POINTERS TO SOME HAYFEVER REMEDIES - by Dr. Margaret L. Tyler Dr Margaret Lucy TYLER (1857-1943) Allium Cepa Begins sneezing, with increasing frequency. Watery discharge drips from nose; excoriates lip and wings of nose. ( Ars ., Arum trip .) Rawness in nose; copious lachrymation. Fluid from nose excoriating: from eyes bland. (Reverse of Euphrasia ). Generally begins left side and goes to right. Every year in August ( Naja ) morning coryza with violent sneezing: very sensitive to odor of flowers and skin of peaches. Spring coryza: Hayfever in August every year on rising from bed, and handling peaches. Arsenicum Discharge burns a red streak over upper lip and about wings of nose, with sneezing and profuse, watery nasal discharge The typical Ars. patient is anxious, restless, often asthmatic, when his worst hour is soon alter midnight. Sneezing a prominent symptom, but sneezing no joke.

Starts from tickling in one spot nose; after sneezing tickling as bad as before. Hay asthma. Hay fever with fetid, corrosive discharge. Discharges excoriating, thick and yellow, resembling honey. (Graph.) Arum Triphyllum A prickling sensation that cannot be left alone. Pinches and pricks, and bores into the nostrils, however sore. A dreadful catarrh. Nose stopped, worse left side. Sneezing worse during the night. Fluent acrid coryza, with lachrymation usually bland. (Comp. Allium Cepa .) Fluid from nose, produces rawness, smarting, burning: leaves red streaks as it flows over skin'. ( Ars .) - KENT. Arundo Mauritanica KENT gives this drug in black type in the Repertory for Hay Fever. Hay fever begins with burning and itching of palate and conjunctiva. Coryza with snuffling. First water runs from the nose, later green mucus. With sneezing, pieces of indurated greenish mucus. Itching, burning, dryness of Schneiderian membrane.

Curious symptoms, when sneezing, stitches in loins. Bromium Fluent coryza with frequent violent sneezing. Corrosive soreness under and margins of nose. Right nostril more affected. Aversion to smoking: to drinking cold water. Carbo Vegetabilis Frequent sneezing, with constant violent crawling and tickling in nose; lachrymation and biting pain in and above nose. Ineffectual desire to sneeze, with crawling in left nostril. Watery discharge, and sneezes day and night. Suffers from heat: is chilled by cold: sweats in a hot room. No comfortable place. Dulcamara Nostrils stopped up, cannot breathe through nose. ( Lach ) Constant sneezing, profuse watery discharge from nose and eyes. Worse open air: better in closed room: worse near newly cut grass: better at Seaside. ( Nat.mur .) Eyes swelled and full and most affected, then nose, then again eyes. Dulc . cannot stand cold and wet: worse from chill when hot.

Euphrasia Profuse acrid lachrymation, with profuse bland coryza (reverse of Allium Cepa ). Short-acting remedy: very useful in catarrhal affections without fever. Sneezing; fluent bland coryza with acrid tears Eyes worse open air, and wind. Gelsemium Sneezing: hot face: feeling of great weight and tiredness in whole body and limbs. Violent morning paroxysms of sneezing: tingling in nose. Watery, excoriating discharge. Curious symptom, a feeling from throat up to left nostril, like a stream of scalding water. Kali Iodatum Violent sneezing, acrid, watery discharge. Worse cool air, worse open air: but patient feels better in open air: i.e.: finds no quarters for relief. Frontal sinuses involved with the coryza; much pain in forehead, eyes, cheekbones. Kali Phosphoricum Hay fever, said to be prophylactic. Itching in posterior nares. Sneezing ; at 2 a.m. Eyes burn, sting, swim in tears.

