Short Notes

Shalakya tantra (I)

4th Professional BAMS

Rabin Singh
 Shalakya tantra- 1 ϭ

नत्र ार र 
(Anatomy of Eyes)
नत्र र्ाार्  नत्र, नर्न, क्ष, क्षक्ष, क्षि, ल िं , नत्र , नर्न द् etc.

नत्र ार र  The eyeball (नर्न द् ) is almost round shaped and resembles the teat of cow ( स् ना ार). It is formed by the essence of Panchamahabhuta with
Agni bhuta predominance.
नत्र प्रमा 
1. नत्र ाहुल्र्म 2 िं (1 िं = स्र्ािं ष्ठ र क्षमम म)

2. नत्र र्ा ः प्रमा ( र्ाम) 2½ िं

3. ष् मण् प्रमा नत्र र्ाम = 5/2/3 = 5/6 िं
3
4. क्षि मण् प्रमा ष् मण् प्रमा = 5/6/7 = 5/42 िं
7
5. प्रमा क्षि मण् प्रमा = 5/42/5= 1/42 िं
5

Parts of Eyeball (नत्र )

5 मण् 6 क्षधि 6
(Circles of eyeball) (Junctions of eyeball) (Tunics of eyeball)
1. क्ष्म मण् (Circle of eyelashes) 1. क्ष्मर्र्तमा क्षधि (Lid margins – Junction between eyelid and 2 र्र्तमा & 4 क्षक्ष
2. र्र्तमा मण् (Circle of eyelids) eyelashes) क्षक्ष 
3. क् मण् (Sclera & Bulbar conjunctiva) 2. र्र्तमा क् क्षधि (Fornix – Junction of palpebral conjunctiva 1. प्र म – ाश्रर्
4. ष् मण् (Cornea & Iris) and bulbar conjunctiva) 2. क्षि र् – मिं ाक्षश्र
5. क्षि मण् (Pupil-Lens-Retina) 3. क् ष् क्षधि (Limbus – Sclero corneal junction) 3. र् –म क्षश्र
4. ष् क्षि क्षधि (Pupillary margin) 4. ा – क्षस् क्षश्र
5. नन क्षधि ((Inner canthus))
6. ािं क्षधि (Outer canthus)

Rabin Singh
 Shalakya tantra- 1 Ϯ

Anatomy of the Eye 

The eye is the organ responsible for vision. Vision can be defined as the eyesight or the ability to see.
Human eyes and its appandages are situated in the orbits.

Anatomy of Orbit  (नत्र ा)  The orbits are a pair of pyramidal cavities or sockets of the skull in which the eyes and its appandages are situated. Orbits are
situated one on each side of nose. Orbits are formed by the combination of following 7 bones 
1. Frontal bone, 2. Sphenoid bone, 3. Ethmoid bone, 4. Maxilla, 5. Palatal bone, 6. Lacrimal bone, 7. Zygomatic bone.

Measurements of orbit  Anteroposteriorly 5 to 8 cm. Vertically (at base) and Horizontally (at base) 4 cm.
Parts of orbit  1. Base, 2. Apex, 3. Roof (Superior wall), 4. Floor (inferior wall), 5. Medial wall, 6. Lateral wall.
Contents of orbit  1. Eyeball and intra orbital part of optic nerve
2. Tenon s capsule (it forms a socket in which eyeball moves, it extends from limbus to the attachment of optic nerve.)
3. Extra-ocular muscles for the movement of eye ball in different directions (4 Rectus muscles & 2 Oblique muscles)
4. Lacrimal gland and Lacrimal sac.
5. Ophthalmic artery with its branches.
6. 3rd, 4th, 5th (1st and 2nd branches only) and 6th cranial nerves.
7. Branches from carotid and cavernous plexus of sympathetic.
8. Ciliary ganglion, 9. Orbital fat and fascia.

Arterial supply  Ophthalmic artery (branch of internal carotid artery)

Venous drainage  Ophthalmic veins
Nerve supply  Motor  Superior rectus muscle – 4th Cranial nerve (Trochlear nerve)
Lateral rectus muscle – 6th Cranial nerve (Abducens nerve)
Rest of 4 muscles – 3rd Cranial nerve (Oculomotor nerve)
Sensory  1st and 2nd divisions of Trigeminal nerve (Ophthalmic nerve and Maxillary nerve.)

Rabin Singh
 Shalakya tantra- 1 ϯ

Accessory Structures of Eye 

1. Eyebrows 
They are two arches of thick skin over the eyes containing thick hairs. They prevent the dripping of sweat, water and other debris into the eyes.

2. Eyelids 
An eyelid is a thin fold of skin that covers and protects the eye. The upper eyelid is larger and more mobile, and it is raised by Levator palpebrae muscle. Both
the eyelids are covered externally by skin and lined internally by conjunctiva.
Layers of eyelid  1.Cutaneous layer (skin), 2.Muscular layer (orbicularis oculi & levator palpebrae), 3.Fibrous layer (Septum orbitale & Tarsal plate),
4.Mucous layer (palpebral conjunctiva).

Glands of the eyelids  3

i. Meibomian glands  (Tarsal glands) modified sebaceous glands, 30 to 40 glands in upper lid and 20 to 30 glands in lower eyelid, secrete meibum –
an oily secretion that prevents evaporation of the eye s tear film.
ii. Glands of zeis  These are sebaceous glands developed as out growths of the epithelial wall of the hair follicles of the eyelashes.
iii. Glands of Moll  These are modified sweat glands found on the lid margin.

