SHUKLAGATA ROGAS

No. of Disease: 11 (Sushruta)

13 (Vagbhatta)

No. Name of Disease Dosha Prognosis (Sadhya)

1 Prastari Arma Sannipataja
2 Shukla Arma Kaphaja
3 Kshtaja/ Lohita Arma Raktaja
4 Adhimamsa Arma Sannipataja Chhedana
5 Snayu Arma Sannipataja
6 Sirajala Raktaja
7 Sirapidika Sannipataja
8 Shuktika Pittaja
9 Arjuna Raktaja
Aushadha Sadhya
10 Pistaka Kaphaja
11 Balasagrathita Kaphaja

Shuklagata Roga

Non- Inflammatory (9) Inflammatory (2)

Growth Like (5) Spot Like (3)

Pterigium Shuktika Sirajala (Scleritis)

Prastari Arma Pistaka Sirapidika (Episcleritis)

Shukla Arma Arjuna

Kshataja Arma

Adhimamsa Arma

Snayu Arma Balasagrathita

 1. ARMA

VyuiÝ - #yRiÄ gCDit #it, -Which is always progressive in nature.

\ + minn! àTyy = AmR

Types: 5

àStairzu¬]tjaixma<s õaYvmRs<}a> olu p raega>. su % 4 3

Prastari arma, shukla arma, raktaja arma, adhimamsa arma, and snayu arma (five
types of arma) occur in the white portion of the eye.

1 àStair -àStair àiwtimhamR zu¬Éage ivStI[R tnu éixràÉ< snIlm!. su % 4 4

Prastari Arma arising in the white portion is extensive, thin, having bloody lustre and
bluish.

iÇdae;j< #d< saXy< c. fLh[

Dosha: Sannipataja Prognosis: Sadhya

According to A. H.: m&Öazuv&Ï(é'œ ma<s< àStair Zyavlaeihtm! àStayRmR mlE> öaöE>, A hœ % 10

17 18

A soft, quick developing, painless, growth of muscle spread sidewards, bluish-red in

colour is known as Prastaryarma and is caused by all the doshas together with blood.

According to B.P..: àStayRmR tnuStI[R Zyav< r´inÉ< istm!. Éavàkaz m 4

2 zu¬amR - zu¬aOy< m&Ê kwyiNt zu¬Éage sñet< smimh vxRte icre[. su % 4 4

Shukla arma appearing in white portion is soft, whitish and even and has delayed
growth.

ðe:mj< #d< saXy< c. fLh[

Dosha: Kaphaja Prognosis: Sadhya

According to A. H.: k)aCDu¬e sm<ñet< icrv&Ïyixma<skm! zu¬amR, A hœ % 10 12

From Kapha, there develops on the sclera, an extra growth of muscle which is even,
white and growing very slow, this is shuklarma.

According to A. H.: sñet< m&Ê zu¬amR zu¬etdœ vxRte icrat!. Éavàkaz m 4

3 laeihtamR /]tjamR -yNma<s< àcymupiE t zu¬Éage pÒaÉ< tÊpidziNt laeihtamR. su % 4 5

The fleshy tissue having lotus like lustre and growing in the white portion is known as
Raktarma.

@td r´j< saXy< c. fLh[

Dosha: Raktaja Prognosis: Sadhya

According to A. H.: zaei[tamR sm< ðú[< pÒaÉmixma<skm!, A hœ % 10 16

Shonitarma is an extra growth of muscle which is even, smooth and resembling a

lotus flower (in colour).

According to B. P.: pÒaÉ< m&Êr´amR yNma<s< icyte iste. Éavàkaz m 4

4 Aixma<samR-ivStI[R m&Ê bhl< yk«tàkaz< Zyav< v tdixkma<s\jamR iv*at!. su % 4 6

Extensive, soft, thick, liver like or blackish in colour is known as Adhimamsa arma.

@td siÚpatj< saXy< c. fLh[

Dosha: Sannipataja Prognosis: Sadhya

According to A. H.: zu:kas&kip{dœfvCD(av< yNma<s< bhl< p&wu, Aixma<samR tdœ, A hœ % 10 18

The muscle (of the sclera) becoming thick and hard, blue in colour like the clump of
dried blood – this is known as Adhimamsa arma.

