• Users Online:322
  • Home
  • Print this page
  • Email this page
Home About us Editorial board Search Ahead of print Current issue Archives Submit article Instructions Subscribe Contacts Login 


 
 Table of Contents  
CASE REPORT
Year : 2019  |  Volume : 13  |  Issue : 1  |  Page : 48-54

Resolution of lacrimal gland tumour by Homoeopathic medicines - A case report


Dr Anjali Chatterji Regional Research Institute (H), Under Central Council for Research in Homoeopathy, Kolkata, West Bengal, India

Date of Submission15-Dec-2018
Date of Acceptance08-Mar-2019
Date of Web Publication29-Mar-2019

Correspondence Address:
Partha Pratim Pal
37C, Hemchandra Street, Kidderpore, Kolkata - 700 023, West Bengal,
India
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijrh.ijrh_68_18

Rights and Permissions
  Abstract 


Lacrimal glands are exclusive structures possessing both epithelial and lymphoid tissue and may produce a variable range of pathologies such as neoplastic, infective, infiltrative, inflammatory and structural. Treatment is either anti-inflammatory in the form of corticosteroids, radiotherapy or complete excision in the field of modern medicine. A female patient named IB, aged 35 years, came with bilateral firm swelling of the lacrimal gland. She started treatment under modern medicine doctors; however, when she was advised for biopsy, for histopathological examination, she preferred to go for Homoeopathy. The swelling was developing gradually for 2 months – painless, no fluctuation, no fixity to skin and underlying structures. After thorough case-taking followed by repertorisation, Calcarea carbonica 1M, two doses were prescribed. The patient reported after 2 months with zero Outcome in Relation to Impact on Daily Living instrument score. Further modification was done in repertorisation, and now Silicea 1M, two doses was prescribed. Treatment continued for 4 more months and no new medicine or further repetition was required. Documentation was done in the form of photographs of the patient from the same angle under similar light exposure in every follow-up.

Keywords: Calcarea carbonica, Inflammatory, Lacrimal gland, Silicea


How to cite this article:
Pal PP. Resolution of lacrimal gland tumour by Homoeopathic medicines - A case report. Indian J Res Homoeopathy 2019;13:48-54

How to cite this URL:
Pal PP. Resolution of lacrimal gland tumour by Homoeopathic medicines - A case report. Indian J Res Homoeopathy [serial online] 2019 [cited 2019 Jun 26];13:48-54. Available from: http://www.ijrh.org/text.asp?2019/13/1/48/255272


  Introduction Top


Lacrimal gland tumours represent only 10% of all space-occupying orbital lesions.[1] They are generally divided into two broad categories: epithelial and non-epithelial. Inflammatory lesions and lymphoproliferative lesions are a common variety of non-epithelial lesions. In the epithelial category, it is either a benign growth (pleomorphic adenoma) or malignant growth (adenoid cystic carcinoma). Characteristics of the particular lesion, duration of symptoms, presence of pain and radiologic findings are the major focusing points in the management.[2]

Acute onset of swelling associated with periorbital pain, chemosis and indurated lid indicates an inflammatory lesion. Lacrimal gland inflammation results in insufficient secretion, leading to dry eye syndrome.[3] Lymphoproliferative growths are characterised by insidious-onset, painless proptosis and are often bilateral. Pleomorphic adenomas present as painless, progressive proptosis and downward and inward displacement of the globe. A non-tender palpable mass in the superotemporal orbital quadrant is present in most patients. These palpebral lobe tumours are freely movable and do not produce proptosis or bony changes.[4] The most common malignant epithelial tumour of the lacrimal gland is adenoid cystic carcinoma, which presents with a shorter duration of proptosis, globe displacement and characteristic pain due to perineural invasion and may be associated with motility disorder, diplopia, ptosis, lachrymation, numbness and decreased vision. The following case was either having benign, inflammatory or lymphoproliferative growth as there were no destructive and invasive changes such as ptosis, displacements or bony erosions. Of the above characteristics mentioned, the below-mentioned case report is most likely to be lymphoproliferative, i.e., painless, gradual development and bilateral.


  Case Report Top


A female patient (IB) aged 36 years attended the outpatient department with a complaint of swelling on superolateral side (close to the outer canthus) of the left and right orbital rims of both eyes. The swelling had been developing gradually for the last 2 months. It was a firm painless (occasional pain), no fluctuation, no fixity to skin and underlying structures. The size of the swelling was approximately 15 mm × 10 mm × 15 mm and 20 mm × 10 mm × 15 mm of the left and right orbital rims, respectively. Hot compression was used twice a day although with no results (as per the suggestion of the previous physician who diagnosed the swelling to be chalazion). The only symptom was the absence of tear.