Lid margin  It is the anterior thick border of eyelid. In between anterior margin and openings of the meibomian glands there is a grey line known as inter
marginal sulcus. Lid margins unite medially to form medial canthus (inner canthus) and laterally to form lateral canthus (outer canthus).

Eyelashes  Stouter than hair and are arranged in 2 to 3 rows in upper lid and 1 to 2 rows in lower lid. Upper lid lashes are curved forwards and upwards
and lower lid eyelashes are downwards and forwards.

Arterial supply  Lacrimal & Palpebral branches of Ophthalmic artery,

Facial artery, Superficial temporal artery, Intra orbital artery.
Venous drainage  Ophthalmic vein, Temporal vein, Facial vein.
Nerve supply  Motor  Orbicularis oculi supplied by branches of facial nerve,
Levetor palpebrae superioris supplied by the branches of Oculomotor nerve.
Sensory  1st & 2nd branches of Trigeminal nerve.

Rabin Singh
 Shalakya tantra- 1 ϰ

3. Lacrimal apparatus 
The Lacrimal apparatus consists of  a secretory portion (the lacrimal gland) and an excretory portion (lacrimal passage).

Lacrimal gland  A serous gland situated at the upper and outer part of the orbit, in a depression of the orbital plate
of frontal bone known as Lacrimal fossa. The histological structure resembles the salivary gland. It secretes the fluid
(tears) through lacrimal ducts which cleanses and moistens the eye s surface.

Lacrimal passage  1. Lacrimal puncta (upper and lower), 3. Lacrimal sac,

2. Lacrimal canaliculi (upper and lower), 4. Naso-lacrimal duct.

Arterial supply  Lacrimal & Palpebral branches of Ophthalmic artery,

Angular branch of facial artery, Infra orbital & Spheno palatine branches of internal maxillary artery.
Venous drainage  Lacrimal vein that opens into ophthalmic vein.
Nerve supply  Motor  Facial nerve
Sensory  Lacrimal branch of the ophthalmic division of trigeminal nerve.

4. Exrinsic muscles of eye  The eyeball is moved by six muscles. These muscles arise from the posterior bony wall of orbit and inserted into the sclera.
(i) Superior rectus, (ii) Inferior rectus, (iii) Medial rectus, (iv) Lateral rectus, (v) Inferior oblique, and (vi) Superior oblique.

5. Conjunctiva 
Connunctiva is a thin layer of mucous membrane which lines the under surface of eyelids and is reflected on the anterior part of eyeball, forming a sac called
conjunctival sac. It is named differently according to the site, they are 
(a) Palpebral conjunctiva  It covers the inner surface of eyelids.
(b) Fornix  Fold of conjunctiva formed by the reflection of the mucous membrane from the lid to the eyeball.
(c) Bulbar conjunctiva  It covers the anterior part of eyeball upto the limbus.
(d) Conjunctiva of the Limbus  It covers the Limbal area (sclero corneal junction)
(e) Plica semilunaris  It is a crescentric fold of conjunctiva at inner canthus.

Rabin Singh
 Shalakya tantra- 1 ϱ

The Eyeball 
The eyeball is almost spherical in shape and it is situated in the anterior part of orbital cavity. The eyeball contains: 1. three coats & 2. Light transmitting
structures. The three coats of eyeball are 
1. Outer fibrous coat containing sclera and cornea.
2. Middle vascular coat (Uveal Tract) containing choroid, ciliary body and iris.
3. Inner nervous coat containing retina.
The light transmitting structures are 
1. Aqueous humour
2. Lens
3. Vitrous humour

Sclera  It forms the posterior five-sixth of the outer coat. It forms the white of the eye and it is continuous with cornea in the front. Sclera protects the internal
structures and also maintains the shape of eyeball. The optic nerve passes through the posterior aspect of sclera and reaches the retina.

Cornea  It forms the anterior one-sixth of the outer coat. It is transparent and has a convex anterior surface. It has no blood supply, but it is richly supplied
by sensory nerves. Cornea is composed of five layers from out to inwards 
1. Epithelial membrane, 2. Bowman s membrane, 3. Substantia propria, 4. Descemet s membrane, 5. Endothelial membrane.

Choroid  It is thin, pigmented and highly vascular membrane. It lines the posterior compartment of eye and lies between the inner surface of sclera and
retina. It provides nourishment to retina and vitreous.

Ciliary body  It is the anterior continuation of choroid and it lies between choroid and iris. The ciliary body contains ciliary muscle. The suspensory ligament
of lens is attached to ciliary muscle.

Iris  It is the anterior continuation of ciliary body. Iris is a pigmented membrane and the colour of eye is dependent on its pigments. Iris has a central
opening called pupil. Pupil allows light to strike the retina, it gets wider in the dark and narrower in light.

Rabin Singh
 Shalakya tantra- 1 ϲ

Retina  It is the innermost nervous coat of eyeball. The retina consists of several layers of neurons interconnected by synapses. The neural retina refers to
the three layers of neural cells (photo receptor cells, bipolar cells, and ganglion cells) within the retina, which in its entirely comprises ten distinct layers 
1. Layer of pigment epithelium
2. Layer of rods and cones
3. External limiting membrane
4. Outer nuclear layer
5. Outer plexiform layer
6. Inner nuclear layer
7. Inner plexiform layer
8. Layer of ganglion cells
9. Nerve fibres layer
10. Internal limiting layer
Light transmitting structures 
1. Aqueous humour  It is a fluid present in the both the anterior and posterior chambers of eye. Anterior chamber is the space between cornea in front and
iris and ciliary body at the back. Posterior chamber is the space between iris and lens. 2. Lens  It lies immediately behind the iris and pupil. Lens is a
transparent, biconvex structure with rounded border; it is made up of lens fibres and enclosed in an elastic capsule. It is attached to the ciliary body by means
of suspensory ligament of lens. The lens focusses light entering through pupil on the retina. 3. Vitreous humour  It is a jelly like fluid which fills the space
between lens and retina. It maintains the shape of the eye and gives shape and firmness to retina and it keeps the retina in contact with choroid and sclera.