According to B. P.: p&wu m&Öixma<samR bhl< c yk«iÚÉm!. Éavàkaz m 4

5 õayu AmR - zu¬e yt! ipiztmupiE t v&iÏmett! õYvmeRTyiÉpiQt< or< àpa{fu. su % 4 6

Fleshy tissue rough and pale growing in white portion is known as snayu arma.

@td iÇdae;j< saXy< c. fLh[

Dosha: Sannipataja Prognosis: Sadhya

According to A. H.: õavamR õavsiÚÉm!, A hœ % 10 18

Snava arma resembles a tendon.

According to B. P.: iSwr< àStair ma<saF(< zu:k< pÂmm!. Éavàkaz m 4

Chikitsa:

AmR caLp< dixinÉ< nIl< r´mwaip va xUsr< tnu y½aip zu³vÄÊpacret!. Su. Ut. 15/17

ALp< ivStare[ dixinÉ< zu¬amR nIl< àStair r´< laeihtamR

xUsr< pa{fur< tnu õayu AmR zukvdev leOyaÃnErevaepcar[Iym!,

Arma which is small, curd like, blue or red, grey and thin should also be treated like
Shukra (Thus arma of five types should be treated with scraping with collyrium like shukra.)

cmaRÉ< bhl< yÄu õayuma<s"nav&tm!, De*mev tdmR Syat! k«:[m{flg< c yt!. Su. Ut. 15/17

Arma which is leathery, thick and densely covered with fibres and fleshy tissue and
has reached the black circle should be excised verily.

AmaeR´ pÂxa tÇ tnu xUmaivl< c yt!, r´< dixinÉ< y½ zu³vtSy Ée;jm!. A hœ % 11 13

Among the five varieties of Arma described, that which is thin, turbid like smoke, red
and which resembles curds, are to be treated in the same manner as of Shukra.

Ayurvedic Shashtrakarma of Arma:

iõGx< Éu´vtae ýÚmupivòSy yÆt>, s<rae;yeÄu nyn< iÉ;kœ cu[ERStu lav[E>.

tt> s<raei;t< tU[¡ suiSvÚ< pir"i”tm!, AmR yÇ vlIjat< tÇEt‘gyeiÑ;kœ.

Apa¼< àe]ma[Sy bifzen smaiht>, mucu{f(a=day me"avI sUcIsUÇe[ va pun>.

n caeTwapyta i]à< kayRm_yuÚt< tu tt!, zôabaxÉya½aSy vTmRnI ¢ahyeÎFm!.

tt> àiziwlIÉUt< iÇiÉrev ivliMbtm!, %i‘oNm{fla¢e[ tIú[en pirzaexyet!.

ivmu´< svRtíaip k«:[aCDu¬a½ m{flat!, nITva knInkaepaNt< iDN*aÚaitknInkm!.

ctuÉaRgiSwte ma<se nai] VyapiÄm&CDit, knInkvxadö< nafI va=Pyupjayte.

hInCDedat! punv&RiÏ< zIºmevaixgCDit, Su. Ut. 15/3-10

After the patient has taken unctuous food and position the surgeon should irritate his
eye carefully with powdered salt. Then the irritated arma should be fomented well and shaken
and when it is wrinkled it should be caught hold of cautiously with hook held with a forceps
while the patient looks at the outer corner of the eye; again with the help of needle-thread it
should be raised but should not be lifted too much suddenly; at the same time the lids should
be held firmly to avoid surgical injury. Thus when lossened being held with all the three, it
should be lifted and all its connection are removed with sharp mandalagra instrument and
freed fully from black and white circles it should be taken near inner canthus and excised not
touching it (inner canthus). If one-fourth of the tissue remains there is no risk to eyes but if
inner canthus is injured, it may cause haemorrhage or sinus. If excision is deficient, it grows
again quickly.
AmR y¾alvÖyaip tdPyuNmaJyR liMbtm!. iDNdyaÖa³e[ zôe[ vTmRzu¬aNtmaiïtm!, Su. Ut. 15/10-
11
Arma which is spread like network and located in white circle near lids should also be
lifted, held with hook and excised (with mandalagra).

