the increase in the ?uid in the eyeball that characterises GLAUCOMA.

Many beta-blocking drugs are now available; minor therapeutic di?erences between them may in?uence the choice of a drug for a particular patient. Among the common drugs are:

Primarily cardioselective	Non-cardioselective
Acebutolol	Labetalol
Atenolol	Nadolol
Betaxolol	Oxprenolol
Celiprolol	Propanolol
Metoprolol	Timolol

These powerful drugs have various side-effects and should be prescribed and monitored with care. In particular, people who suffer from asthma, bronchitis or other respiratory problems may develop breathing diffculties. Long-term treatment with beta blockers should not be suddenly stopped, as this may precipitate a severe recurrence of the patient’s symptoms – including, possibly, a sharp rise in blood pressure. Gradual withdrawal of medication should mitigate untoward effects.... beta-adrenoceptor-blocking drugs

Linn.

Synonym: C. indica Linn.

Family: Cannabinaceae.

Habitat: Cultivated all over the country. Commonly occurs in waste grounds, along road side, often becoming gregarious along the irrigation channels of gardens.

English: Hemp, Indian Hemp.

Ayurvedic: Vijayaa, Bhangaa, Maadani, Maatulaani, Indraasana, Trailokya-vijayaa, Tribhuvana- vijayaa, Shukranaashana, Ganjaa, Bhangaa. (Bhangaa is consumed orally; Ganjaa and charas are usually smoked.)

Unani: Bhang, Charas, Qinnab.

Siddha/Tamil: Ganja.

Folk: Bhaanga.

Action: Hallucinogenic, hypnotic, sedative, analgesic, anti- inflammatory, Hemp derivatives are suggested for treating glaucoma and as an antiemetic in cancer chemotherapy. All variants produce initial excitement followed by depression.

Cannabis yields 421 chemicals of various classes—cannabinoids, canna- bispirans and alkaloids. More than 60 cannabinoids have been isolated, the most important one is delta-9- tetrahydrocannabinol (THC).

Toxic constituents are readily absorbed, excreted in urine and feces, stored in lipid tissues, especially CNS, crosses placenta. High doses in animals have damaged developing embryos and resulted in birth defects. (Francis Brinker.)

Dosage: Dried leaves, after removing turbity—125-250 mg powder. (API Vol. I.)... cannabis sativa

One of the ANTIARRHYTHMIC DRUGS given by intravenous injection after myocardial infarction to restore supraventricular and ventricular arrhythmias to normal, particularly when patients have not responded to lidocaine (lignocaine). It can impair the contractility of heart muscle and it does have an antimuscarinic e?ect (see ANTIMUSCARINE); consequently its administration has to be undertaken with care, especially in patients with GLAUCOMA or enlargement.... disopyramide

Coleus spp.

Lamiaceae

The genus Coleus of the family Lamiaceae (Labiatae) comprises a number of herbaceous medicinal plants which are particularly employed in home remedies for various ailments. Three species are most popular and commonly cultivated. They are Coleus aromaticus, C. vettiveroides and C. forkoshlii.

1. Coleus aromaticus Benth. syn. C. amboinicus Lour., Plectranthus amboinicus (Lour.) Spreng.

Eng: Country borage, Indian borage;

San: Karpuravalli, Sugandhavalakam;

Hin: Patharchur;

Ben: Paterchur;

Mal: Panikkurkka, kannikkurkka;

Tam: Karpuravalli;

Kan: karpurahalli;

Tel: Sugandhavalkam.

It is found through out the tropics and cultivated in homestead gardens. It is a large succulent aromatic perennial herb with hispidly villous or tomentose fleshy stem. Leaves are simple, opposite, broadly ovate, crenate and fleshy. Flowers are pale purplish in dense whorls at distant intervals in a long slender raceme. Fruits are orbicular or ovoid nutlets. The leaves are useful in cephalagia, otalgia, anorexia, dyspepsia, flatulence, colic, diarrhoea, cholera, halitosis, convulsions, epilepsy, cough, asthma, hiccough, bronchitis, strangury, hepatopathy and malarial fever (Warrier et al,1995).

2. Coleus vettiveroides K.C. Jacob, syn. Plectranthus vettiveroides (Jacob) Singh & Sharma.

San: Valakam, Hriberam;

Hin: Valak;

Mal: Iruveli;

Tam: Karuver;

Tel: Karuveru,

It is seen in tropical countries and cultivated in gardens. It is a small profusely branched, succulent aromatic herb with quadrangular stems and branches and deep straw coloured aromatic roots. Leaves are glandular hairy, broadly ovate with dentate margins and prominent veins on the bark. Blue flowers are borne on terminal racemes. Fruits are nutlets. The whole plant is useful in hyperdipsia, vitiated conditions of pitta, burning sensation, strangury, leprosy, skin diseases, leucoderma, fever, vomiting, diarrhoea, ulcers and as hair tonic.

3. Coleus forskohlii Briq. syn. C. barbatus Benth.

Hin: Garmai

Kan: Maganiberu, Makandiberu

Guj: Maimul

It is a perennial aromatic herb grown under tropical to temperate conditions for its carrot-like tubers which are used as condiments in the preparation of pickles. Its tuberous roots are an exclusive source of a diterpenoid forskolin which has the unique property of activating almost all hormone sensitive adenylate cyclase enzymes in a biological system. It is useful in the treatment of congestive heart failure, glaucoma, asthma, cancer and in preventing immature greying of hair (Hegde,1997).

Agrotechnology: The Coleus group of plants grows in tropical to subtropical situations and in warm temperate climatic zone on mountains of India, Nepal, Burma, Sri Lanka, Thailand and Africa. It comes up well on the sun exposed dry hill slopes from 300m to 1800m altitude. A well drained medium fertile soil is suitable for its cultivation. it is propagated vegetatively through stem and root cuttings. Vine cuttings to a length of 10-15cm from the top portion are most ideal for planting. The land is ploughed or dug to a depth of 15-20cm and ridges are formed 30cm apart. Vine cuttings are planted on the ridges at 30cm spacing after incorporating basal manure. 10t of FYM and NPK at 50:50:50kg/ha are incorporated into the soil. Top dressing of N and K is also suggested for improved yields. Weeding and earthing up at 45 days after planting along with topdressing is highly beneficial. Bacterial wilt and root knot nematode are reported in the crop. Drenching the soil with fungicide, deep ploughing in the summer, burning of crop residues and crop rotation are helpful to tide over the disease and pest problem. The crop can be harvested after 5-6 months.

Properties and activity: The medicinal property of Coleus amboinicus is attributed to codeine, carvacrol, flavones, aromatic acids and tannins present in the plant. The essential oil from the plant contains carvacrol, ethyl salicylate, thymol, eugenol and chavicol. Leaves also contain cirsimaritin, -sitosterol- -D-glucoside and oxalacetic acid. Leaves are bitter, acrid, thermogenic, aromatic, anodyne, appetising, digestive, carminative, stomachic, anthelmintic, constipating, deodorant, expectorant, diuretic and liver tonic.

Coleus vettiveroides is bitter, cooling, diuretic, trichogenous and antipyretic.

Coleus forskohlii roots are rich in diterpenoids like forskolin, coleonols, coleons, barbatusin, cyclobutatusin, coleosol, coleol, coleonone, deoxycoleonol, 7-deacetylforskolin and 6-acetyl-7-deacetylforskolin. Its root is spasmolytic, CNS active, hypothermic and diuretic. Forskolin is bronchodialative and hypotensive (Hussain et al,1992). Forskolin is also useful in preventing the clotting of blood platelets, in reducing intraocular pressure in glaucoma and as an aid to nerve regeneration following trauma (Sharma, 1998)... coleus

A coloured circle seen around a bright light in some eye conditions. When accompanied by headache, it is especially likely to be caused by GLAUCOMA.... halo

A beta-adrenoceptor-blocking drug which is of value in the treatment of ANGINA PECTORIS, myocardial infarction (see HEART, DISEASES OF) and HYPERTENSION. It is also used in the treatment of GLAUCOMA. (See also ADRENERGIC RECEPTORS.)... timolol maleate

Benth.

Synonym: C. forskohlii Briq. Plectranthus barbatus Andr.

Family: Lamiaceae.

Habitat: The sub-tropical Himalayas of Kumaon and Nepal; cultivated in Andhra Pradesh.

Ayurvedic: Gandira (Achyranthes aquatica Br. is also equated with Gandira). (Doubtful synonym.)

Folk: Garmar (Gujarat), Gurmal.