Tongue coated like stale brownish liquid mustard. Lachesis Paroxysms of sneezing worse after sleep even in the day time. Headache extending into nose, with frequent and violent paroxysms of sneezing. Mucous membrane or nose thickened: dry stuffed sensation through head: face red, puffed: eyes seem almost pressed out. Red, sore nostrils and lips. Lach . is purple: sleeps into aggravation; throat sensitive to touch or pressure. Naja Much sneezing: water runs from nose: cannot lie down at night; dryness of air passages of nose. Hay fever. Suffocative attacks in August. ( All. Cepa .). Like Lach. wakes suffocating gasping, choking. Rawness of trachea and larynx, as if excoriated. Natrum Muriaticum Squirming as from a small worm. Watery discharge from eyes and nose. Severe coryza, had to lay a towel under nose. Woke with headache; after rising nasal discharge with violent and frequent sneezing. Loss of taste and smell: cough from tickling in throat pit.

Lachrymation acrid; canthi red and sore. Characteristics: Worse in sun; desire for salt in hay fever, better at seaside. Recorded case, cured by a swim in the sea. Nux Vomica Distressing prolonged paroxysms of sneezing. Excessive irritation in nose, eyes. face; - Heat as if a hot iron plate were near it. Itching extends to larynx and trachea. Nux is very irritable: very sensitive to cold. Psorinum A sort of continuous hay fever, runs all the year and ripens up in the Fall. Catarrhal state of eyes and nose. Nose dries up part of the time and runs part of the time: must continually use handkerchief. "Hay fever a difficult condition to fit a remedy to; constitution must be built up before hay fever will cease" - KENT. Must wrap up in hottest summer. Wants head covered. Skin greasy, oily, looks unwashed. Ranunculus Eyes smart; lips burn and are sore. Nose stuffed, especially evenings, with pressure root of nose and tingling and crawling inside.

May attack posterior nares: hawks and swallow in effort to scratch affected part. (Comp. Wyeth .) Hoarseness: stitching pains chest: muscles sore. Sabadilla Spasmodic sneezing: fluent coryza. Nostrils stuffed up: inspirations through nose laboured: snoring. Itching in nose; bleeding from nose. ( Zinc .)Violent sneezing; with copious watery discharge. Severe frontal pains and redness eyelids. Very sensitive to smell of garlic. Sanguinaria Rose colds in June. Sensitive to flowers and odors. Hay fever with burning in nose, throat - dry: as if mucous membranes would crack open. Dry burning in larynx with hoarseness of chest with asthma. Palms dry, burning, wrinkled. Burning palms and soles: puts them out of bed. (Sulph., Puls., Cham., Med.) Silica begins with itching and tingling in nose. Violent sneezing and excoriating discharge. Itching in posterior nares, or orifice of Eustachian tubes.

( Ars ., Sil ., Wyeth .) Sinapis Nigra Mucous membrane of nose dry and hot: worse afternoon and evening: one nostril affected, or alternate nostrils. Nose swollen, stuffed: discharges a thin acrid mucus. ( Ailanthus .) Eyes suffused, itch, smart . Sticta Pulmonaria Constant need to blow nose, but no discharge results on account of dryness. Nose is stuffed up; secretion drying so rapidly it cannot be discharged. Almost constant sneezing; tingling right side nose. Fullness right side forehead to root nose. Excessive dryness of soft palate. Tickling high up in pharynx. Wyethia Peculiar itching in roof of mouth ( Arund .), for relief patient must draw tongue back and forth over soft palate; with this coryza, sneezing, etc. Zincum Frequent sneezing starts with cutting-crawling in nose, without coryza; or fluent coryza; sensitive nostrils; crawling in nose; frequent sneezing. Itching in left nostril: in right: followed by frequent sneezing. Much burning in eyes. Itching. Photophobia.