Arma Shashtrakarma Paschyata Karma (Post Operative Procedure):

àitsar[mú[aeStu tt> kayRmnNtrm!.

yavnalSy cU[eRn! iÇkqaelRv[Sy c, SvediyTva tt> píaÓ×Iyat! k…zlae iÉ;kœ.

dae;tuRblkal}> SÚeh< dÅva ywaihtm!, ì[vt! s<ivxan< tu tSy k…yaRdt> prm!.

ÈyhaNmu®va krSved< dÅva zaexnmacret!, Su. Ut. 15/11-14

Thereafter eyes should be rubbed with powder of yavakshara, trikatu and salt. Then
after fomenting, the expert surgeon considering dosha, season, strength and condition should
bandage it after applying (suitable) sneha. Then it should be managed like wound; after three
days the bandage should be removed, the wound fomented with hand and cleansed.

Post Operative Management of Complication:

krÃbIjamlkmxukE> saixt< py>. ihtmaZCyaetn< zUle iÖrý> ]aEÔs<yutm!,

mxukaeTplikÃLkËvaRkLkEí mUxRin. àlep> s"&t> zIt> ]Iripò> àzSyte, Su. Ut. 15/14-16
In case of pain, milk cooked with karanja seed, amalaki, and madhuka mixed with
honey should be used as eye drop twice a day.
The paste of madhuka, utpala, lotus stames and durva pounded with milk, mixed with
ghee and cooled should be applied to head.

leOyaÃnErphredmRze;< Éve*id. Su. Ut. 15/16

If there be residual of arma, it should be removed with scraping collyrium.

 PTERYGIUM

Definition: Pterygium (L. Pterygion = a wing) is a wing-shaped fold of conjunctiva

encroaching upon the cornea from either side within the interpalpebral fissure.

Etiology: Etiology of pterygium is not definitely known. But the disease is more common in
people living in hot climates. Therefore, the most accepted view is that it is a response to
prolonged effect of environmental factors such as
 exposure to sun (ultraviolet rays),
 dry heat,
 high wind
 abundance of dust.
Pathology: Pathologically pterygium is a degenerative and hyperplastic condition of
conjunctiva. The subconjunctival tissue undergoes elastotic degeneration and proliferates as
vascularised granulation tissue under the epithelium, which ultimately encroaches the cornea.
The corneal epithelium, Bowman's layer and superficial stroma are destroyed.
Clinical features: Pterygium is more common in elderly males doing outdoor work. It may
be unilateral or bilateral. It presents as a triangular fold of conjunctiva encroaching the cornea
in the area of palpebral aperture, usually on the nasal side
(Figure), but may also occur on the temporal side. Deposition
of iron seen sometimes in corneal epithelium anterior to
advancing head of pterygium is called stocker's line.
Parts: A fully developed pterygium consists of three parts
(Figure):
i. Head (apical part present on the cornea),
ii. Neck (limbal part), and
iii. Body (scleral part) extending between limbus and the
canthus.

Types: Depending upon the progression it may be progressive or regressive pterygium.

 Progressive pterygium is thick, fleshy and vascular with a few infiltrates in the
cornea, in front of the head of the pterygium (called cap of pterygium).
 Regressive pterygium is thin, atrophic, attenuated with very little vascularity. There
is no cap. Ultimately it becomes membranous but never disappears.

Symptoms: Pterygium is an asymptomatic condition in the early stages, except for cosmetic
intolerance. Visual disturbances occur when it encroaches the pupillary area or due to corneal
astigmatism induced due to fibrosis in the regressive stage. Occasionally diplopia may occur
due to limitation of ocular movements.

Complications: like cystic degeneration and infection are infrequent. Rarely, neoplastic
change to epithelioma, fibrosarcoma or malignant melanoma, may occur.
Differential diagnosis: Pterygium must be differentiated from pseudopterygium.
Pseudopterygium is a fold of bulbar conjunctiva attached to the cornea. It is formed due to
adhesions of chemosed bulbar conjunctiva to the marginal corneal ulcer. It usually occurs
following chemical burns of the eye.