Action: Root and leaf—spasmolytic, antithrombotic, anti-inflammatory, lipolytic.

In experimental amoebiasis of rats, the root powder and ethanolic extract showed amoebicidal activity against Entamoeba histolytica.

An alcoholic extract of the roots and essential oil from it, were found to inhibit passive cutaneous anaphylaxis in the mouse and rat.

The plant produces the labdane diterpenoid, forskolin in its tuberous roots.

Forskolin was discovered during a screening of medicinal plants by Central Drug Research Institute, Luc- know, India, in 1974. (Planta Medica, 1985, 51, 473-477.) The screening revealed the presence of a hypoten- sive and spasmolytic principle, named coleonol (later the name was changed to forskolin). The basic mechanism of forskolin is the activation of an enzyme, adenylate cyclase, which increases the amount of cyclic adeno- sine monophosphate (cAMP) in cells. Raised intracellular cAMP level exhibits following physiological effects : inhibition of platelet activation and degranulation; inhibition of mast cell degranualation and histamine release; relaxation of the arteries and other smooth muscles; increased insulin secretion; increased thyroid function; increased lipolysis.

Forskolin, in clinical studies, reduced intraocular pressure when it was applied to the eyes for treating glaucoma. It has been shown to be a direct cerebral vasodilator. It has also been studied as a possible bron- chodilator (in the treatment of asthma) and has been shown to effectively reverse methacholine-induced broncho constriction in extrinsic asthmatics.

Standardized Coleus extracts containing forskolin (18% in 50 mg) find application in weight-loss programmes. (Michael T. Murray.)

Studies on forskolin and some 50 derivatives of the compound indicate that the natural product is more active than the analogs prepared from it.

The wild var. is known as Kaffir Potato.... coleus barbatus

Contact lenses are lenses worn in contact with the EYE, behind the eyelids and in front of the cornea. They may be worn for cosmetic, optical or therapeutic reasons. The commonest reason for wear is cosmetic, many short-sighted people preferring to wear contact lenses instead of glasses. Optical reasons for contact-lens wear include cataract surgery (usually unilateral extraction) and the considerable improvement in overall standard of vision experienced by very short-sighted people when wearing contact lenses instead of glasses. Therapeutic lenses are those used in the treatment of eye disease: ‘bandage lenses’ are used in certain corneal diseases; contact lenses can be soaked in a particular drug and then put on the eye so that the drug slowly leaks out on to the eye. Contact lenses may be hard, soft or gas permeable. Hard lenses are more optically accurate (because they are rigid), cheaper and more durable than soft. The main advantage of soft lenses is that they are more comfortable to wear. Gas-permeable lenses are so-called because they are more permeable to oxygen than other lenses, thus allowing more oxygen to reach the cornea.

Disposable lenses are soft lenses designed to be thrown away after a short period of continuous use; their popularity rests on the fact that they need not be cleaned. The instructions on use should be followed carefully because the risk of complications, such as corneal infection, are higher than with other types of contact lenses.

Contraindications to the use of contact lenses include a history of ATOPY, ‘dry eyes’, previous GLAUCOMA surgery and a person’s inability to cope with the management of lenses. The best way to determine whether contact lenses are suitable, however, may be to try them out. Good hygiene is essential for wearers so as to minimise the risk of infection, which may lead to a corneal abscess – a serious complication. Corneal abrasions are fairly common and, if a contact-lens wearer develops a red eye, the lens should be removed and the eye tested with ?uorescein dye to identify any abrasions. Appropriate treatment should be given and the lens not worn again until the abrasion or infection has cleared up.... contact lenses

Refer: ALCOHOLISM, CATARACT, CONJUNCTIVITIS, DIABETES, ECLAMPSIA, GLAUCOMA, IRITIS, MIGRAINE, MULTIPLE SCLEROSIS, RETINITIS, SHOCK. ... blurred vision

See entries:– CONJUNCTIVITIS, CONTACT LENS FATIGUE, GLAUCOMA, IRITIS, PALMING, RETINITIS, RETINITIS PIGMENTOSA, RETINOPATHY, SCLERITIS AND EPISCLERITIS, XEROPHTHALMIA (dryness of the eyes). ... eyes

Inability to see at night or in imperfect light due to a deficiency of visual purple (rhodopsin) in the rods at the back of the eye due to low level Vitamin A. Night myopia usually affects people during twilight. “One in five people are not fit to drive at night.” May occur in glaucoma and other eye disorders. Other causes: old age, free radical damage.

Alfalfa tea freely.

Of value: Kelp, Irish Moss, Iceland Moss.

Diet. Vitamin A foods, carrots, bilberries, Cod Liver oil.

Supplements. Vitamin A, Beta-carotene. C (2g), E (400iu). B-complex, B2, Niacin, Zinc. ... eyes  - night blindness

Many causes, including neuralgia, frontal sinusitis, eye troubles (pain of glaucoma being referred to the temples), dental problems, shingles, psychogenic, migraine; pain referred from lungs or heart. See appropriate entries for each of these complaints.

Maria Treben’s Facial Pack: of any of the following – Thyme, Mullein, Chamomile or Yarrow. Fill small muslin bag and steep in boiling water. Ring out. Apply as hot as possible.

Internal: Chamomile tea. ... facial pain

n. a *carbonic anhydrase inhibitor used to reduce intraocular pressure in the treatment of *glaucoma when beta blockers are not effective or appropriate: it decreases the production of aqueous humour. It may cause local irritation and taste disturbance.... brinzolamide

n. a *beta blocker used as eye drops in the treatment of *glaucoma; side-effects may include local stinging and burning.... carteolol

n. the destruction of part of the *ciliary body of the eye to reduce the production of aqueous humour and hence reduce intraocular pressure. This technique is used in the treatment of advanced glaucoma resistant to other forms of treatment.... cycloablation

n. the destruction of part of the *ciliary body (see cycloablation) by freezing. It is used to reduce intraocular pressure in the control of glaucoma.... cyclocryotherapy

n. separation of the *ciliary body from its attachment to the sclera, producing a cleft between the two (cyclodialysis cleft). This may be the result of trauma or it may be performed as part of an operation in the treatment of glaucoma.... cyclodialysis

n. the use of light or lasers to destroy the *ciliary body of the eye in order to reduce production of aqueous humour and hence reduce intraocular pressure. It is used in the treatment of glaucoma.... cyclophotoablation

a type of laser whose medical uses include treating diseases of the retina, by producing small burns in the retina (see photocoagulation), and selected cases of glaucoma (cyclophotocoagulation). It is also used for treating varicose veins (see endovenous laser treatment).... diode laser

an abnormal enlargement of the central depression of the *optic disc due to loss of nerve fibres, as occurs in glaucoma.... disc cupping

a condition characterized by chronic low-grade inflammation of the ciliary body and iris (anterior *uveitis) with depigmentation of the affected iris (*heterochromia). Glaucoma and cataract can develop in the affected eye.... fuchs’ heterochromic cyclitis

pl. n. small anterior subcapsular lens opacities seen in acute (angle-closure) glaucoma.... glaukomflecken

(trabeculotomy) n. a primary surgical procedure for treating congenital glaucoma (see buphthalmos). A fine knife is used to make an incision into the blocked *trabecular meshwork from within the eye, thus creating an opening through which the aqueous fluid can drain.... goniotomy

splits or tears in *Descemet’s membrane occurring during infancy, commonly as a result of congenital glaucoma. [O. Haab (1850–1931), German ophthalmologist]... haab’s striae

pl. n. coloured rings seen around lights by people with acute (angle-closure) glaucoma and sometimes by people with cataract.... haloes

n. an operation for *glaucoma, now rarely performed, in which a small incision is made beneath the *conjunctiva close to the cornea and part of the iris is drawn into it. The iris acts like a wick and keeps the incision open for the drainage of fluid from the anterior chamber of the eye to the tissue beneath the conjunctiva.... iridencleisis

an abnormal condition of the eye in which the iris bulges forward towards the cornea. It is due to pressure from the aqueous humour behind the iris when its passage through the pupil to the anterior chamber of the eye is blocked (pupil-block glaucoma).... iris bombé

n. a *beta blocker used in the treatment of open-angle *glaucoma; it reduces intraocular pressure, probably by reducing the rate of production of aqueous humour. Side-effects may include local stinging and burning.... levobunolol

(myosis) n. constriction of the pupil. This occurs normally in bright light. It is also seen in *Horner’s syndrome, but persistent miosis is most commonly caused by certain types of eye drops used to treat glaucoma. See also miotic. Compare mydriasis. —miotic adj.... miosis