Medical report of slit lamp examination reflected a firm swelling in the lacrimal gland on the upper eyelid of both eyes [Figure 1].
Figure 1: Report of Slit Lamp findings

Click here to view


History

The patient had a history of appendicectomy 10 years ago. There were no post-operative complications. She suffered from Jaundice 14 years back during her college days. No specific medications were used except some liver tonics, and no significant consequences felt after recovery. The patient is a known case of essential hypertension and is under anti-hypertensive allopathic drugs for 3 years. She also had a constant predisposition to get affected by humid conditions. She said that whenever she returns to Kolkata, she develops cough and cold. In addition to this, she had a chronic diathesis of nasal obstruction.

Family history

Mother is suffering from uric acid diathesis and some kind of hearing impairment. Father is a patient of hypertension for 10 years and is on anti-hypertension drugs.

Personal history

The patient by occupation is a teacher in English-medium school, living with her spouse in Hyderabad who is an Engineer doing his job in a private firm. They had no issue although they are married for >7 years. For this problem, they were under consultation with a fertility clinic 2 years ago, but no result. As per the oral conversation (since they did not bring any reports regarding the infertility clinic and was only concerned with the swelling on the eyelids) with the couple, the patient had polycystic ovary detected in a ultrasonography.

Generals

The patient by nature was a perfect example of a foodie. She enjoys food with delight. Of many things, she had strong desire for egg and milk. Bowel movements and urination had no significant points of deviations. The patient had an extreme intolerance to the cold (dry and wet) of winter and rainy seasons. She also had tendency of profuse sweating, especially on head and scalp. Menstrual irregularities were marked of which late catamenia was the key.

Local and systemic examination

The patient had Endomorph body with obesity (body mass index = 31). Fatty streaks along the flanks on lower abdomen and also around the anterior folds of axilla (both) were observed. Numerous brown spots were visible on the skin.

Analysis of the case

After analysing the symptoms of the case, the characteristic general and particular symptoms were considered for framing the totality. Desire for egg and milk, delayed menses, profuse perspiration on scalp ailments from humid and cold weather, chronic nasal obstruction and swelling on eyelids were included in totality.

Miasmatic analysis

Miasmatic evaluation of all the presenting symptoms was done which showed the predominance of psoric and sycotic miasm in combination[5] [Table 1].
Table 1: Miasmatic evaluation of all the presenting symptoms was done which showed the predominance of psoric and sycotic miasm in combination

Click here to view


Reportorial analysis

Considering the above symptomatology, Kent Repertory was preferred, and using HOMPATH software,[6] systemic repertorisation was done. The repertorisation chart is presented in [Figure 2].
Figure 2: Repertorization chart for second prescription

Click here to view


After repertorisation, many medicines were competing with each other, namely Calcarea, Silicea, Mercurius and Sulphur, where the maximum number of symptoms was covered by Calcarea (i.e., 7 out of 8) with maximum score. Ultimately, on consultation with Materia Medica, Calcarea 1M, two doses were prescribed in the first visit.

Follow-ups

The follow ups are given at [Table 2] along with the photographs [Figure 3-11].
Table 2: Follow up

Click here to view



  Discussion Top


The above swelling of the lacrimal gland was considered to be lymphoproliferative as per the clinical features, but the rubric selection during the 2nd repertorisation (in the 2nd visit) was ‘eye–inflammation–lacrimal gland’ replacing the rubric ‘eye–swollen–lids’ during the 1st repertorisation (1st visit). This should not be doubted as an error as literature search from reputed clinical Materia Medicas such as TF Allen's Encyclopedia of pure Materia Medica; Boger Boenninghausen's Characteristics and Repertory and Clark's Dictionary of Materia Medica showed ‘swelling in the region of the right lachrymal gland and lachrymal sac (after six days)’ and ‘swelling of lachrymal gland', respectively, under the drug Silicea.[6] However the term ‘inflammatory’ is found in many books of therapeutics and Materia Medica under other drugs also. Hence, it is understandable that finer discrimination between ‘swelling', ‘inflammatory’ or ‘lymphoproliferative’ (which was not found in proving records) is not possible from our 200-year-old literature. Interpretation of such clinical understanding is just essential for academic purposes. Another point of differentiation is that according to JH Allen – ‘Disturbances in the glandular structures or in the lachrymal apparatus are always syphilitic or tubercular', but in the above-mentioned, the miasmatic analysis of the present symptomatology indicates sycosis on a psoric platform.[10]