Overworked; over-excitable; extremely over-sensitive. ( Nux .) Characteristic: Burning whole length of spine: fidgety feet; relief with menstruation. The copy I have is in the same style of typography as "Pointers..." Trigeminal Neuralgia Differential Diagnoses Trigeminal Neuralgia Differential Diagnoses Author: Manish K Singh, MD; Chief Editor: Robert A Egan, MD more... Share DDx Diagnostic Considerations Other causes of facial pain than trigeminal neuralgia (TN) are excluded by history, physical examination, and special investigations (when necessary). In symptomatic cases, a persistence of aching can occur between paroxysms, as well as signs of sensory impairment in the trigeminal division. Then, a cause is demonstrated by appropriate investigation. Migraine, cluster headaches, and atypical face pain Migraine and cluster headaches may produce severe unilateral pain, but unlike trigeminal neuralgia, these conditions are not triggered by movement or contact with the face nor do they respond promptly to carbamazepine. See Table 1, below. Table 1.

Characteristic Features of 3 Common Craniofacial Pains (Open Table in a new window) Condition Horner syndrome, conjunctival injection, epiphora 15-180 minutes Clusters with weeks to months intervals Nocturnal attacks Days to weeks intervals Variable According to Turp and Gobetti, atypical face pain usually extends beyond the distribution of the fifth cranial nerve, is rarely triggered, and presents with a steady unrelenting discomfort lasting hours to days. [ 19 ] See Table 2, below. In persistent idiopathic facial pain, psychiatric disturbances are associated with pain that is of vague localization and long duration (usually chronic and daily). In Raeder syndrome (paratrigeminal neuralgia), ophthalmoparesis is present. In current practice, Raeder syndrome is believed to essentially be carotid dissection. Tolosa-Hunt syndrome (ophthalmoplegia) presents with pain of longer duration but that is not triggerable; cranial nerve deficits are observed.

Short-lasting, unilateral neuralgiform headache attacks with conjunctival injection and tearing (SUNCT) present with pain of longer duration (2-3 min) and associated prominent autonomic symptoms (eg, lacrimation, rhinorrhea). [ 20 ] Temporomandibular joint pain and dental problems in the evaluation of trigeminal neuralgia. Table 2. Distinguishing Features Between Trigeminal Neuralgia and Atypical Facial Pain (Open Table in a new window) Feature Light touch, washing, shaving, eating, talking Stress, cold Sensory abnormalities Glossopharyngeal neuralgia and occipital neuralgia syndromes Other syndromes with paroxysmal lancinating head pain include the less common glossopharyngeal neuralgia and occipital neuralgia syndromes. Glossopharyngeal neuralgia causes pain in the tonsillar fossa, posterior pharynx, and ear and may be initiated by coughing, yawning, or swallowing cold liquids. During acute attacks of this condition, which is frequently associated with an underlying pathology, the patient may be unable to speak and tries to avoid moving the lips or tongue.

An involuntary startle during an attempt to touch the affected side of the face is diagnostic. Occipital neuralgia causes pain in the posterior head region. Thus, the distribution easily distinguishes it from trigeminal neuralgia. Confusion arises only if the patient cannot provide a clear history. Paroxysmal hemicrania syndromes According to Goadsby and Lipton, similar to trigeminal neuralgia, paroxysmal hemicrania syndromes typically last only seconds, however, the latter syndromes occur in and around 1 eye. [ 21 ] Intense unilateral conjunctival injection and lacrimation signal an autonomic component, which further distinguishes paroxysmal hemicrania syndromes. Another feature is that paroxysmal hemicrania syndromes do not respond to carbamazepine. Secondary vs idiopathic trigeminal neuralgia Symptomatic or secondary trigeminal neuralgia is a more likely consideration than the idiopathic form when pain is associated with hyperesthesia along the course of the fifth nerve or is observed with other cranial neuropathies.