Differences between pterygium and pseudopterygium.

Pterygium Pseudopterygium
1. Etiology Degenerative process Inflammatory process
2. Age Usually occurs in elderly Can occur at any age
persons
3. Site Always situated in the Can occur at any site
palpebral aperture
4. Stages Either Progressive, regressive Always stationary
or stationary
5. Probe test Probe cannot be passed Probe can be passed under
underneath the neck

Treatment: Surgical excision is the only satisfactory treatment, which may be indicated for:

(1) cosmetic reasons,

(2) continued progression threatening to encroach onto the pupillary area (once the pterygium
has encroached pupillary area, wait till it crosses on the other side),

(3) diplopia due to interference in ocular movements.

Recurrence of the pterygium after surgical excision is the main problem (30-50%).
However, it can be

reduced by any of the following measures:

1. Transplantation of pterygium in the lower fornix (McReynold's operation) is not performed

now.

2. Postoperative beta irradiations (not used now).

3. Postoperative use of antimitotic drugs such as mitomycin-C or thiotepa.

4. Surgical excision with bare sclera.

5. Surgical excision with free conjunctival graft taken from the same eye or other eye is
presently the preferred technique.

6. In recurrent recalcitrant pterygium, surgical excision should be coupled with lamellar

keratectomy and lamellar keratoplasty.
Surgical technique of pterygium excision:

1. After topical anaesthesia, eye is cleansed, draped and exposed using universal eye
speculum.

2. Head of the pterygium is lifted and dissected off the

cornea very meticulously (Fig. A).

3. The main mass of pterygium is then separated from

the sclera underneath and the conjunctiva
superficially.

4. Pterygium tissue is then excised taking care not to

damage the underlying medial rectus muscle (Fig. B).

5. Haemostasis is achieved and the episcleral tissue

exposed is cauterised thoroughly.

6. Next step differs depending upon the technique

adopted as follows:

i. In simple excision the conjunctiva is sutured

back to cover the sclera (Fig. C).

ii. In bare sclera technique, some part of

conjunctiva is excised and its edges are sutured to the
underlying episcleral tissue leaving some bare part of
sclera near the limbus (Fig. D).

iii. Free conjunctival membrane graft may be

used to cover the bare sclera (Fig. E). This procedure
is more effective in reducing recurrence. Free
conjunctiva from the same or opposite eye may be
used as a graft.

iv. Limbal conjunctival autograft

transplantation (LLAT) to cover the defet after
pterygium excision is the latest and most effective
technique in the management of pterygium.
 6. SHUKTIKA:

Zyava> Syu> ipiztinÉaí ibNdvae ye zu®yaÉa> istnyne s zui´s<}>, Su. Ut. 4/7

Blackish fleshy dots resembling oyster-shell located in white portion is known

as Shuktika.

“zu´yaÉa #it jlzui´irv ikiÂd dI"aR zu¬m{fle” Dalhana.

Dosha: Pittaja Prognosis: Shadhya

According to A. H.: ipÄ< k…yaRiTste ibNËnistZyavpItkan!,

mla´adzRtuLy< va sv¡ zu¬< sdahékœ.

raegae=y zui´kas<}> szk«Ñedt&fœ Jvr>, A. H. Ut. 10/10-11

Pitta increased produces in white portion of eye, small dots (spots) of black
blue/ yellow colour; the entire white portion of eye appearing like a mirror covered by
dirt & has burning sensation and pain. This disease is known as Shuktika is
accompanied with diarrhoea, thirst and fever.

Acc. to Y.R.: Zyav> Syu> ipiztinÉaStu ye, zu®yaÉaSTvistista> szui´s<}>.

According to B. P.: Zyava> Syu> ipiztinÉaí ibNdvae ye, zu¬aÉa> istinicta> s

zui´s<}>. Bhavaprakasha Madhyama Khanda 4

Treatment:

In Shuktika roga, after eliminating Dosha by purgation, collyrium should be applied

with cold drugs.
Ghritapana: Triphala Ghrita or Tilwaka Ghrita
Vaiduryadi Anjana: Fine powder of Vaidurya, Sphatika, Coral, Pearl, Conch-shell,
Silver and Gold mixed with sugar and honey applied as collyrium alleviates Shuktika.
 Xerosis of conjunctiva
Definition: Xerosis of the conjunctiva is a symptomatic condition in which conjunctiva
becomes dry and lustreless.