Visual Pathway  The mechanism of sight 

 Light enters the eye through the cornea (which acts as an entrance window for light).
 Iris and the pupil regulate the amount of light entering the eye.
 The image is then focused through the lens on the retina.
 The image then stimulates the receptors present in the rod and cons of retina.
 These impulses are then carried through optic nerve. The optic nerves of both sides
cross at optic chiasma, the impulses are carried by optic tract to visual cortex present
in the occipital lobe (of brain). Here the image is perceived.

Rabin Singh
 Shalakya tantra- 1 ϳ

ा ाक्र् धत्र  ा ार्ा र्र्त मा क्रिर् च् ा ाक्र्म The branch of Ayurveda, in which shalaka is used frequently in the diagnostic and treatment procedures, is
called as Shalakya-tantra.
ा ाक्र्िं नाम र्धर्ा त्र ानािं श्रर् नर्नर् नघ्रा ाक्र िंक्षश्र ानािं व्याि नाम मना ाम ( . .1/10) The branch of Ayurveda dealing with description and treatment of diseases
of organs situated above jatru (clavicle) i.e. ears, eyes, mouth, nose etc.

नत्रर ामाधर् क्षन ान 

उष् ाक्षि प्तस्र् प्रर् ा रक्ष ा स्र्प्नक्षर् र्ााच्च प्र क्त िंर न क् ाक्षि ा ा क्ष म नाच्च
क्तार ा ाम र्त मा क्षन र् ा र् क्षर्क्षनग्र ाच्च स्र् ा िमक्षन र् ाच्च क्षे र् ा ा र्मनाक्ष र् ा
र्ाष् ग्र ा क्ष्मक्षनर क्ष ाश्च नत्रक्षर् ारान नर्क्षध ाः ( .उ. 1/26-27)
Exposing or drinking cool water immediately after exposing to heat, seeing very distant objects, abnormal sleeping habits, continuous weeping, excessive
anger, grief, stress, injury to the eyes, excessive sexual intercourse, excessive intake of shukta-aranala-amala-kulattha-masha, excessive sveda
(fomentation), exposure to smoke or excessive smoking, suppression of urge of vomiting, suppressing tears, observing the minute things etc.

नत्रर ामाधर् मप्राक्षप्त 

क्ष रान ाररक्षि ो ः क्षर् र्धर्ामा ः ार्ध नत्रिा र ाः रम ा ाः ( .उ. 1/20-21)
The vitiated vatadi dosha propagates through the channels of sira –dhamani towards the uttamanga (head) and into the eyes and produces dreadful diseases
in the eyes.

नत्रर ामाधर् र्ा 

त्राक्षर् िं िंरमिमश्र ण् र् ा रा ा ाििं ाव्यक्त क्ष ः
िं र्र्तमा ाािमर् क्षर् धर्मानिं र्ा क्रिर्ास्र्क्षक्ष र् ा रा
ष््र्र् ि मान र्धर् ाक्षिक्षष्ठ िं ( .उ.1/21-23)
Dirty eye with discharge, angry look with watering eyes, itching sensation, sticking of eyelids due to organized discharge, heaviness of the lids, burning
sensation, pricking pain, hyperaemia, pain in the eyelids, foreign body sensation, visual disturbance , difficulty in opening the lids an dimproper visualization.

नत्रर ामाधर्  Generally due to Vata vitiation pricking pain, dryness or thin fluid discharge etc. / due to Pitta or Rakta vitiation burning sensation,
oedema, redness (hyperaemia), and pus discharge etc. / due to Kapha vitiation heaviness in the eyes, itching sensation, and sticky discharge etc. occur in
the eye-disorders.

नत्रर ामाधर् क्ष क्र र्त ा 

िं क्ष ः क्रिर्ार् क्षन ान ररर् न
ा म र्ा ा नािं प्र ा ः प्र क्त क्षर्स् र ः नः ( .उ.1/25)
क्षन ान ररर् ान  र् ार्श्र् िं िन (स् ाक्षन & र्ा क्ष )  िं मन क्ष क्र र्त ा  स्त्र क्ष क्र र्त ा ( र्ा मा-प्रिान मा- श्चार्त मा)  थ्र्- थ्र्

Rabin Singh
 Shalakya tantra- 1 ϴ

नत्रर ख्
िं र्ा  Acc. to श्र & र् रत्ना र 76 / Acc. to र्ाग्ि & ारिं िर 94 / Acc. to र 96 / Acc. to िार्क्षमश्रा 78
क्षधि र्र्तमा क् ष् र्ा क्षि ाह्य Total
Acc. to श्र 9 21 11 4 17 12 2 76
Acc. to र्ाग्ि 9 24 13 5 16 27 - 94