1. n. a drug that causes the pupil of the eye to contract by constricting the ciliary muscle (see ciliary body). Miotics, such as *pilocarpine, are used to reduce the pressure in the eye in the treatment of glaucoma: contraction of the ciliary muscle increases the angle between the iris and cornea through which aqueous humour drains from the eye. 2. adj. showing *miosis.... miotic

a valved device used in the surgical treatment of some types of glaucoma to control intraocular pressure by allowing fluid to drain from the anterior chamber into the subconjunctival space.... molteno implant

n. light amplification by stimulated emission of radiation: a laser is a device that emits light through such a process; it can be used to operate on small areas of abnormality without damaging the delicate surrounding tissues. For example, lasers are used to unblock coronary arteries narrowed by atheroma and to remove certain types of birthmark (see naevus). In ophthalmology different types of laser are used for operations on the cornea (see excimer laser), lens (see femtosecond laser), lens capsule (see YAG laser), and retina (see argon laser; diode laser) and for glaucoma (see trabeculoplasty). Lasers are also used in the treatment of *endometrial ablation and large fibroids (the Nd:YAG laser), *cervical intraepithelial neoplasia, and varicose veins (*endovenous laser treatment).... laser

n. (pl. naevi) a birthmark: a clearly defined malformation of the skin, present at birth. There are many different types of naevi. Some, including the strawberry naevus and port-wine stain, are composed of small blood vessels (see haemangioma). The strawberry naevus (or strawberry mark) is a raised red lump usually appearing on the face and growing rapidly in the first month of life. These birthmarks slowly resolve and spontaneously disappear between the ages of five and ten. The port-wine stain (or capillary naevus) is a permanent purplish discoloration that may occur anywhere but usually appears on the upper half of the body. Laser treatment can reduce the discoloration. Occasionally a port-wine stain may be associated with a malformation of blood vessels over the brain, for example in the Sturge-Weber syndrome (see angioma).

It is not uncommon for a pale or white halo to develop around an ordinary pigmented naevus, especially on the trunk, forming a halo naevus. The pigmented naevus disappears over the course of a few months; this is followed by resolution of the pale area. A blue naevus is a small blue-grey papule appearing at birth or later in life, mainly on the extremities. Progression to malignant melanoma is very rare. A naevus of Ota is a blue-grey pigmented area on the cheek, eyelid, or forehead with similar pigmentation of the sclera of an eye. It is associated with melanomas of the uvea, orbit, and brain as well as with glaucoma of the affected eye. See also mole2.... naevus

(OHT) a constantly raised intraocular pressure (greater than 21 mmHg by Goldmann applanation *tonometry) registered on two or more occasions in one or both eyes with the absence of evidence of optic nerve damage or visual field defect. Intraocular pressure increases slowly with age and OHT can increase the risk of developing glaucoma. It is treated with eye drops and surgery if indicated.... ocular hypertension

n. measurement of the pressure inside the eyeball. A rising or above-normal pressure is an important indication of the presence of *glaucoma.... oculoplethysmography

n. an instrument for mapping the extent of the *visual field. The patient fixes his or her gaze on a target in the centre of the inner surface of the hemisphere. Objects are presented on this surface and the patient says if they can be seen. The area of the visual field can be defined and any gaps in the field can be detected. There are several types of perimeter. In the static perimeter the movable object is replaced by a system of tiny lights that can be flashed briefly. A patient with a field defect will fail to see the lights that flash in the area of the defect. Modern visual field testing uses computer-assisted automated perimeters to map out and analyse visual fields and thus detect very subtle field defects (computerized perimetry). Automated perimeters are commonly used in the diagnosis and follow-up of glaucoma. —perimetry n.... perimeter

(noncontact tonometer) n. an instrument that blows a puff of air at the cornea to cause flattening and hence measure intraocular pressure. It is commonly used by optometrists in tests for glaucoma.... pneumotonometer

the appearance of white dandruff-like deposits on structures in the anterior chamber of the eye, which are especially prominent around the pupil margin and on the anterior lens capsule. It is a sign of zonular weakness and indicates an increased risk of secondary glaucoma.... pseudoexfoliation syndrome

(Fourier domain OCT) a noncontact noninvasive imaging technique that can reveal layers of the retina by looking at the interference patterns of reflected laser light. Automated software is able to outline the retinal nerve-fibre layer with great precision, which is relevant in glaucoma.... spectral domain optical coherence tomography

n. the measurement and recording of intraocular pressure while the eyeball is subjected to pressure over a period of several minutes. It is used to assess aqueous outflow and diagnose glaucoma. See tonometer.... tonography

n. a method used to selectively destroy parts of the *trabecular meshwork and hence reduce intraocular pressure in the treatment of glaucoma. This may be achieved by means of a laser, as in argon laser trabeculoplasty (ALT; see argon laser) and selective laser trabeculoplasty (SLT), in which a YAG laser is used to selectively target melanin within the pigmented trabecular meshwork cells to achieve lowering of the intraocular pressure.... trabeculoplasty

*uveitis associated with *glaucoma and *hyphaema. This is an uncommon inflammatory condition occurring as a complication of intraocular lens *implants.... ugh syndrome

Linn.

Habitat: Native to Europe and Asia. Occurs in the temperate Himalayas from Kashmir to Garhwal.

English: Indian Henbane, Black Henbane.

Ayurvedic: Paarsika-yavaani, Yavaani, Madkaarini, Turushkaa, Khuraashaanikaa, Khuraasaani Ajwaayin.

Unani: Barz-ul-Banj, Khuraasaani Ajwaayin.

Siddha/Tamil: Paarseekayavani, Khurasani Omam.

Action: Sedative. Narcotic drug. Used for convulsions. Action similar to Belladonna.

Key application: In spasms of gastrointestinal tract. (German Commission E, The British Herbal Pharmacopoeia.)

The leaves and flowering tops contain tropane alkaloids, 0.045-00.14%, the principal ones being hyoscyamine and hyoscine. The alkaloids are para- sympatholytic, with similar actions to Belladonna, although with less cerebral excitement.

The seeds show inhibitory activity against digestive enzyme, lipase in vitro.

Contraindicated in tachycardias, prostatic hyperplasia, narrow-angle glaucoma, acute pulmonary oedema, stenosis of gastrointestinal tract, maga colon.

Dosage: Seed—3-5 g powder. (CCRAS.)... hyoscyamus niger

If you want both an aromatic tea, as well as a healthy one, orange peel tea is perfect. It is a delicious beverage, especially during cold winter days. It also helps you stay healthy, especially thanks to the amount of vitamin C it contains. Read this article to find out more about its health benefits and side effects. About Orange Peel Tea Orange peel tea is made from the peel of the orange fruit. The fruit grows in orange trees, which are cultivated all around the world. The orange peel is the outer skin of the orange, leathery-textured and with many oil glands. Orange peel, as well as the peel from other fruits (lemon, lime) has been used for medical purposes for many years. They are also used for culinary purposes, as they can be added to soups, stews, cakes or cookies. Components of Orange Peel Tea It is well-known that oranges have many nutritional components. Some are included in the orange peel, as well, and are thus transferred to the orange peel tea. The orange peel tea is, of course, a great source of Vitamin C, and also has vitamin B1. Other important active constituents are: choline, folic acid, antioxidant flavonoids, d-limonene, alpha-carotene, beta-carotene, and aldehydes. How to make Orange Peel Tea If you’ve got some oranges around, you can easily make your own orange peel tea from scratch. Peel the skin from an orange, cut it in smaller pieces, and let them dry, preferably in a cool, dry place. Once they’re dry, you can use them for your orange peel tea. Add a bit to a cup of boiling water and let it steep for about 10-15 minutes. Remove the pieces of dried orange peel and you’re ready to drink your cup of tea! Orange Peel Tea Benefits Because of its many active constituents, orange peel tea helps you stay healthy. One cup brings many health benefits. Orange peel tea helps you fight against viruses and bacteria. It is also useful when treating coughs, asthma, bronchitis, tightness in the chest, and colds. Generally, it is good at helping the body eliminate the phlegm in the lungs. Drinking orange peel tea helps you have a good digestion. It is useful when relieving gas, bloating and nausea, symptoms of an upset stomach. Also, it is drunk in order to treat constipation, and it helps boost your appetite. Orange peel tea is also helpful when it comes to having a good oral hygiene. It helps you take care and treat sensitive skin, and it also eliminates bad breath. Another benefit is related to stimulating blood circulation and the flow in the lymphatic system. Also, orange peel tea is useful with helping you fight stress, nervousness, and insomnia. For women who have just given birth, orange peel tea helps treat mastitis (when the breast feels swollen because of excess milk production). If this is your case, then it’s recommended that you drink it twice a day. Orange Peel Tea Side Effects Just like any type of tea, orange peel tea also comes with a few side effects. First, it is recommended that you not drink orange peel tea while you’re pregnant. It might cause problems to the baby. Orange peel tea can act as a stimulant in some cases. It might cause symptoms such as nervousness or restlessness, and you might also have trouble falling asleep. It will act even more as a stimulant if you take a supplement that contains caffeine. If your family has a history of heart diseases, speak to your doctor before drinking orange peel tea. It might be harmful for you, and cause high blood pressure, hypertension, arrhythmias, tachycardia, fainting, heart palpitations and chest pains. Be careful if you’re suffering from hyperthyroidism. Orange peel tea may aggravate the thyroid’s condition. It might also weaken your body, or cause vision problems. It can cause your vision to get blurry, difficulty in focusing, and it might also worsen glaucoma. Not only is orange peel tea richly aromatic and delicious, but it is also good for your health. Make sure you get no side effects and then you can enjoy a cup of orange peel tea!... orange peel tea - a bittersweet tea