Normal conjunctiva is kept moist by its own secretions, mucin from goblet cells and
aqueous solution from accessory lacrimal glands. Therefore, even if the main lacrimal gland
is removed, xerosis does not occur.

Types: Depending upon the etiology, conjunctival xerosis can be divided into two groups,

 parenchymatous and
 epithelial xerosis.

1. Parenchymatous xerosis. It occurs following cicatricial disorganization of the conjunctiva

due to local causes which can be in the form of

(i) widespread destructive interstitial conjunctivitis as seen in trachoma, diptheric

membranous conjunctivitis, Steven-Johnsons syndrome, pemphigus or pemphigoid
conjunctivitis, thermal, chemical or radiational burns of conjunctiva,

(ii) exposure of conjunctiva to air as seen in marked degree of proptosis, facial palsy,
ectropion, lack of blinking (as in coma), and lagophthalmos due to symblepharon.

2. Epithelial xerosis. It occurs due to hypovitaminosis -A. Epithelial xerosis may be seen in
association with night blindness or as a part and parcel of the xerophthalmia (the term which
is applied to all ocular manifestations of vitamin A deficiency which range from night
blindness to keratomalacia.

Epithelial xerosis typically occurs in children and is characterized by varying degree

of conjunctival thickening, wrinkling and pigmentatiion.

Treatment: Treatment of conjunctival xerosis consists of

(i) Treatment of the cause, and

(ii) Symptomatic local treatment with artificial tear preparations (0.7% methyl cellulose or
0.3% hypromellose or polyvinyl alcohol), which should be instilled frequently.
 7. ARJUNA

@kae y> zzéixraepmStu ibNÊ> zu¬Swae Évit tmjuRn< vdiNt. Su. Ut. 4/7
Single dot like rabbit’s blood in the white portion is known as Arjuna.

Dosha: Raktaja Prognosis: Sadhya

According to A. H.: nIékœ ðú[ae=juRn< ibNÊ> zzlaeihtlaeiht, A.H. Ut. 10/17.

Arjuna is a dot which is painless, smooth and of the colour of the blood of the rabbit.

Treatment:

For pacifying Arjuna, all paitika measures should be employed.

 Parisheka & Anjana – sugarcane, honey, sugar, breast-milk, daruharidra, madhuka

and saidhava are useful.
 Aschyotana – Amla Dravyas (Sours), sugar, Madhuka, Katavanga, Curd-water,
Honey, Sour gruel, Saindhava, Bijapura, Sour Jujube and pomegranate- these should
be used as Aschyotana singly or in combination of two or three.
 Anjana –
1. Sphatika, Coral, Conch-shell, Madhuka and Honey;
2. Samudraphena combined with conch-shell, honey & sugar.
3. Saindhava, Honey, Kataka and Rasanjana with honey or
4. Kasisa with honey.

ECCHYMOSIS OF CONJUNCTIVA /
SUBCONJUNCTIVAL HAEMORRHAGE
Definition: Ecchymosis or subconjunctival haemorrhage is of very common occurrence. It
may vary in extent from small petechial haemorrhage to an extensive one spreading under the
whole of the bulbar conjunctiva and thus making the white sclera of the eye invisible. The
condition though draws the attention of the patients immediately as an emergency but is most
of the time trivial.

Etiology: Subconjunctival haemorrhage may be associated with following conditions:

1. Trauma. It is the most common cause of subconjunctival haemorrhage. It may be in

the form of
 (i) local trauma to the conjunctiva including that due to surgery and subconjunctival

injections,

(ii) retrobulbar haemorrhage which almost immediately spreads below the bulbar
conjunctiva. Mostly, it results from a retrobulbar injection and from trauma involving various
walls of the orbit.