क्षधि नत्रर :
Acc. to श्र  9  र्ा -उ ना -4नत्रस्रार्- र्ा - - क्षमग्रक्षध
Disease Prognosis Clinical features Correlation Treatment
र्ा क्षत्र र्ा व्र ः क्ष्मः िंरमि र्ा ः Acute  स्न न – उ ना स्र्
व्यिन ार्धर् न न धिार्ार्धमार् र्ास्रार् र् नः ( .हृ.उ.)
Dacryocystitis  क्ष राव्यि (रक्तम क्ष ) –
A suppurative & spreading type of cyst develops in
 व्र क्ष क्र र्त ा
kaneenika sandhi. Purulent discharge & pricking pain.  ञ्जन  ा + धिर्+ र्द्ा +मि
ा + धिर्+ र्द्ा +मि+ िस्म+ ाम्रिस्म
उ ना न स् क्ष् ाग्रः क्षार मः Lacrimal cyst  स्र् न – ि न – न – प्रक्ष ार
ि न ार्धर् म ः क्षस्नग्िः र् ो म क्ष क्षच् ः
or Iris cyst ि न 𝑐̅ व्र क्ष म स्त्र and न 𝑐̅ मण् ाग्र स्त्र
म ान ा ः ण् मान ना ः न ः ( .हृ.उ.)
प्रक्ष ार 𝑐̅ क्ष प् +मि+ धिर् र्
A painless, non-suppurative, bigger, deep rooted, sticky
 In रक्तान धि  प्रच् न & प्रक्ष ार
and same coloured cyst develops in drishti sandhi with
 प्रक्षा न 𝑐̅ उष् & धिन 𝑐̅ +मि
itching sensation.
 श्च्र् न 𝑐̅ म ी and त्र क्वा
नत्रस्रार् Painless, whitish, sticky, solid discharge Epiphora 4 types of नत्रस्रार् are ार्धर्, but can be tried
ार्धर्
to manage like following:
क्ष त्त नत्रस्रार् क्ष त्त Yellowish or bluish, hot, watery discharge Epiphora
ार्धर्  ग्रा  क्ष ल्र्, ा , ार्र्ान
र् नत्रस्रार् क्षत्र Foul, sticky, purulent discharge Epiphora  िन  म न , क्षत्रर् , ध , एरण्
ार्धर्  र ार्न र्  क्षत्र ा र ार्न
रक्त नत्रस्रार् रक्त Semi-solid, hot, blood stained discharge Epiphora  प्रक्षा न and रक्तम क्ष (क्ष राव्यि)
ार्धर्

Rabin Singh
 Shalakya tantra- 1 ϵ

र्ा रक्त र्र्तमा धर्धर्ाश्रर्ा क् क्ष र ा ा क्ष न Phlyctenular  स्र् न – न

न ार्धर् ाम्रा मद्ग मा क्षिन्ना रक्तिं स्रर्क्ष र्ा ( .हृ.उ.)
conjunctivitis  Residue has to be scrapped by न or
A small, round, copper coloured nodule (pitika)
प्रक्ष ार 𝑐̅ धिर् र् + मि etc.
resembling the mudga, develops in vartma-shukla sandhi
(Sushruta told shukla-krishna sandhi) with pain and
burning sensation, if nodule is excised it bleeds.
क्षत्र ा ा धि ष् क् स्र्ा क्षस्मन्नर् ख्र्ाक्ष ा र्ाल िं ः Advanced  ार्धर्, but can be tried to manage like
ार्धर् ( .उ.) र्ा क्ष क्र र्त ा
Phlyctenular
Advanced stage of Parvani  acc. to Sushruta affected
conjunctivitis
sandhi is shukla-krishna sandhi, and acc. to vagbhata it is
kaneenika sandhi.
क्षमग्रक्षध क्षमग्रक्षध र्ार्तमानः क्ष्म श्च ण् र्ाः मर्ः क्षधि ा ाः Blepharitis  स्र् न – ि न
ि न ार्धर् नाना ा र्र्तमा क् स्र् धि रध ों नार्निं र्क्षध ( .उ.)  प्रक्ष ार 𝑐̅ धिर् र् + मि
Different types of microorganisms or parasites by vitiating  ञ्जन 𝑐̅ र् ी prepared of क्षत्र ा + र्त +
pakshma-vartma sandhi (acc. to Vagbhata it is kaneenika ा + धिर् र्
& apanga sandhi) produces small cysts in the eyelid
margin, infection spreads to vartma-shukla sandhi and
interior of the eye with irritation, discomfort, itching,
burning, and falling of eyelashes.

Rabin Singh
 Shalakya tantra- 1 ϭϬ

Dacryocystitis 
Inflammation of the lacrimal sac is called dacryocystitis. It is a common disease occurring at any age. It is usually divided into two forms: congenital
dacryocystitis and dacryocystitis in adult.

Congenital Dacryocystitis 
Etiology  The congenital dacryocystitis or dacryocystitis of newborn is usually caused by membranous blockage of the lower end of the nasolacrimal duct
(valve of Hasner) or failure in canalization of nasolacrimal duct.
Clinical Features  (The obstruction of the nasolacrimal duct is present in approximately 50% of the newborns at birth. However, watering does not occur
immediately as lacrimation does not begin until 6 weeks after birth. Patency may be restored spontaneously in some cases after birth.)
 Epiphora (watering of eye)
 Muco purulent discharge through punctum by pressing over the sac area
 Slight distension of lacrimal sac
 The discharge is sterile at first later becomes infected
Treatment 
 Massaging of the lacrimal sac region and frequent instillation of antibiotic drops usually cure the condition in few weeks, and the duct becomes patent.
 The index finger is kept over the common canaliculus to prevent the regurgitation through the puncta, then it is stroked downwards firmly 10-12 times at
one sitting. The procedure is repeated 4 times a day. Each massage is followed by instillation of antibiotic drops.
 Probing of the lacrimal passage is warranted in failed cases. But it should not be undertaken until the age of 6 months.

