Unilateral eyelid ptosis: A case report cured by Gelsemium sempervirens

Background: A 60 years-old man presented with an 8-day history of acute onset painless left upper eyelid ptosis covering the pupil entirely. Ptosis can affect unilateral or bilateral. He had no other symptoms; importantly pupils were equal and reactive and eye movements were full. There was no palpable mass or swelling. He had a headache but had no other focal neurological signs or symptoms of fatigue. MRI of brain and Orbits showed no remarkable abnormality detected in brain & orbits.


Introduction
Homeopathy can be considered as a complementary treatment option for patients with severe form of the ptosis whose symptoms cannot be controlled with conventional medication without surgery. Individual therapy is conducted based on the level of health theory [1].
Eyelid ptosis, a common neurological sign, is classically explained by weakness of the levator palpebrae superior muscle due to oculomotor nerve disturbance, or by weakness of Muller's muscle secondary to involvement of its sympathetic innervations, or by intrinsic disorders of the lids and their musculature [2]. Early diagnosis and proper evaluation are the important factors aiding treatment of this condition which can improve the quality of life of the people affected [3].

Methodology
This study was conducted in Jannat Homeo Hall (JHH), Kazipara, Mirpur, Dhaka, Bangladesh over a period of three and half weeks i.e. from 15, September 2020 to 10, October 2020.

Study design
A prospective observational study is conducted in secondary care homeopathic clinic.

Case presentation
A

Homeopathic approach
Homeopathy is the method of treatment with that medicine which can produce symptom similarity. Homeopathy is a therapeutic approach of medicine that uses substances selected from nature, such as minerals, chemicals, and plants, which are diluted and potentiated [4]. Its aim is to restore the internal order by stimulating the patient's defense mechanisms [5].
The energy complex of the organism is the capacity of the body to react to overall stimuli, and the symptoms produced by the defense mechanism may appear to protect the inner vital organs. Hahnemann's law of cure states that the symptoms of the remedy and the symptoms produced by the defense mechanism of a patient in a disease state are similar [5].
Homeopathic approaches are based on the levels of health theory, which implies that each person has a specifi c energy needed for all vital functions and health maintenance, and this energy is infl uenced by genetics, environment, thoughts, and treatments. People with a low level of health are more diffi cult to treat or are less likely to present with a systematic improvement until they are treated with the correct successive remedies for a long period of time; those with a higher level of health can be completely cured in a faster and easier manner [6].
A homeopathic treatment uses a source substance and passes through a dilution process (potentization) in which the substance is still biologically active by retaining the proprieties of the initial material [7].

General approach
Blepharoptosis (or ptosis) is a down-ward displacement of the upper eyelid margin [9]. Drooping of the upper eyelids in adults, most commonly due to separation of the tendon of the lid-lifting (levator) muscle from the eyelid [10]. Most cases of ptosis can be categorized into one of the following fi ve forms: aponeurotic, myogenic, neurogenic, mechanical, and traumatic. The aponeurotic form is the most common type of ptosis in adults and is due to disinsertion or stretching of the levator aponeurosis . Stretching can be caused by normal aging, repetitive eye rubbing, or previous intraocular surgery [11]. Age-related blepharoptosis (ptosis) is one of the common conditions encountered in ophthalmology clinics. It can cause superior visual fi eld defect at primary and downward reading gaze and affect quality of life [12].

Selection of medicine
We take this patient as a challenge from the very beginning.
We collected physical, mental symptoms including all other symptoms of the patient. Some of the symptoms that are more important in the case of ptosis are differentiated Table 1.
Then remedy selection was done with the help of a homeopathic repertory by sorted out symptoms Table 2.
We then initially selected the homeopathic medicine Gelsemium for this ptosis patient to conduct repertory Table 3.
To choose the more accurate medicine, drug fi lter was conducted by the stage of disease, sex, thermal state of the patient and side of the patient through the homeopathic software Edu Homeopathy. Ultimately we agreed that Gelsemium would be a more effective drug for this patient

Selection of scale and potency
Professional homeopaths frequently use the potencies from the centesimal scale [13]. In the 5 th Edition, Organon of Medicine, Hahnemann states that the centesimal potencies are quick in their onset and tend to aggravation in the beginning of chronic treatment. He seemed to use his centesimal for the most acute diseases, crisis, or as acute intercurrents during the disruptions of chronic treatment [14].
We took some criteria for potency selection such as susceptibility, nature of diseases, miasmatic background, seat of diseases, general condition of patient, and history of

Conclusion
We

Author contribution
NEAR: served as the principal author, collected and analyzed the data, and wrote the article. MAZ and RAR: collected the data and contributed to the writing process.