2. Inflammations of the conjunctiva. Petechial subconjunctival haemorrhages are

usually associated with acute haemorrhagic conjunctivitis caused by picornaviruses,
pneumococcal conjunctivitis and leptospirosis, icterohaemorrhagica conjunctivitis.
3. Sudden venous congestion of head. The subconjunctival haemorrhages may occur
owing to rupture of conjunctival capillaries due to sudden rise in pressure. Common
conditions are whooping cough, epileptic fits, strangulation or compression of jugular
veins and violent compression of thorax and abdomen as seen in crush injuries.
4. Spontaneous rupture of fragile capillaries may occur in vascular diseases such as
arteriosclerosis, hypertension and diabetes mellitus.
5. Local vascular anomalies like telengiectasia, varicosities, aneurysm or angiomatous
tumour.
6. Blood dyscrasias like anaemias, leukaemias and dysproteinaemias.
7. Bleeding disorders like purpura, haemophilia and scurvy.
8. Acute febrile systemic infections such as malaria, typhoid, diphtheria, meningococcal
septicaemia, measles and scarlet fever.
9. Vicarious bleeding associated with menstruation is an extremely rare cause of
subconjunctival haemorrhage.

Clinical features: Subconjunctival haemorrhage per se is symptomless. However, there may

be symptoms of associated causative disease. On examination subconjunctival haemorrhage
looks as a flat sheet of homogeneous bright red colour with well defined limits (Fig.). In
traumatic subconjunctival haemorrhage, posterior limit is visible when it is due to local
trauma to eyeball, and not visible when it is due to head injury or injury to the orbit. Most of
the time it is absorbed completely within 7 to 21 days.

During absorption colour changes are noted from bright red to orange and then
yellow. In severe cases, some pigmentation may be left behind after absorption.

Treatment:

(i) Treat the cause when discovered.

(ii) Placebo therapy with astringent eye drops.

(iii) Psychotherapy and assurance to the patient is most important part of treatment.

(iv) Cold compresses to check the bleeding in the initial stage and hot compresses may help
in absorption of blood in late stages.
 8. SIRAPIDIKA

zu¬Swa> istipfka> israv&ta yaSta iv*adistsmIpja> israja>. Su. Ut. 4/

White boils covered by veins and located in the white portion near the black portion
are known as Sirapidika.
Dosha: Sannipataja Prognosis: Sadhya
Treatment:

Sirapidikas which do not respond to drug therapy should be excised with Mandalagra
like Arma.
Lekhana Anjana- (Churnanajana)-
Sankha, Samudraphena, Muktashukti,
Sphatika, Kuruvinda, Pravala, All in
equal
Asmantaka, Vaidurya, Pulaka, parts
Mukta, Loha Bhasma, Tamra Bhasma

Churnanjana Mix with ½ amount of

Srotonjana & Pounded.

Storage of Churnanjana- in a container made of Meshashringa.

Application- Twice a day regularly.
It allieviates Arma, Sirapidika and Sirajala.
 EPISCLERITIS
Episcleritis is benign recurrent inflammation of the episclera, involving the overlying
Tenon's capsule but not the underlying sclera.
It typically affects young adults, being twice as common in women than men.

Etiology
 Exact etiology is not known.
 It is found in association with gout, rosacea and psoriasis.
 It has also been considered a hypersensitivity reaction to endogenous tubercular or
streptococcal toxins.

Pathology
Histologically, there occurs localised lymphocytic infiltration of episcleral tissue associated
with oedema and congestion of overlying Tenon's capsule and conjunctiva.

Clinical picture
Symptoms:
Episcleritis is characterised by
 redness,
 mild ocular discomfort described as gritty, burning or foreign body sensation.
Many a time it may not be accompanied by any discomfort at all. Rarely, mild
photophobia and lacrimation may occur.
Signs: On examination two clinical types of episcleritis, diffuse (simple) and nodular may be
recognised. Episclera is seen acutely inflamed in the involved area.
 In diffuse episcleritis, although whole eye may be involved to some extent, the
maximum inflammation is confined to one or two quadrants (Fig. 6.2A).
  In nodular episcleritis, a pink or purple flat nodule surrounded by injection is seen,
usually situated 2-3 mm away from the limbus (Fig. 6.2B). The nodule is firm, tender
and the overlying conjunctiva moves freely.