Further, consider secondary trigeminal neuralgia in patients with bilateral sensory loss or weakness of the facial muscles or jaw. Additional investigation may reveal multiple sclerosis (MS), a tumor in the posterior fossa, or a tumor on the trigeminal nerve. Acoustic neuromas, cerebral aneurysms, trigeminal neuromas, and meningiomas can produce syndromes similar to idiopathic trigeminal neuralgia. Consider these conditions in patients with onset of pain when younger than 40 years, those with predominant forehead and/or orbit pain (ie, first division of the trigeminal nerve), or those with bilateral facial pain. Also consider granulomatous inflammation (eg, tuberculosis, sarcoidosis, Behçet syndrome, collagen vascular diseases) and other vasculitides, as these may affect the trigeminal nerve and simulate trigeminal neuralgia. Patients with prominent hemifacial spasm, especially if it is continuous, may have tic convulsif, a condition associated with a dilated and ectatic basilar artery or other vascular malformation compressing the trigeminal nerve. Brain magnetic resonance imaging (MRI) with and without contrast is critical in diagnosing the secondary causes of trigeminal neuralgia.

Failure to properly assess for secondary trigeminal neuralgia is a major potential pitfall. A careful examination of the cranial nerves and an MRI of the brain, especially in an individual who develops the disorder when younger than 60 years, should protect against missing structural lesions (eg, tumor, cerebral aneurysm, acoustic neuroma). Trigeminal neuropathy and atypical trigeminal neuralgia Trigeminal neuropathy is also a consideration in the evaluation of trigeminal neuralgia. This condition presents as a constant, unilateral, often mild facial pain with prominent sensory loss. It is nontriggerable and unremitting, and it may be either symptomatic or idiopathic. By contrast, as previously discussed, idiopathic trigeminal neuralgia presents as episodic, unilateral, lancinating, triggerable, often shocklike facial pain with pain-free intervals. To further complicate diagnostic matters, the clinician may encounter atypical trigeminal neuralgia, a syndrome that overlaps trigeminal neuralgia and trigeminal neuropathy. This syndrome consists of constant pain that episodically intensifies. According to Burcheil, these patients experience both lancinating triggered pain and a baseline, constant, dull, and throbbing discomfort.

[ 2 ] The atypical form may occur in up to 5% of people after facial surgery or significant trauma and in 1-5% after the removal of impacted teeth. In the experience of many neurosurgeons, atypical trigeminal neuralgic pain results from lesions or injuries of the trigeminal nerve root distal to the route entry zone but with even greater compression than found in the idiopathic form of trigeminal neuralgia. In contrast to trigeminal neuropathy, whether typical or atypical, atypical facial pain is distinguished by the extension of discomfort beyond the distribution of the fifth cranial nerve and by the frequent lack of lancinating pain and triggers. Multiple sclerosis As discussed in the Clinical section, rarely, multiple sclerosis (MS) presents with trigeminal neuralgia. Consider multiple sclerosis in the diagnostic evaluation of individuals who display other features of this demyelinating disorder. Herpetic and postherpetic neuralgia Herpetic and postherpetic neuralgia (PHN) usually affects the first branch of the trigeminal nerve. The diagnosis of postherpetic neuralgia usually requires the outbreak of shingles (herpes zoster) in the forehead or eye.

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[Medline] . Truini A, Galeotti F, Haanpaa M, Zucchi R, Albanesi A, Biasiotta A, et al. Pathophysiology of pain in postherpetic neuralgia: A clinical and neurophysiological study. Pain. 2008 Oct 25. [Medline] . Media Gallery Illustration depicting the trigeminal nerve with its 3 main branches Microscopic demonstration of demyelination in primary trigeminal neuralgia. A tortuous axon is surrounded by abnormally discontinuous myelin. (Electron microscope; 3300×). Magnetic resonance image (MRI) with high resolution on the pons demonstrating the trigeminal nerve root. In this case, the patient with trigeminal neuralgia has undergone gamma-knife therapy, and the left-sided treated nerve (arrow) is enhanced by gadolinium. Microvascular decompression (Jannetta procedure) used to treat trigeminal neuralgia. The anteroinferior cerebellar artery and the trigeminal nerve are in direct contact.