Serious eye injuries may be caused either by penetration of the eye by a foreign body (see eye, foreign body in) or by a blow to the eye.

A blow to the eye may cause tearing of the iris or the sclera, with collapse of the eyeball and possible blindness. Lesser injuries may lead to a vitreous haemorrhage, hyphaema, retinal detachment, or injury to the trabeculum (the channel through which fluid drains from inside the eye), which can lead to glaucoma. Injuries to the centre of the cornea impair vision by causing scarring. Damage to the lens may cause a cataract to form.... eye injuries

A common combination of eye symptoms that may be due to any of several eye disorders.

Uveitis is a common cause of dull, aching pain. The redness is caused by widening of blood vessels around the iris. Another serious cause of pain and redness in one eye is acute closedangle glaucoma. Other causes include keratitis, usually due to a corneal ulcer, or a foreign body in the eye (see eye, foreign body in). The most common cause of redness and irritation in the eye is conjunctivitis.... eye, painful red

Pu’erh tea is a type of post-fermented tea produced in China. Read this article to find out more about its many health benefits! About Pu’erh Tea Pu’erh tea is a post-fermented tea produced in the Chinese province Yunnan. Post-fermented teas are different from other types of tea in the sense that, after the leaves are dried and rolled, they undergo a microbial fermentation process. The pu’erh teais available as loose leaves or as tea brick (tea leaves packed in molds and pressed into block form). There are also two categories of pu’erh tea: the raw type and the ripe type. Raw pu’erh tea can count as a type of green tea. Ripened or aged pu’erh tea is often mistakenly called a type of black tea, though it isn’t. How to prepare Pu’erh Tea Pu’erh tea can be bought and prepared in loose leaf form, in tea bag form, or in compacted cake form. If you’re using leaves, add a teaspoon to a cup of freshly boiled water and let it steep for about 20 seconds before you pour off the water; this process id called rinsing, in order to prepare the leaves for the tea. Next, pour freshly boiled water again, let it steep for 30 seconds or one minute. This will give the tea a mild, but pleasant flavor. If you want a stronger flavor, you can let it steep up to 50 minutes, until it turns as dark as coffee. Pu’erh leaves can be resteeped several times (4-8 times). Just add about 20 more seconds to each steeping process. The same applies to pu’erh tea in compacted cake form. To get the leaves, either flake off pieces of the cake, or steam the entire cake until it becomes soft. Pu’erh Tea Benefits Pu’erh tea had important health benefits related to blood circulation. It can help lower blood cholesterol levels. It also boosts the flow of blood and enhances your blood circulation. Drinking pu’erh tea can help prevent cancer, as it helps prevent the formation and growth of cancer cells. It also promotes a proper, healthy digestion, and is good for your spleen. You don’t have to worry even if you’re on a diet; drinking pu’erh tea will help you lose weight, as it breaks down and reduces the fat in your body. As pu’erh tea contains caffeine, drinking it helps keep you alert and focused. It also helps with removing toxins from your body, and it can prove to be useful if you’re dealing with various aches and pains. Pu’erh tea can also help you if you’ve got a hangover, especially if you get a headache. Also, it can act as a substitute for coffee, and can have a relaxing effect on you. Pu’erh Tea Side Effects Because of its caffeine content, pu’erh tea shouldn’t be consumed by pregnant or breastfeeding women, as it can affect the baby. Also, you shouldn’t drink pu’erh tea if you’ve got anxiety, bleeding disorders, heart problems, diabetes, irritable bowel syndrome, glaucoma, high blood pressure or osteoporosis. It can affect your condition in all of these cases. Pu’erh tea can also interact with medications. A few examples include amphetamines, cimetidine, ephedrine, adenosine, or medications for depression, asthma and slow blood clotting. The list includes more, so if you’re under medication, make sure you check with your doctor first, to see if it’s safe to drink pu’erh tea.   Pu’erh tea has important health benefits, though the same goes for side effects, as well. Make sure it’s safe to drink pu’erh tea, and then you can enjoy a cup of tea without having to worry about its side effects.... pu’erh tea pros and cons

Displacement of the crystalline lens from its normal position in the eye. Lens dislocation is almost always caused by an injury that ruptures the fibres connecting the lens to the ciliary body. In Marfan’s syndrome, these fibres are particularly weak and lens dislocation is common.A dislocated lens may produce severe visual distortion or double vision, and sometimes causes a form of glaucoma if drainage of fluid from the front of the eye is affected. If glaucoma is severe, the lens may need to be removed. (See also aphakia.)... lens dislocation

Drugs used in the treatment of glaucoma to reduce pressure in the eye. Used topically, miotic drugs cause the pupil to contract, which opens up the drainage channels and drains fluid from the front of the eye. Side effects include headache, particularly over the eye, and blurred vision. Common miotics include carbachol and pilocarpine. (See also mydriatic drugs.)... miotic drugs

The study of the eye and the diagnosis and treatment of the disorders that affect it. Ophthalmology covers assessment of vision, prescription of glasses or contact lenses, and surgery for eye disorders, such as cataracts and glaucoma. (See also eye, examination of; optician; optometry; orthoptics.)... ophthalmology

Blockage of a vein carrying blood away from the retina.

It usually results from thrombosis in the affected vein, and is more common in people who have glaucoma.

Retinal vein occlusion may cause visual disturbances, glaucoma, or blindness.... retinal vein occlusion

When the eye looks at a speci?c point or object, that point is seen clearly. Other objects within a large area away from this ?xation point can also be seen, but less clearly. The area that can be seen around the ?xation point, without moving the eye, is known as the ?eld of vision. The extent of the ?eld is limited inwards by the nose, above by the brow and below by the cheek. The visual ?eld thus has its greatest extent outwards from the side of the head. The ?eld of vision of each eye overlaps to a large extent so that objects in the centre and towards the inner part of each ?eld are viewed by both eyes together. Because the eyes are set slightly apart, each eye sees objects in this overlapping part of the ?eld slightly di?erently. It is because of this slight di?erence that objects can be perceived as three-dimensional.

Defects in the visual ?eld (scotomas) can be produced by a variety of disorders. Certain of these produce speci?c ?eld defects. For example, GLAUCOMA, some types of brain damage and some TOXINS can produce speci?c defects in the visual ?eld. This type of ?eld defect may be very useful in diagnosing a particular disorder. The blind spot is that part of the visual ?eld corresponding to the optic disc. There are no rods nor cones on the optic disc and therefore no light perception from this area. The blind spot can be found temporal (i.e. on the outer side) of the ?xation point. (See also EYE.)... vision, field of

Compounds that protect the body against free radical activity and lipid peroxidation. Free-radical scavengers. Low levels in the tissues reduce the span of human life. High levels enable humans to live longer. The greater the oxidation damage to the DNA, the shorter the lifespan.

Vitamins A, C and E inhibit production of free radicals. Especially effective is beta-carotene, the precursor of Vitamin A, found in carrots, spinach, yams and some green leafy vegetables. Vitamin E and Selenium work together to prevent free radical damage to cell membrane. Antioxidants act favourably on glaucoma, Parkinson’s disease and rheumatoid arthritis.