Clinical course: Episcleritis runs a limited course of 10 days to 3 weeks and resolves
spontaneously. However, recurrences are common and tend to occur in bouts. Rarely, a
fleeting type of disease (episcleritis periodica) may occur.

Differential diagnosis:
Occasionally episcleritis may be confused with
 inflamed pinguecula,
 swelling and
 congestion due to foreign body lodged in bulbar conjunctiva and
 very rarely with scleritis.

Treatment
1. Topical corticosteroid eyedrops instilled 2-3 hourly, render the eye more comfortable
and resolve the episcleritis within a few days.
2. Cold compresses applied to the closed lids may offer symptomatic relief from ocular
discomfort.
3. Systemic non-steroidal anti-inflammatory drugs (NSAIDs) such as flurbiprofen (300
mg OD), indomethacin (25 mg three times a day), or oxyphenbutazone may be
required in recurrent cases.
 9. SHIRAJALA

jalaÉ> kiQnisrae mhan! s r´> sNtan> Sm&t #h jals<i}tStu. Su. Ut. 4/8.

A large, extensive, net like red structute of rigid veins is known as Sirajala.

israsNtan>- Anulaemivlaem ivSt&tisraincy -ivrictTva¾alSyev AaÉa ySy s twa. Dalhana.

Dosha: Raktaja Prognosis: Sadhya

Acc. A.H.: israjale israjal< b&hÔ´< "naeÚtm!. A.H. Ut. 10/16.

Extensive, thick, slight elevated net like red structure of rigid veins is known as
Sirajala.

Treatment:
 In Sirajala, Hard Siras should be elevated with Badisha yantra and then
scarraped/ excised with Mandalagra Shashtra.
 Anjana mentioned in Arma Chikitsa.

SCLERITIS
Scleritis refers to a chronic inflammation of the sclera proper. It is a comparatively
serious disease which may cause visual impairment and even loss of the eye if treated
inadequately. Fortunately, its incidence is much less than that of episcleritis. It usually occurs
in elderly patients (40-70 years) involving females more than the males.

Etiology

It is found in association with multiple conditions which are as follows:

1. Autoimmune collagen disorders, especially rheumatoid arthritis, is the most common

association. Overall about 5% cases of scleritis are associated with some connective
tissue disease. About 0.5 percent of patients (1 in 200) suffering from seropositive
rheumatoid arthritis develop scleritis. Other associated collagen disorders are
Wegener's granulomatosis, polyarteritis nodosa (PAN), systemic lupus erythematosus
(SLE) and ankylosing spondylitis.
2. Metabolic disorders like gout and thyrotoxicosis have also been reported to be
associated with scleritis.
3. Some infections, particularly herpes zoster ophthalmicus, chronic staphylococcal and
streptococcal infection have also been known to cause scleritis.
4. Granulomatous diseases like tuberculosis, syphilis, sarcoidosis, leprosy can also
cause scleritis.
5. Miscellaneous conditions like irradiation, chemical burns, Vogt-Koyanagi-Harada
syndrome, Behcet's disease and rosacea are also implicated in the etiology.
6. Surgically induced scleritis follows ocular surgery. It occurs within 6 month
postoperatively. Exact mechanism not known, may be precipitation of underlying
systemic cause.
7. Idiopathic. In many cases cause of scleritis is unknown.
Pathology
Histopathological changes are that of a chronic granulomatous disorder characterised
by fibrinoid necrosis, destruction of collagen together with infiltration by
polymorphonuclear cells, lymphocytes, plasma cells and macrophages. The granuloma is
surrounded by multinucleated epitheloid giant cells and old and new vessels, some of which
may show evidence of vasculitis.

Classification
It can be classified as follows:
I. Anterior scleritis (98%)
1. Non-necrotizing scleritis (85%)
(a) Diffuse
(b) Nodular
2. Necrotizing scleritis (13%)
(a) with inflammation
(b) without inflammation (scleromalacia perforans)
II. Posterior scleritis (2%)

Clinical features

Symptoms: Patients complain of moderate to severe pain which is deep and boring in
character and often wakes the patient early in the morning . Ocular pain radiates to the jaw
and temple. It is associated with localised or diffuse redness, mild to severe photophobia and
lacrimation. Occasionally there occurs diminution of vision.