Finally, it should always be kept in mind that ‘those affections, alterations and ailments appearing on the external parts, which do not arise from any external injury or which have only some slight external wound for their immediate exciting cause, are produced in quite a manner and their sources lies in some internal malady'.[11] The above illustration of lacrimal gland tumour is an example of such an ailment locally appearing over the eyelids and having negligible particular symptoms. These cases can be rightly said as one-sided diseases in which selection of Simillimum is based on the mental and physical generalities along with past and family history.[12]


  Conclusion Top


The beauty of Homoeopathy is that it has widespread effectiveness. For example, many a times, certain cases which are expected to be entirely surgical (as per the printed books, journals, articles, etc.) may be annihilated with Homoeopathic medicines and lifestyle modifications only. The outcome of the above-mentioned case clearly proves that proper selection of the Homoeopathic remedy after classical miasmatic and repertorial approach can remove tumours without any surgical intervention, and this can serve as an alternative option. This is definitely cost-effective and may be an alternative for the reasonably under-privileged section of the people, particularly residing in distant areas where medical facilities and infra-structural conveniences for doing surgery are negligible.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form, the patient has given her consent for her images and other clinical information to be reported in the journal. The patient understands that her name and initials will not be published and due efforts will be made to conceal identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

None declared.



 
  References Top

1.
Shields CL, Shields JA, Eagle RC, Rathmell JP. Clinicopathologic review of 142 cases of lacrimal gland lesions. Ophthalmology 1989;96:431-5.  Back to cited text no. 1
    
2.
Hada M. Ocular Malignancies. Lacrimal Gland Tumor – An Overview. 2014:20(6):29-34. Available from: http://www.dosonline.org. [Last accessed on 2018 Aug 22].  Back to cited text no. 2
    
3.
Zoukhri D. Effect of inflammation on lacrimal gland function. Exp Eye Res 2006;82(5):885-98.  Back to cited text no. 3
    
4.
Vangveeravong S, Katz SE, Rootman J, White V. Tumors arising in the palpebral lobe of the lacrimal gland. Ophthalmology 1996;103(10):1606-12.  Back to cited text no. 4
    
5.
Patel RP. Chronic Miasms in Homoeopathy and Their Cure with Classification of Their Rubrics/Symptoms in Dr. Kent's Repertory. Indian edition. New Delhi: Indian Books and Periodicals Publishers; 1996.  Back to cited text no. 5
    
6.
Shah J. Hompath Classic-Homeopathic Software. Version. 8.0. Mumbai: Premium; 2005.  Back to cited text no. 6
    
7.
Reilly D, Mercer SW, Bikker AP, Harrison T. Outcome related to impact on daily living: Preliminary validation of the ORIDL instrument. BMC Health Serv Res 2007;7:139.  Back to cited text no. 7
    
8.
Tang SX, Lim RP, Al-Dahmash S, Blaydon SM, Cho RI, Choe CH, et al. Bilateral lacrimal gland disease: Clinical features of 97 cases. Ophthalmology 2014;121(10):2040-6.  Back to cited text no. 8
    
9.
Moffat J. Homoeopathic Therapeutics in Ophthalmology. New Delhi, B Jain Publishers Pvt. Ltd., 1995.  Back to cited text no. 9
    
10.
Allen JH. The Chronic Miasm. Vol. 1, 2. Low Price edition. New Delhi: B. Jain Publishers (P) Ltd.; 2002.  Back to cited text no. 10
    
11.
Hahnemann S, Krauss J. Organon of Medicine. Translated by Dudgeon RE, Boericke W. 5th ed., 6th ed. New Delhi: B. Jain Publishers (P) Ltd.; 2010.  Back to cited text no. 11
    
12.
Chattopadhyay R. A Complete Book on Cardiovascular System for Homoeopaths. 1st ed. New Delhi: B. Jain Publishers (P) Ltd.; 2005. p. 208.  Back to cited text no. 12
    


    Figures

  [Figure 1], [Figure 2]
 
 
    Tables

  [Table 1], [Table 2]



 

Top
 
 
  Search
 
Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
 Related articles
Access Statistics
Email Alert *
Add to My List *
* Registration required (free)

 
  In this article
   Abstract
  Introduction
  Case Report
  Discussion
  Conclusion
   References
   Article Figures
   Article Tables

 Article Access Statistics
    Viewed462    
    Printed23    
    Emailed0    
    PDF Downloaded183    
    Comments [Add]    

Recommend this journal


[TAG2]
[TAG3]
[TAG4]