Dacryocystitis in Adults 
The dacryocystitis in adults may occur in an acute or a chronic form.

1. Acute Dacryocystitis  Acute dacryocystitis is an acute suppurative inflammation of the lacrimal sac.
Etiology  Acute dacryocystitis may occur due to various causes, the commonest being the complete obstruction of NLD. The chronic stasis of tears in the
sac leads to secondary infection by Streptococcus pneumoniae, Streptococcus pyogenes, Staphylococcus aureus and Actinomyces. Acute dacryocystitis is
usually preceded by a chronic dacryocystitis or an infective conjunctivitis.

Rabin Singh
 Shalakya tantra- 1 ϭϭ

Clinical Features  Acute dacrocystitis is characterized by severe pain and marked swelling and redness of the sac region and both the eyelids
 Initially the sac region is swollen, red and tender. The erythema below the medial canthus spreads to the cheek.
 It is often associated with tenderness and enlargement of the regional lymph nodes.
 Later the sac becomes filled with pus and its distended anterior wall ruptures to give rise to a pericystic swelling.
 A lacrimal abscess develops which usually points below and to the outer side of the sac owing to the gravitation of the pus. It often bursts spontaneously
on the skin surface forming a lacrimal fistula.
Complications  (i) Lacrimal fistula, (ii) Osteomyelitis of lacrimal bone, (iii) Orbital cellulitis, (iv) Facial cellulitis, (v) Cavernous sinus thrombosis.
Treatment 
 Local hot compresses several times in a day and systemic NSAIDs relieve the pain.
 Infection is controlled by topical application of antibiotic drops and ointment and systemic administration of ciprofloxacin or cephalosporins or tetracycline
for seven days.
 In case pus point is formed, an incision is made to evacuate it. When acute inflammation subsides, the case is treated on the lines of chronic
dacryocystitis. Fistulectomy with DCR operation is preferred.

2. Chronic Dacryocystitis 
Etiology  Chronic dacryocystitis is more common than acute dacryocystitis and occurs following obstruction of the nasolacrimal duct due to chronic
inflammation. The disease is predominantly seen in females (80%) and is usually unilateral.
Predisposing factors  Stricture of NLD due to narrowing of bony canal associated with inflamed nasal mucosa, Hypertrophied inferior turbinate, deviation of
Nasal septum and by the pressure of the Nasal polyp etc.
Exciting factors  Infection of stagnant sac-contents by the pneumococcus, streptococcus and staphylococcus.
Clinical Features  can be divided into three stages 
a) Catarrhal stage  Epiphora, Conjunctival hyperemia at affected inner canthus, No local swelling on the sac area is found.
b) Mucocele stage  Epiphora, Conjunctival hyperemia, Swelling of sac area with no tendernesss, mucoid material comes through punctum when pressed
over the sac area (Sometimes both canaliculi may be blocked – no regurgitation through punctum – Encysted mucocele).
c) Pyocele / Suppurative stage  Epiphora, Conjunctival hyperemia, Mucopurulent discharge comes through punctum when pressed over the sac area.

Rabin Singh
 Shalakya tantra- 1 ϭϮ

Complications  Acute dacryocystitis, Corneal ulcer, Chronic conjunctivitis etc.

Treatment 
 Probing the nasolacrimal duct and syringing the sac with antibiotic solution like Penicillin 50000 units / cc of distilled water.
 If the disease is not controlled, surgical correction has to do by following method 
i. Dacryocystectomy (sac is removed, life long epiphora remains)
ii. Dacryocystorhinostomy (medial wall of the sac is anastomosed with the mucous membrane of the middle meatus of nose)

Epiphora 
Epiphora refers to excessive watering of the eye or an overflow of tears due to excessive secretion of the lacrimal glands or obstruction of the lacrimal ducts.
Etiology  Epiphora can be due to overproduction of tears (e.g. Ocular irritation and inflammation, dacryocystitis, trichiasis, entropion), or an obstruction to
ducts (e.g. Punctal, canalicular or nasolacrimal duct obstruction, ectropion).
Clinical features  Excessive watering of eyes / Overflow of tears onto the face, with associated symtoms of underlying cause.
Treatment  Treat the cause.

Blepharitis 
Blepharitis is a chronic inflammation of the lid margin. Clinically, it occurs in two forms, squamous blepharitis and ulcerative blepharitis.

1. Squamous Blepharitis 
Squamous blepharitis is characterized by the presence of small white scales at the root of the lashes which may fall out but are replaced without distortion.
Etiology  The blepharitis is common in children who suffer from dandruff of the scalp. The squamous blepharitis is essentially a metabolic disorder and
often associated with seborrhea.
Clinical Features  Irritation, itching and watering are common symptoms.
White dandruff-like scales on the eyelid margins are often found. If the scales are removed the underlying area is found to be hyperemic but not ulcerated.