Signs: The salient features of different clinical types of scleritis are as follows:
1. Non-necrotizing anterior diffuse scleritis. It is the commonest variety,
characterised by widespread inflammation involving a quadrant or more of the
anterior sclera. The involved area is raised and salmon
pink to purple in colour (Fig. 6.3).
2. Non-necrotizing anterior nodular scleritis. It is characterised by one or two hard,
purplish elevated scleral nodules, usually situated near the limbus (Fig. 6.4).
Sometimes, the nodules are arranged in a ring around the limbus (annular scleritis).
3. Anterior necrotizing scleritis with inflammation. It is an acute severe form of
scleritis characterised by intense localised inflammation associated with areas of
infarction due to vasculitis (Fig. 6.5). The affected
necrosed area is thinned out and sclera becomes transparent and ectatic with uveal
tissue shining through it. It is usually associated with anterior uveitis.
4. Anterior necrotizing scleritis without inflammation (scleromalacia perforans).
This specific entity typically occurs in elderly females usually suffering from long-
standing rheumatoid arthritis. It is characterised by development of yellowish patch of
melting sclera (due to obliteration of arterial supply); which often together with the
overlying episclera and conjunctiva completely separates from the surrounding
normal sclera. This sequestrum of sclera becomes dead white in colour, which
eventually absorbs leaving behind it a large punched out area of thin sclera through
which the uveal tissue shines (Fig. 6.6). Spontaneous perforation is extremely rare.
 5. Posterior scleritis. It is an inflammation involving the sclera behind the equator.
The condition is frequently misdiagnosed. It is characterised by features of associated
inflammation of adjacent structures, which include: exudative retinal detachment,
macular oedema, proptosis and limitation of ocular movements.

Complications:
These are quite common with necrotizing scleritis and include
 sclerosing keratitis,
 keratolysis,
 complicated cataract and
 Secondary glaucoma.

10. PISTAKA

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A dot raised, water like, white as rice flour paste and round is known as
Pistaka.

Acc. To A.H.: ibNÊiÉ> ipòxvlEétsÚE> ipòk< vdet!. A.H. Ut. 10/13.

Acc. To Bhavprakash:
ðe:m maét kaepn
e zu´e ma<s smuÛtm!,

ipòvt! ipòk< iviÎ mla´dzRsiÚÉm!. Bhav. Madhyama. 4

Dosha: Kaphaja Prognosis: Sadhya

Treatment:
 As like Kaphaja Abhishyanda
 Anjana: Mahaushadhadi Anjana –Shunthi + Pippali + Sweta Maricha +
Saindhava + Musta; All this take in equal quantity and macerated with
Matulunga Swarasa and then apply as collyrium.
 Anjana: Bruhatyadi Anjana- Take ripe Brihati Phala and squeeze pulp out
of it. Then filled with Pippali Churna and Srotonjana. Kept aside for 1
week. Then Take out the content of Bruhati Phala and macerated with
Matulunga swarasa. Dry it and apply as a collyrium.
 11. BALASAGRATHITA

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That which has lusture like that of bell metal (white), is raised like waterdrop, hard
and painless located in white portion of eye is known as Balasagrathita.

Acc. To Videha: maétaeTpIift> ðe:ma zu¬Éage VyviSwt>, jlibNÊirvaeCDUnae m&Ê> k)smuÑv>,

Acc. To A.H.: zae)STvéj> sv[aeRbhlae=m&Ê>,

Dosha: Kaphaja Prognosis: Sadhya

Treatment:
 Siravedhana,
 Virechana,
 Shirovirechana (Nasya)
 Ksharanjana: Nila Yava should be macerated with Go-dugdha for 7 days and kept
aside. Meanwhile make kshara by firing flowers of Arjaka, Asphotaka, Kapittha,
Bilwa, Nirgundi and Jati. After that take 1 Prastha of above kshara and add saindhava
+ Tuttha + Gorochana and prepare kshara by cooking with fire. Apply as collyrium
with lauha shalaka.