This group claims to have an anti-tumour effect. Epithelial cancers may invade the respiratory and gastro-intestinal tracts, lungs, skin and cervix of the womb. The higher the level of antioxidants in the cells, the lesser the risk of epithelial cell cancer, and blindness in the aged. vChief antioxidants: Alfalfa, Comfrey, Asparagus (fresh), Beet tops, Dandelion leaves, Ginseng, Gotu Kola, Goldenseal, Irish Moss, Parsley, Walnuts, Watercress, Wheat sprouts. Perhaps the cheapest and most effective is Garlic.

Diet. Highly coloured fruits and vegetables: oranges, red and green peppers, carrots, apricots, mangoes, liver and spinach.

Supplements. Beta carotene (Vitamin A), Vitamin C, Vitamin E, Selenium, Zinc. See: SOD, FREE RADICALS. ... antioxidants

Deadly nightshade. Atropa belladonna L. German: Amaryllis. French: Belladonne d’Automne. Spanish: Belladonna. Italian: Amarilli a fiori rosei. Indian: Suchi.

Action. Antispasmodic, antasthmatic, anti-sweat, sedative, lactifuge.

For use by qualified practitioner only.

Uses: Spasmodic asthma; colic of intestines, gall bladder or kidney; spasm of bladder and ureters. Whooping cough, excessive perspiration (night sweats, etc), spermatorrhoea, bed-wetting (dose afternoon and at bedtime), dribbling of saliva in Parkinsonism. The common cold, hay fever, acidity – to inhibit secretion of stomach acid.

Contra-indications. Glaucoma, rapid heart, pregnancy, enlarged prostate. Side-effects – dry mouth, dilated pupils, mental disorientation. Used for a millennia in China as an anaesthetic (Kiangsu – 1719)

Widely used in homoeopathic medicine.

Preparations: Unless otherwise prescribed – up to thrice daily. Dried herb, 50mg in infusion. Tincture, BHC (vol 1). 1:10, 70 per cent ethanol, 0.5ml.

Initial dose recommended per week by British Herbal Compendium, Vol 1; dried leaf, 200mg (max 1g); tincture, 2ml (max 10ml).

A weaker solution may sometimes be used with good effect: 5 drops tincture to 100ml water – 1 teaspoon hourly. (Dr Finlay Ellingwood)

Pharmacy only sale ... belladonna

Gradual loss of sight following chemical disturbance in the lens protein of the eye resulting in degeneration and loss of transparency. Greyish white pupil which in normality is jet black. Occurs chiefly in the elderly due to injury of the lens capsule, glaucoma, the use of microwave or diet-mineral deficiency (calcium). In the ageing process there is a lack of antioxidant protection of the lens usually due to low Vitamin C, the major antioxidant in lens physiology. May also be congenital.

High blood glucose levels, diabetes, drugs, steroids, Down’s syndrome, kidney failure, uraemia and chronic diarrhoea predispose. There is no pain. Vision is as if looking through a frosted glass.

Treatment. Restore lens metabolism.

“My father-in-law knew people who had been cured by steeping Wild Burdock burrs and taking a small drink 3-4 times a day” (John Tobe, in “Cataract, Glaucoma and other Eye Disorders”) Cider Vinegar. 2 teaspoons to glass water, sips once or twice daily.

Chinese medicine. Hachimi jiogan to increase glutathione content of the lens.

Topical. Greater Celandine. 5-10 drops fresh juice of plant to 4oz distilled extract Witch Hazel. 10-20 drops in an eyebath half filled with warm water; use as a douche.

Cineraria maritima (Dusty Miller). 2-3 drops fresh plant juice applied to the eye with a medicine dropper. Same refers to Yucca and Chaparral. For early non-diabetic cataract.

Diet. Lacto-vegetarian. Carrot juice. Brewer’s Yeast, yellow-green vegetables. Spinach as an item of diet appears to reduce risk of cataract.

Supplementation. Vitamin C slows down the ageing process of the lens, protecting it from damage by free radicals: 1500mg daily. Vitamin B2. Vitamin E, 400iu daily. Selenium, 200mcg daily. Amino acids: cysteine, methionine, glutathione.

General. Surgical treatment is invariably successful. Cold packs and manipulation of the neck improve circulation and drainage of the head. ... cataract

A rare, congenital condition that affects the skin and the brain. Characteristically, a large purple birthmark (port wine stain) extends over one side of the face, including the eye. Malformation of cerebral blood vessels may cause weakness on one side of the body, progressive mental handicap, and epilepsy. Glaucoma may develop in the affected eye, leading to loss of vision.

Seizures can usually be controlled with anticonvulsant drugs.

In severe cases, brain surgery may be necessary.... sturge–weber syndrome

Acute red eye. Inflammation of the conjunctiva. Allergic or infective. Fifty per cent cases in hay fever season are due to allergy.

Causes: environmental chemicals, drugs, feathers, animal hairs. Infections include staphylococcus, pneumococci, herpes, gonococcal (rare). Conjunctivitis never causes persistent visual disturbance. Symptoms. Watery discharge, itching, blood vessels visibly engorged, sensation of grit, mucopus discharge may cause lids to stick together.

A casual attitude to Conjunctivitis can no longer be justified. Prolonged use of antibiotics and corticosteriods is best avoided, where possible. Eye infections of virus origin become more common. A simple douche with herb teas enables eyes to stay clear of most minor infections. If ‘red eye’ does not clear within 3 days refer to Eye Department of a modern hospital, especially infections from herpes (shingles).

Treatment. External. The following soothe and do not exacerbate herpes or cause glaucoma: Eyebright, Chamomile, Marshmallow, Mullein, Marigold, Fumitory, Rose petals, Melilot, Plantain, Elderflowers, Fennel, Rue, Raspberry leaves, Witch Hazel, Aloe Vera gel, Borage. Conjunctivitis of infants – Elderflowers, Rosewater.

Douche. 1 teaspoon any of the above herbs to cup boiling water; infuse 15 minutes. Strain. Half-fill eye- bath for tepid douche freely. Separate baths for each eye.

Internal: tablets, liquid extracts, tinctures or powders: Echinacea, Goldenseal, Myrrh, Garlic (juice, corm or capsules freely – not to children). Dr Alfred Vogel. Apply white of an egg.

Supplements. Daily. Vitamin A 7500iu, Vitamin B2 10mg, Vitamin C 3g, Vitamin E 400iu. Zinc. Cod Liver oil. ... conjunctivitis

A persistent change of mood deeper than superficial sadness. Of symptoms, headache is the commonest presenting complaint (Feverfew, Skullcap). Release from symptoms may be obtained from teas, powders or liquid extracts of the following.

Liver causation: Dandelion (Coffee), Wild Yam, Goldenseal.

In the elderly: Skullcap, Sage.

With restlessness: Lemon balm, Californian Poppy.

With palpitations: Hawthorn, Motherwort.

From abuse of coffee: German Chamomile.

Unable to relax: Passion Flower.

Epileptic: Mistletoe. Vervain.

Parkinsonian: St John’s Wort, broad beans.

To correct hormone imbalance: Helonias, Raspberry leaves.

Pre-menstrual tension: Evening Primrose, St John’s Wort, Rosemary.

With painful menstruation: Black Cohosh.

Associated with glaucoma: Rutin tea.

The hidden alcoholic: Ginseng.

Pregnant depressive: Raspberry leaves.

Obese depressive: Cider vinegar.

Enuresis schoolchild: Liquorice.

With swollen prostate gland: Pulsatilla.

In heart cases, and to counter side effects of beta blockers: Hawthorn, Lily of the Valley.

Drug-induced: St John’s Wort, Californian Poppy, Ginseng.

General anti-depressives: Lemon balm, Celery, Chamomile, Borage, Ginkgo, Damiana, Kola, Mistletoe, Mugwort, Oats, Rosemary, Skullcap, Southernwood, Valerian, Vervain, Wormwood, St John’s Wort, Peppermint.

BHP (1983) combination: Kola nuts, Skullcap, Oats, Damiana.

Evening Primrose: 4 × 500mg capsules daily.

Temporary depression from physical and mental exhaustion: Life Drops (see entry). Pinch of Cayenne in cup of tea.

Old men. Low cholesterol levels are linked to depression among older men.

Practitioner: Persistent depression from shock: Tincture Arnica, 2-5 drops in water, thrice daily.

(Practice among German physicians.)

Aromatherapy. Inhalant: any one oil: Rose, Tangerine, Geranium.

Diet. Low caffeine. Oats: good for depression (oatmeal porridge, oatcakes, etc). Spinach for iron and calcium.