Rabin Singh
 Shalakya tantra- 1 ϭϯ

2. Ulcerative Blepharitis 
Ulcerative blepharitis is an infective condition of the lid margin characterized by the deposition of yellow crusts at the roots of eyelashes, swelling of the lid
margins and falling of the eyelashes. The removal of the crust leaves a small round ulcer which bleeds readily.
Etiology  Ulcerative blepharitis is common in debilitated children with poor personal hygiene. Staphylococcus aureus is the most common organism causing
ulcerative blepharitis. The condition may be secondary to chronic conjunctivitis. Eyestrain and refractive errors are known risk factors.
Clinical Features  Intense itching, swelling and redness of lid margins, falling of lashes, watering and photophobia are common symptoms of ulcerative
blepharitis. The crusts glue the eyelashes together and cause difficulty in opening the lids.
Complications  When blepharitis persists for a long time, the ulcerative process extends deeply and destroys the hair follicles resulting in falling of cilia. The
cilia are often not replaced, and if they regrow only a few distorted ones come. The condition is known as madarosis. The excessive fibrosis of the lid margin
leads to its thickening known as tylosis.
The shallow ulcers of blepharitis heal by fibrosis, the contraction of fibrous tissue may cause misdirection of a few eyelashes which rub against the cornea,
the condition is termed as trichiasis. The ulcerative blepharitis may also be associated with recurrent styes and angular conjunctivitis.
Treatment 
 The crust can be softened and removed through bathing with warm 3% sodium bicarbonate lotion or hydrogen peroxide.
 Associated seborrheic dermatitis and dandruff need special care and should be managed by medicated shampoo.
 Local and systemic antibiotics should be used.
 Treat the complications.

Rabin Singh
 Shalakya tantra- 1 ϭϰ

र्र्तमा नत्रर :
Acc. to श्र  21  उर्त िंक्ष न - मि ा- ी-र्र्तमा ा रा- ोर्र्तमा- ष् ा ा- िं ननाक्षम ा- र्र्तमा-र्र्तमाार् धि-क्षक् िर्र्तमा-र्र्तमा म
ा -श्र्ार्र्र्तमा-प्रक्षक् न्नर्र्तमा- क्षक् न्नर्र्तमा-र्ा र्र्तमा-
ा -क्षनम - क्ष ा -ा -क्ष र्र्तमा- क्ष्म
Acc. to र्ाग्ि  24  क्ष ार्र्तमा(उर्त िंक्ष न - मि ा- ी-र्र्तमा ा रा)-र्र्तमाा ा( ोर्र्तमा)- क्ष्म र ि( िं ननाक्षम ा- र्र्तमा-र्र्तमा म
ा -श्र्ार्र्र्तमा-र्ा र्र्तमा-र्र्तमाा ा -क्षनम - -
क्ष र्र्तमा- क्ष्म )- - क्ष्म ा - च्र धम न- -क्षििर्र्तमा-उक्षर्तक् ि-उक्षर्तक् िर्र्तमा- क्षर्तक् ि-क्ष त्त क्षर्तक् ि
Disease Prognosis Clinical features Correlation Treatment
उर्त िंक्ष न क्षत्र भ्र्ध रम ाह्य र्त िं sि र्र्तमानश्च र्ा Chalazian  न मा
न ार्धर् क्षर्ज्ञर् र्त िंक्ष न नाम र्द् क्ष ाक्ष ा ( .उ.) (For bigger and non-suppurative क्ष ा 
cyst or
One or multiple cysts originates commonly in the lower न followed by न)
Meibomian
eyelid, if multiple cysts present the bigger cyst is  श्चा मा 
encircled with others.
or Tarsal cyst प्रक्ष ार with र+ए ा+ धिर्+मि
क् ाण् र म स्रार्  discharge resembling egg yolk रर with क्वा of ररर्द्ा + र्क्षिमि + त्र +
ध्र + मि
after suppuration or after incision.
िंिन (bandaging) & व्र ार
मि ा Zeis gland cyst मि प्रक्ष माः क्ष ा र्ास् र्र्तमा ाः क्षत्र  न– न – प्रक्ष ार
( मि क्ष ा) र्धमा र्क्षध क्षिन्ना र्ाः मि क्ष ास् ाः ( .उ.) न ार्धर्
or Stye  रर with क्वा of र्क्षिमि+ म ी+
Small papules (cysts) resembling Kumbhika-beeja
 & व्र ार
(pomegranate seeds) originate in the eyelid margin,
suppurates, discharges the fluid and bulges again.
ी Trachoma स्राक्षर्ण्र्ः ण् रा व्यो रक्त ा ाक्षन्निाः  प्रच् न – न
क्ष ाश्च ार्र्तर्ः क्र् क्ष िंक्षज्ञ ाः ( .उ.) न ार्धर्  प्रक्ष ार with मनःक्ष ा + ा + ण् +
Multiple pidakas (follicles) resembling Rakta sarshapa
मरर + क्ष प् + र ािं न + ैंिर् + मि
beeja (red mustard seeds) originates in the eyelids,
 प्रक्षा न with ष्
associated with lacrimation, itching sensation, heaviness
 with & िंिन
of eyelid, and pain. (Acc. to Vagbhata pidakas resemble
 श्च्र् न with क्वा of म्र त्र, म त्र, क्र र
Shweta sarshapa beej)
etc.
 ञ्जन with क्षर् िं + ाक्षा + ा ररर्द्ा + रर +
मनःक्ष ा + मि