Courtesy of PT Dang, CH Luxembourg of 4 Lacrimal Duct Obstruction | definition of Lacrimal Duct Obstruction by Medical dictionary Lacrimal Duct Obstruction | definition of Lacrimal Duct Obstruction by Medical dictionary Definition A lacrimal duct obstruction is blockage of the tear duct, the thin channel that normally drains tears from the surface of the eye. Description The lacrimal glands, located above each eyeball, produce tears. The tears flow over the eye, then drain through the nasolacrimal ducts. A tiny hole at the inner edge of each eyelid marks the opening of the ducts, which lead to the lacrimal sacs located on the side of the nose. The tears pass from the sacs into the nasolacrimal ducts and then into the nose. When a tear duct becomes obstructed, tears may spill over the eyelids and run down the face. Stagnant tears within the system can become infected, leading to recurrent red eyes and infections. Excessive tearing can also produce secondary skin changes on the lower eyelids. Causes and symptoms An obstructed lacrimal tear duct can result in inflammation and infection of the lacrimal sac.

The area beneath the eyes next to the nose can become red, inflamed, and sensitive to the touch. The area usually is swollen, and there may be a mucous discharge from the opening of the nasal corner of the eye. Common complaints include itching , irritation, burning, redness, foreign body sensation, and tearing. Children frequently have a congenital lacrimal duct obstruction. Six to ten percent of all children are born before their tear ducts are open. In adults, a common cause of lacrimal duct obstruction is involution, which is progressive degeneration occurring naturally with advancing age, resulting in shrivelling of organs or tissues. Other causes include eyelid disorders , infections by bacteria, viruses, fungi, and parasites, inflammations, the use of eye drops or excessive nasal spray, systemic chemotherapy , trauma from previous surgeries, injury to the bone at the side of the nose, foreign bodies, sinus disease, nasal polyps , and malignant or benign tumors. Diagnosis If the primary symptom is excessive tearing, the first step is for the health care professional to determine if the overflow of tears is due to an increase in tear production or a decrease in tear drainage.

Causes of increased tear production may include trichiasis, a disease in which the eyelashes produce constant irritation, and eyelid malpositions and diseases. If abnormal tear production is ruled out, then obstructions in tear drainage is the most likely cause of the excessive tearing. Additional observations of swollen lacrimal sac area and purulent eye discharge indicate that there may be a lacrimal duct infection present. To further define the diagnosis, the lacrimal discharge may be cultured to determine possible infective agents, while various imaging techniques may be used to detect the type of obstruction. Dye tracer tests are also used to test for blockages. Treatment Lacrimal duct obstructions in children often resolve spontaneously, with 95% showing resolution before the child is one year old. Daily massaging of the lacrimal sac may help open the blockage. A topical antibiotic ointment may be applied if infection is present. If the blockage is not resolved after several weeks to months of this therapy, a physician may attempt forceful irrigation. Surgical probing to open up the duct under general anesthesia is a last resort, after a year or so of less invasive treatments. In adults, conservative treatments are usually recommended.

The infected or inflamed area may be massaged, with warm compresses applied to provide relief and speed the healing process. The health care provider may also massage or irrigate the infected area. Topical antibiotic ointments and oral antibiotics may also be used reduce infection. The use of analgesics such as aspirin may be recommended to control discomfort and reduce swelling. Severe cases may require surgical intervention to prevent future recurrences. Surgical approaches include insertion of a probe or catheter to remove an obstruction or creation of an artificial duct to bypass the obstruction. Prognosis If more conservative approaches fail to clear the obstruction, surgical procedures are available, with success rates greater than 90%. Prevention In many cases, the cause of a lacrimal duct obstruction is not known. However, in some cases, lacrimal duct obstruction may be caused by smoking and abuse of nasal sprays. Resources Periodicals

Question: What fluid results from lachrymation?
Answer: Tears