Supplementation. Vitamins: B-complex, B6, B12, C. Thiamine, Niacin. Minerals: Dolomite, Iron, Chromium, Iodine, Zinc.

Note: Depression may trigger mechanisms that introduce chronic disease by lowering immune response, hence need for conscientious patient compliance. ... depression

Ephedra sinica stapf., Ephedra equisentina Bunge and Ephedra gerardiana Wall (including Ephedra nebrodensis Tineo). Twigs. German: Meertra?ubchen. French: Ephe?dre. Italian: Uva di mare. Iranian: Huma. Japanese: Ma oh. Indian: Butshur. Chinese: Ma Huang.

Constituents: Alkaloids – ephedrine, pseudoephedrine.

Action: brain, heart and circulatory stimulant, antasthmatic, bronchodilator, anti-allergic, vasodilator, hypertensive, diaphoretic. Dilates vessels of the heart causing a rise in blood pressure. Cough sedative. Febrifuge, antispasmodic. The essential oil has antibacterial and antiviral properties.

Uses: Practitioner’s first choice for asthma. Bronchitis, breathlessness, whooping cough. Used for such chest conditions for over a millennia in Chinese medicine.

Allergies: hay fever, irritative skin rashes. Low blood pressure. Hypothermia. Bed-wetting. Myasthenia gravis BHP (1983). Chinese Barefoot doctors inject the tea into nostrils for hay fever.

Usually given with expectorants: Liquorice, Lobelia, Senega, Sundew. “Combines well with Lobelia and Skunk Cabbage for bronchitis; and with Horsetail for frequency of urine.” (Fletcher Hyde) Contra-indications: hypertension, coronary thrombosis, thyrotoxicosis, glaucoma. Not given with anti- depressants (MAO inhibitors).

Preparations: Thrice daily. Average dose: 15-60mg.

Tea. Quarter to half a teaspoon herb to cup water simmered gently 5 minutes. Half a cup. Liquid extract. BHP (1983) 1:1 in 45 per cent alcohol. Dose: 15-45 drops (1-3ml). Tincture BHP (1983) 1 part to 4 parts 45 per cent alcohol. Dose: 6-8ml.

Ephedrine. Maximum dose: 30mg. Maximum daily dose 60mg.

Store in airtight container out of the light. Pharmacy only medicine. Practitioners only. ... ephedra

The procedure for measuring the pressure of the fluid within the eye, usually performed by an ophthalmologist during an eye examination (see eye, examination of). Tonometry is useful in diagnosing glaucoma.... tonometry

 Sugar diabetes. Chronic disorder of fat, protein and carbohydrate metabolism. A decrease of insulin by the pancreas gives rise to high level blood sugar (glucose) which is eliminated in the urine by the kidneys. With low insulin production the body cannot convert food into energy. In Britain over 30,000 new cases are diagnosed each year. One in five people go blind because of diabetes. The genetic factor is important; it may run in families due to defect in the immune system. Women who have German measles during the first three months of pregnancy can have a child who develops diabetes during adolescence.

Etiology. The more severe form, in younger patients, needs insulin treatment, without which ketosis and diabetic coma are possible. The milder form in older patients can be managed with diet and hypoglycaemic agents. Now considered due to auto-immune attack on Islet of Langerhams cells in pancreas which secrete insulin. “The Pill” often raises blood sugar. Lack of trace minerals (chromium and zinc). Zinc is a component of insulin and Chromium produces enzymes to stimulate metabolism of sugars. Diabetes can cause heart attack, stroke, hardening of arteries, blindness. It is the leading cause of kidney failure and gangrene.

Symptoms. Great thirst. Urine of high specific gravity. Weakness, emaciation, skin ulcers, loss of tactile sensation in the fingertips (Vitamin B6). In men there may be inflammation of the glans penis and in women, itching of the vulvae. Boils are common. In spite of large appetite there may by severe weight loss. Magnesium deficiency.

Diabetics are subject to glaucoma and detachment of the retina. There is a high incidence of cataract of the eye. While surgery may be necessary, effective supportive herbal treatment can do much. Regular visits to the Hospital Specialist help detect in time future eye, kidney and circulation damage.

High fibre, low fat, high carbohydrate. To help control blood sugar a diabetic must avoid sweets.

Exercise lowers blood sugar.

Agents used with some success: Alfalfa, Damiana leaves, Fenugreek seeds, Aloe Vera juice, Dandelion, Fringe Tree, Guar gum, Garlic (anti-diabetic action shown by Dr Madaus, West Germany, 1967), Bilberry berries, Goat’s Rue (dried aerial parts reduce blood sugar BHP (1983), Olive leaves, onions, Nettles, Pipsissewa, White Horehound, Sweet Sumach, Jambul seeds rapidly reduce sugar in the urine. Karela. Gurmar, (Gymnema sylvestre) leaves are chewed in India to reduce sugar in the urine (mild cases). Balsam pear. Bitter melon (Momordica charastia).

Hypoglycaemic herbs can be effective where the pancreas still functions. Type 1 diabetes, suffered by children whose insulin-producing cells have been destroyed and who produce no insulin at all will always require administered insulin. Maturity-onset diabetes (Type 11) occurs in middle life, insulin- production being insufficient. This form is usually associated with obesity for which herbs are helpful.

Diabetics are specially prone to infections; a course of Echinacea at the onset of winter is beneficial. Coronary artery disease is common in diabetics (especially women) who may develop atherosclerosis at an early age. High blood pressure places undue strain upon kidneys which may excrete too much protein (Yarrow, Lime flowers, Hawthorn). Lack of sensation in the feet exposes the subject to unconscious bruising and injury from which septic ulceration may arise (Chamomile foot baths).

Alternatives. Liver herbs work positively on the pancreas. Diabetic cases should receive treatment for the liver also, Dandelion and Fringe Tree being a reliable combination. Dr John Fearn, California (Ellingwood) used Fringe Tree for all his cases of sugar in the urine: 10 drops, Liquid Extract, 4-5 times daily.

Tea. Equal parts: Peppermint leaves, Dandelion leaves, Goat’s Rue leaves. 1-2 teaspoons to each cup boiling water infuse 5-15 minutes. Cup 2-3 times daily.

Teas from any one of the following: Bilberry berries or leaves, Nettles, White Horehound, Alfalfa, Olive leaves.

Decoction. Fenugreek seeds. 2 teaspoons to each large cup water simmered gently 5 minutes. One cup daily, consuming the seeds.

Powders. Equal parts: Sweet Sumach, Jambul seeds, Dandelion. Dose: 750mg (three 00 capsules or half a teaspoon) thrice daily.

Tinctures. Formula. Equal parts: Jambul, Fringe Tree, Goat’s Rue. Dose: 1 teaspoon thrice daily and at bedtime.

Tablets. Dr Alfred Vogel: tablet containing: Bilberry, Kidney Bean, Tormentil, English Walnut leaves, Alfalfa leaves, Cuckoo flowers.

Karela (Momordica Charantia) Hypoglycaemic action gave good results in clinical trials. Daily dose: 50/60ml fresh juice.

Evening Primrose. See entry.

Guar Gum. 5g unit dose sachets (Guarina) containing dispersible granules. This gum has shown beneficial effects for insulin-dependants.

Hypoglycaemics (second degree). Allspice, Bugleweed, Burdock, Ginseng, Lily of the Valley, Wormwood, Nettles.

Diabetic gangrene. Tinctures: equal parts, Echinacea, Thuja. Internally and externally. Internal dose: 30- 60 drops.

Diabetic neuralgia. Cayenne pepper (Capsicum). Frequently successful.

American traditional. It is claimed that 500mg Bayleaf, Cinnamon, Cloves and Turmeric halve the need for insulin in diabetics.

Diet. Dietary treatment has changed over the past few years. Patients are now advised by the British Diabetic Association to eat food rich in complex carbohydrates (starches) and high in fibre as in wholemeal bread, oats and wholegrain breakfast cereals, wholewheat pasta, brown rice, beans and lentils, vegetables and fruit. Fat intake should be carefully watched (lean meat); skimmed milk, polyunsaturated or low-fat cheeses and salad dressings. Certain foods are known to encourage the pancreas to produce more insulin: banana, barley, cabbage, lettuce, oats, olive, papaya, turnip, sweet potato.

Coffee intake should be limited to prevent hypoglycaemic symptoms.