Rabin Singh
 Shalakya tantra- 1 ϭϱ

र्र्तमा ा रा क्षत्र क्ष ाक्षिः क्ष्माक्षि ानाक्षिरक्षि िंर् ा Lithiasis  न

(क्ष ार्र्तमा) न ार्धर् क्ष ा र्ा रा स् ा ा ज्ञर्ा र्र्तमा ा रा ( .उ.)  प्रक्ष ार 𝑐̅ ैंिर् र्
conjunctivae
Multiple small rough and hard follicles encircled with so
many small follicles resembling sand particles.
ोर्र्तमा क्षत्र एर्ाा प्रक्ष माः क्ष ा मध र् नाः A form of  स्र् न – न
न ार्धर् क्ष्माः राश्च र्र्तमास् ास् ोर्र्तमा ीर्तर् े ( .उ.)  प्रक्ष ार 𝑐̅ ैंिर् र् + ा + क्ष प्
Trachoma
Painful small rough pidakas (follicles or nodules)  Residual part should be burnt 𝑐̅ ा ा
resembling Ervaru-beeja (cucumber seeds) originate in  If the residual part is remained, क्षार &
the internal surface of the eyelid. प्रक्ष ार should be used
ष् ा ा क्षत्र ोsङ् रः रः स् ब्ि ा र्र्तमा िंिर्ः Polyp of the  ोर्र्तमार् क्ष क्र र्त ा
न ार्धर् व्याक्षिर माख्र्ा ः ष् ा ा क्ष िंक्षज्ञ ः ( .उ.) palpebral-
A long, rough, rigid, troublesome ankura (polyp) develops
conjunctiva
in the internal surface of the eyelid.
िं ननाक्षम ा रक्त ा र् ाम्र क्ष ा र्र्तमा िंिर्ा Zeis gland  म स्र् – ि न
ि न ार्धर् मि मध ा क्ष्मा ज्ञर्ा ाsञ्जननाक्षम ा ( .उ.)  प्रक्ष ार 𝑐̅ ए ा + र + मनःक्ष ा + ैंिर्
cyst
Small copper-coloured pidakas (follicles) originate in the र् + मि
or Multiple  रक्तम क्ष 𝑐̅ ा can be done
eyelid, associated with burning sensation, and dull
stye
pricking pain. Acc. to Vagbhata pidakas resemble mudga
(green gram).
र्र्तमा रक्त र्र्तमो र् र्स्र् क्ष ाक्षिः मध ः Multiple  म स्र् – प्रच् न – न
न ार्धर् र् ााक्षिः माक्षिश्च क्षर् ा र्र्तमा ( .उ.)  प्रक्ष ार 𝑐̅ मनःक्ष ा + ा + ण् +
chalazia
Hard, same coloured and same sized papules originated मरर + क्ष प् + र ािं न + ैंिर् र् + मि
in the eyelid completely and it causes the eyelid thicker.  उष् प्रक्षा न – – िंिन
र्र्तमाार् धि क्षत्र ण् म ाल् न र्र्तमा न र् नरः Imperfect  प्रच् न – न – प्रक्ष ार
(र्र्तमा धि) न ार्धर् न मिं ा र् क्षक्ष िर् धिः र्र्तमानः ( .उ.)
closure of
Imperfect closure of eyelids occurs due to vartma-
shopha, associated with itching sensation, and mild eyelid due to
pricking pain. edema

Rabin Singh
 Shalakya tantra- 1 ϭϲ

क्षक् िर्र्तमा रक्त मिल् र् निं ाम्रिं र् र्र्तमा ममर् Allergic  क्षन ान ररर् ान
न ार्धर् स्माच्च िर्र्द्क्तिं क्षक् िर्र्तमा ाक्र ( .उ.) (Avoiding the allergic cause)
The eyelid suddenly becomes soft, coppery red conjunctivitis
 प्रच् न – न – प्रक्ष ार
coloured with negligible pain.
Acc. to Videha, due to vitiation of Rakta & Kapha the
eyelids become red like hibiscus flower (Japa pushpa).
र्र्तमा म
ा क्षत्र क्षक् ििं नः क्ष त्तर् िं क्षर् च् क्ष िं र् ा Inflamed eye lid  न
न ार्धर् ा क्षक् न्नर्तर्मा न्नमच्र् र्ार्तमा म ा ः ( .उ.)  प्रक्ष ार
This is advanced stage of Klishtavartma  Vitiated with conjunctiva  व्र क्ष क्र र्त ा
Pitta dosha irritates/aggravates the Rakta & Kapha that
leads to more exudation or sticky lacrimation.
श्र्ार्र्र्तमा क्षत्र र् र्र्तमा ाह्य ध श्च श्र्ार्िं निं र् नम Inflamed eye lid  न
न ार्धर् ा ण् ररक् क्र श्र्ार्र्र्तमेक्ष धम म ( .उ.)  प्रक्ष ार
The eyelid completely inflames and becomes blackish  व्र क्ष क्र र्त ा
with edema, pain, burning sensation, itching, and
moistening or discharge.
प्रक्षक् न्नर्र्तमा िं ाह्य ः क्षक् न्निं स्रर्र्तर्क्ष Allergic  र क्रिर्ा ञ्जन with क्षत्र ा or ा ष् or
(क्षक् न्नर्र्तमा / स्त्र ि ण् क्षनस् िक्षर्ििं क्षक् न्नर्र्तमा च्र् ( .उ.)
conjunctivitis ामा ा prepared in ाम्र ात्र
क्ष ल् ) ार्धर् A painless swelling (of external aspect) of eyelid,
 र् ी ञ्जन with ा + मर्द् न+र ाञ्जन+मि
associated with itching, pricking pain, and sticky
exudation.  श्च्र् न with म ी स्र्र
क्षक् न्नर्र्तमा क्षत्र र्स्र् ि ाक्षन ि ाक्षन िं र्धर्ध नः नः Ankylo-  िं न as used in प्रक्षक् न्नर्र्तमा
स्त्र ि र्र्तमााधर् रर क्वाक्षन क्षर् ा क्षक् न्नर्र्तमा ( .उ.)
blepharon  ाां न with मर्द् न + ैंिर् + िं िस्म + मद्ग
ार्धर् Even after washing again and again, the eyelids stick
+ श्व मरर
together without suppuration. symblepharon
र्ा र्र्तमा र्ा ार्धर् क्षर्मर्त क्षधि क्षनश्चििं र्र्तमा र्स्र् न म ल्र् Logophthalmos,  ार्धर्
ए र्ा िं क्षर् ा िं र्क्र र्ाs म ( .उ.)  स्न न, ा & िं न can be used to
Ptosis
Due to vitiation of vata, the kaneenika, apanga and strengthen the muscles and nerves
vartma-shukla sandhi are paralysed and the person
can t able to close his eyelids properly. Sometimes
there is pain, sometimes no pain.