Barley. A study has shown that the use of barley flour as a substitute for wheat in bread helps to control diabetes, in Iraq. (Naismith D, et al, ‘Therapeutic Value of Barley in Management of Diabetes’: Annals Nutr Metab, 35, 61-64 1991)

Supplementation. Vitamins A, B-complex, C, D, E, F. Vitamin B6. Brewer’s yeast. Minerals: Chromium 50mcg; Manganese 15mg; Magnesium 300mg; Zinc 25mg; to normalise glucose metabolism.

Note: Over 400 traditional plant medicines have been documented for diabetes, but few have been evaluated for efficacy. In the undeveloped countries they are chiefly used for non-insulin dependent diabetes. (Diabetes Care, 1989, Sept 12, p553)

Insulin dependents. Whether adults or children, insulin dependents should under no circumstances discontinue insulin injections.

Treatment by or in liaison with general medical practitioner.

Information. British Diabetic Association, 10 Queen Anne Street, London W1M 0BD, UK. Send SAE. ... diabetes, mellitus

A drug used to dilate the pupil. Adverse effects of the drug include blurred vision, increased sensitivity to light, stinging, and, rarely, dry mouth, flushing, and glaucoma.... tropicamide

No remedies may be offered for treatment of sexually transmitted diseases, diabetes, tuberculosis, cancer, epilepsy, fits, locomotor ataxia, Bright’s disease, any kidney disease, cataract, paralysis, glaucoma. No claims must be made by letter, telephone or otherwise that a vendor or practitioner can ‘cure’ or favourably affect the course of any of such conditions. A practitioner has the right to exercise his own judgement should, in the course of his duties, he diagnose one of these conditions except for sexually transmitted diseases for which specialised treatment is given at approved official veneral diseases centres. ... forbidden treatment

An anticholinergic drug derived from belladonna. Atropine is used to dilate the pupil in eye conditions

such as iritis (inflammation of the iris) and corneal ulcer. It is also used in children before eye examination. Atropine may be included in a premedication before general anaesthesia to reduce respiratory secretions and is also used as an emergency treatment for bradycardia (abnormally slow heartbeat). It is sometimes combined with an antidiarrhoeal drug to relieve abdominal cramps accompanying diarrhoea.

Adverse effects include dry mouth, blurred vision, retention of urine, and, in the elderly, confusion.

Atropine eyedrops are rarely given to adults because they cause disturbance of vision lasting 2–3 weeks and may precipitate acute glaucoma in susceptible people.... atropine

A group of drugs, also known as beta-adrenergic blocking agents, prescribed principally to treat heart and circulatory disorders such as angina and hypertension. Beta-blockers block the effects of the sympathetic nervous system, which releases adrenaline (epinephrine) and noradrenaline (norepinephrine) at nerve endings that are known as beta receptors.

There are 2 types of beta receptor: beta 1 and beta 2. Beta 1 receptors are present in the heart and blood vessels, and beta 2 in the lungs. Some betablockers (such as acebutolol, atenolol, and metoprolol) are termed cardioselective and, because they act mostly on beta 1 receptors, are used mainly to treat heart disease such as angina, hypertension, and cardiac arrhythmia. The drugs are sometimes given after a myocardial infarction (heart attack) to reduce the likelihood of further damage to the heart muscle.

Other types of beta-blocker, such as oxprenolol, propranolol, and timolol, may be given to prevent migraine attacks by acting on blood vessels in the head; reduce the physical symptoms of anxiety; or control the symptoms of thyrotoxicosis. Beta-blocker drugs such as timolol are sometimes given in the

form of eye drops to treat glaucoma and work by lowering the fluid pressure in the eyeball.

Beta-blockers may reduce an individual’s capacity for strenuous exercise. The drugs may worsen the symptoms of asthma, bronchitis, or other forms of lung disease. They may also reduce the flow of blood to the limbs, causing cold hands and feet. In addition, sleep disturbance and depression can be side effects of beta-blockers.... beta-blocker drugs

The transparent thin-walled dome that forms the front of the eyeball. The cornea is joined at its circumference to the sclera (white of the eye); the black pupil and the coloured iris are visible beneath it. The main functions of the cornea are to help focus light-rays on to the retina at the back of the eye and to protect the front of the eye. It is kept moist by tears produced by the lacrimal gland and the mucus- and fluid-secreting cells in the eyelids and conjunctiva. cornea, disorders of Injuries or diseases affecting the cornea, the outer shell of the eyeball. Injuries include corneal abrasions, which sometimes become infected and progress to a corneal ulcer. Penetrating corneal injuries can cause scarring, which may lead to impairment of vision. Chemical injuries can result from contact with a corrosive substance and require immediate flushing of the eye with water.

In actinic keratopathy, the outer layer of the cornea is damaged by ultraviolet light. In exposure keratopathy, damage is due to reduced protection by the tear film and blink reflex. The cornea can also be infected by viruses, bacteria, and fungi, the herpes simplex virus being especially dangerous. True inflammation of the cornea (called keratitis) is uncommon as the cornea contains no blood vessels.

Other disorders include: keratomalacia as a result of vitamin A deficiency; keratoconjunctivitis sicca (dry eye); corneal dystrophies such as keratoconus; and oedema, in which fluid builds up in the cornea and impairs vision.

Rare congenital defects include microcornea (smaller cornea than normal) or megalocornea (bigger than normal) and buphthalmos, or “ox-eye’’, in which the entire eyeball is distended as a result of glaucoma.

Degenerative conditions of the cornea such as calcium deposition, thinning, and spontaneous ulceration occur mainly in the elderly, and are more common in previously damaged eyes.... cornea

A system of Hindu philosophy and physical discipline that is becoming increasingly popular throughout the world. The main form of yoga that is practised in the West is hatha-yoga, in which the follower adopts a series of poses, called asanas, and uses a special breathing technique. The practice of

yoga maintains flexibility of the body, teaches both physical and mental control, and is a useful relaxation technique. If attempted by people in poor health, or practised incorrectly, yoga may pose certain health hazards, such as back disorders, hypertension (high blood pressure), and glaucoma (increased pressure in the eye).... yoga

a *shunt used in the treatment of *glaucoma to reduce and control intraocular pressure. The device works by bypassing the *trabecular meshwork and redirecting the outflow of aqueous humour through a small tube into an outlet chamber.... ahmed valve

An enabling Act allowing subsequent definitive statutory instruments to be issued at the discretion of the Medicines Control Agency. The Act controls all aspects of the sale of medicines in the United Kingdom; with no exceptions.

Medicines fall into three categories: POM (Prescription Only Medicines), P (Pharmacy Only), and OTC (Over The Counter). POM and P medicines must be prescribed by a registered medical practitioner and dispensed by a pharmacist. P medicines can be sold only by a registered pharmacist. Health stores are concerned with the OTC products, the sale of which is governed by S.I. Medicines General Sales List, Order 1980, No 1922.

All medicines and substances used as medicine bearing a medicinal claim on label or advertising material must be licenced. Without a licence it is not lawful for any person, in his business, to manufacture, sell, supply, export, or import into the United Kingdom any medicinal products unless some exemption is provided in the Act or subsequent regulations. The prefix ML, followed by the Manufacturer’s number must appear on the label together with the product licence number prefixed by the capitals PL. For example, if any person other than a pharmacist sells a medicinal product which claims to relieve indigestion or headache, but the label of which bears no licence number, that shopkeeper (and the manufacturer) will be breaking the law.

All foods are exempt from licencing provided no claims are made of medicinal benefits.

A special licence (manufacturer’s) is required by any person who manufactures or assembles a medicinal product. (Section 8) He must hold a Product Licence for every product he manufactures unless some special exemption is provided by the Act. He may of course act to the order of the product licence holder. (Section 23)

“Manufacture” means any process carried on in the course of making a product but does not include dissolving or dispersing the product in, or diluting or mixing it with some other substance used as a vehicle for the purpose of administering it. It includes the mixture of two or more medicinal products.

“Assembly” means enclosing a medicinal product in a container which is labelled before the product is sold or supplied, or, where the product is already enclosed in a container in which it is supplied, labelling the container before the product is sold or supplied in it. (Section 132)

From the practitioner’s point of view, herbal medicines are exempt from the Act and no licence is required.

The consulting herbalist in private practice who compounds his own preparations from medicinal substances may apply to the Medicines Control Agency, 1 Nine Elms Lane, London SW8 5NQ for a manufacturer’s licence to authorise mixture and assembly, for administration to their patients after he has been requested in their presence to use his own judgement as to treatment required. Products thus sold, will be without any written recommendation and not advertised in any way.

The “assembly” aspect of his licence refers to his ability to buy in bulk, repackage and label. Where he uses prepackaged products and does not open the packet, or relabel, a licence is not required. He will not be able to use terms, “Stomach mixture”, “Nerve mixture”, etc, implying cure of a specific condition.

It is necessary for the practitioner to have a personal consultation with his patient before making his prescription. Subsequent treatment may be supplied by a third person or by post at the discretion of the practitioner.

A licence is required where one or more non-herbal ingredients (such as potassium iodide, sodium citrate, etc) are included. Dispensing non-herbal remedies constitutes “manufacture” for which a licence is required. (MAL 24 (3))

The main thing the licensing authority looks for before granting a licence is evidence of safety. The manufacturers’ premises must be licenced. A wholesaler or distributor, also, must have a licence.

Where a product is covered by a Product Licence certain medicinal claims may be made. Where claims are made, the Act requires a warning to appear on the label worded: “If you think you have the disease to which this product refers, consult a registered medical practitioner before taking this product. If you are already receiving medical treatment, tell your doctor you are also taking this product.” (SI 41, s.5)

Labels of all medicines, tablets, etc, must carry the words: “Keep out of the reach of children”.

Under the Act it is illegal for medicines to be offered for sale for cancer, diabetes, epilepsy, glaucoma, kidney disease, locomotor ataxy, paralysis, sexually transmitted diseases and tuberculosis; these diseases to be treated by a registered medical practitioner only.

Definition of a herbal remedy. A “herbal remedy” is a medicinal product consisting of a substance produced by subjecting a plant or plants to drying, crushing or any other process, or of a mixture whose sole ingredients are two or more substances so produced, or of a mixture whose sole ingredients are one or more substances so produced and water or some other inert substances. (Section 132)

No licence is required for the sale, supply, manufacture or assembly of any such herbal remedy in the course of a business in which the person carrying on the business sells or supplies the remedy for administration to a particular person after being requested by or on behalf of that person, and in that person’s presence, to use his own judgement as to the treatment required. The person carrying on the business must be the occupier of the premises where the manufacture or assembly takes place and must be able to close them so as to exclude the public. (Section 12 (1))

No licence is required for the sale, supply, manufacture or assembly of those herbal remedies where the process to which the plant or plants are subjected consists only of drying, crushing or comminuting and the remedy is sold or supplied under a designation which only specifies the plant or plants and the process and does not apply any other name to the remedy; and without any written recommendation (whether by means of a labelled container or package or a leaflet or in any other way) as to the use of the remedy. (Section 12 (2)) This exemption does not apply to imported products. Except where a herbal product is supplied for a medicinal use, legally it is not even a medicinal product.

The 1968 Act has been a great step forward in the history of herbal medicine, The British Herbal Medicine Association and the National Institute of Medical Herbalists fought and won many special concessions. In years following the Act standards rose sharply. Practitioners enjoy a measure of recognition, with power to manufacture and dispense their own medicines and issue official certificates for incapacitation for work.

See: BRITISH HERBAL MEDICINE ASSOCIATION. NATIONAL INSTITUTE OF MEDICAL HERBALISTS. ... medicine’s act, 1968. 

(malignant glaucoma) a rare form of secondary angle-closure *glaucoma marked by raised intraocular pressure and shallowing of the central and peripheral anterior chamber.... aqueous misdirection

Drugs that help remove excess water from the body by increasing the amount lost as urine. They are used in the treatment of various disorders, which include severe premenstrual syndrome, hypertension, heart failure, the eye condition glaucoma, nephrotic syndrome, and cirrhosis of the liver.

Types of diuretic drug differ markedly in their speed and mode of action. Thiazide diuretics cause a moderate increase in urine production. Loop diuretics are fast-acting, powerful drugs. They are often used as an emergency treatment for heart failure. Potassium-sparing diuretics are used along with thiazide and loop diuretics, both of which may cause the body to lose too much potassium. Carbonic anhydrase inhibitors block the action of the enzyme carbonic anhydrase, which affects the amount of bicarbonate ions in the blood; these drugs increase urine output moderately but are effective only for short periods of time. Osmotic diuretics are used to maintain urine output following serious injury or major surgery.

Diuretic drugs may cause chemical imbalances in the blood.

Hypokalaemia (low blood levels of potassium) is usually treated with potassium supplements or potassium-sparing diuretic drugs.

A diet rich in potassium may be helpful.

Some diuretics raise the blood level of uric acid, increasing the risk of gout.

Certain diuretics increase the blood glucose level, which can cause or worsen diabetes mellitus.... diuretic drugs

An inspection of the structures of the eyes, either as part of a vision test or to make a diagnosis when an eye disorder is suspected.

An eye examination usually begins with inspection of the external appearance of the eyes, lids, and surrounding skin. A check of eye movements is usually performed and the examiner looks for squint. A check of the visual acuity in each eye using a Snellen chart follows. Refraction testing (using lenses of different strengths) may be performed to determine what glasses or contact lenses, if any, may be needed. A test of the visual fields may be performed, especially in suspected cases of glaucoma or neurological conditions. Colour vision may be checked because loss of colour perception is an indication of certain disorders of the retina or optic nerve. To check for abrasions or ulcers, the conjunctiva and cornea may be stained with fluorescein. Applanation tonometry is an essential test for glaucoma.

The ophthalmoscope is an instrument used to examine the inside of the eye, particularly the retina. The slit-lamp microscope, with its illumination and lens magnification, allows examination of the conjunctiva, cornea, front chamber of the eye, iris, and lens. For a full view of the lens and the structures behind it, the pupil must be widely dilated with eye-drops.... eye, examination of

The pressure within the eye that helps to maintain the shape of the eyeball, due to the balance between the rate of production and removal of aqueous humour. Aqueous humour is continually produced from the ciliary body and exits from the drainage angle (a network of tissue between the iris and cornea). If drainage is impeded, intraocular pressure builds up (a condition known as glaucoma). If the ciliary body is damaged (as a result of prolonged inflammation), ultrasound scanning may be performed to assess the problem. The underlying cause is treated, if possible. If the baby’s growth is slowing, induction of labour or a caesarean section may be necessary. Most babies whose growth was retarded in the uterus gain weight rapidly after delivery. However, if an intrauterine infection or genetic disorder was the cause, poor growth may continue.

less fluid is produced and the eye becomes soft.... intraocular pressure

a type of *laser that utilizes argon gas to produce a beam of intense light, used especially in eye surgery to treat disease of the retina (e.g. diabetic retinopathy) or glaucoma (as in argon laser *trabeculoplasty). See also photocoagulation.... argon laser

(beta-adrenergic receptor blocker) a drug that prevents stimulation of the beta *adrenoceptors at the nerve endings of the sympathetic nervous system. Blockade of ?1 receptors causes a decrease in heart rate and force; blockade of ?2 receptors causes constriction of the airways and the arteries. Beta blockers include *acebutolol, *atenolol, *bisoprolol, *oxprenolol, *propranolol, and *sotalol; they are used to control abnormal heart rhythms, to treat angina, and to reduce high blood pressure (although they are no longer regarded by some experts as the first choice of drug for treating hypertension in the absence of heart disease, being less effective than newer antihypertensive drugs). Beta blockers that block both ?1 and ?2 receptor sites cause constriction of air passages in the lungs, and these drugs should not be used in patients with asthma and bronchospasm. Other beta blockers are relatively selective for the heart (cardioselective) and are less likely to constrict the airways. Some beta blockers (e.g. *carteolol, *levobunolol, and *timolol) reduce the production of aqueous humour and therefore the pressure inside the eye; they are taken as eye drops in the treatment of *glaucoma.... beta blocker

n. a *beta blocker administered to treat chronic simple *glaucoma. Possible side-effects are local stinging and burning.... betaxolol

n. a *prostaglandin analogue (a prodrug) used topically as eye drops to control the progression of glaucoma and in the management of ocular hypertension. It reduces intraocular pressure by increasing the outflow of aqueous fluid from the eyes.... bimatoprost

n. a blister or large vesicle. A filtering bleb is a blister-like cyst underneath the conjunctiva resulting from a surgical procedure such as *trabeculectomy, used in the treatment of glaucoma.... bleb

n. an alpha agonist (see sympathomimetic) used in the form of eye drops in the treatment of *glaucoma and ocular hypertension. The drug reduces the production of aqueous humour and increases its outflow from the eye; it may be used when beta-blocker eye drops are medically undesirable or are ineffective in controlling the glaucoma.... brimonidine