Rabin Singh
 Shalakya tantra- 1 ϭϳ

ा क्षत्र र्र्तमााध रस् िं क्षर् मिं ग्रक्षध ि मर् नम Benign  स्र् न – न

(र्र्तमाा ा ) न ार्धर् क्षर्ज्ञर्म ा िं िं ािं रक्तमर् क्षम म ( .उ.)
tumour in the  प्रक्ष ार with ैंिर् + ा + क्ष प्
A painless, reddish and irregular growth or cystic swelling
eyelid  The residual part should be burnt with
develops by hanging from the internal surface of the
ा ा
eyelid.  If the residual part is remained, it should
Acc. to Vagbhata, the growth resembles mamsa-pinda. be scrapped out by application of क्षार
क्षनम र्ा ार्धर् क्षनम ः क्ष रा र्ार्ः प्रक्षर्ि र्र्तमा िंश्रर्ाः Blinking of  ार्धर्
ा र्र्तर्क्ष र्र्तमााक्षन क्षनम ः म ः ( .उ.)
eye lids
Vitiated vata enters nimeshani sira of vartma causing
painless, abnormally increased blinking of eyelids.
क्ष ा ा रक्त ार्धर् क्ष न्नाक्षश् ना क्षर्र्िाध र्र्तमास् ा म र् sङ् रा Carcinoma of  ार्धर्
ा ण् ास् ाः क्ष िंिर्ा ( .उ.) eye lid
Reddish and soft mamsankuras (polypoidal mass)
develop in the eyelids associated with burning and itching
sensation, and pain. It recurs even after excision.
ा ः र नः स् ग्रक्षध र्ार्तमािर् ः Chalazian or  ि न (with व्र क्ष म स्त्र)
ि न ार्धर् ण् ः क्ष क्षच् ः प्रमा स् ः ( .उ.)
meibomian  प्रक्ष ार with र न + र्र्क्षार + र्त +
A small cystic swelling, resembling Kola-phala, (badara)
क्ष प् + मि
originates in eyelids, which is hard, stout, painless, sticky, cyst
 If swelling is large  र्मन – क्षर्र न and
with itching sensation, and doesn t suppurate. ि न followed by क्षि मा / क्षार मा
 व्र क्ष क्र र्त ा
क्ष र्र्तमा क्षत्र निं र् र्र्तमा हुक्षिः क्ष्मक्षश् र्द्ः मक्षधर् म Porous  स्र् न – ि न
ि न ार्धर् क्ष मध ा र् क्ष र्र्तमेक्ष धम म ( .उ.)
edema of  प्रक्ष ार with ैंिर् र् + ा + क्ष प्
The eyelid inflames and causes multiple small holes, like
+ ष् ािं न + मनःक्ष ा + ए ा + मि
in pot through which inflammatory exudate oozes. eye lid
 मि- & िंिन
 If not relieved by प्रक्ष ार  क्षि मा and
क्षार मा should be used

Rabin Singh
 Shalakya tantra- 1 ϭϴ

क्ष्म क्षत्र र्ाप्र् ाः क्ष्मा र् ास् क्ष् ाग्राक्ष राक्ष Trichiasis  स्त्र मा – क्षि मा – क्षार मा – ि
( क्ष्म र ि) क्षनर्ात्तार्क्षध क्ष्माक्ष ाििं ाक्षक्ष र् ( .उ.)
with  रर िन – न–
Vitiated doshas affects the roots of pakshma (eyelashes)
entropion  क्षर्र न – श्च्र् न – िं न – – िम – नस्र्
causes the eyelashes hard, sharp and misdirected
etc.
(Trichiasis), with inverted lid-margin (entropion). The
hard, sharp and misdirected eyelashes injure the cornea
and produces severe complications.
क्ष्म ा क्ष त्त च्र ार्धर् र क्ष ण् िं ा िं क्ष त्तिं क्ष्माध माक्षस् म Madarosis  ट्टन क्रिर्ा (multiple pricking in the roots of
क्ष्म ािं ा निं ान क्ष्म ा िं र् क्षध म ( .हृ.उ.)
eyelashes)
The vitiated pitta affects the eyelid-margin and causes
or रक्तम क्ष with ा
burning sensation, itching and falling of eyelashes.
 र्मन with ग्ि & क्षर
 नस्र् with मिर र्द्व्य क्ष द्ध
 िं न with ष् ा ा (िार्ना in
स्र्र and kept in ाम्र ात्र for 10 days)
िस् धर् धर् ः क्ष रर् ध र्त क्षत्तक्षनक्षमत्त ः Ophthalmia  ा क्ष क्र र्त ा 
न ार्धर् स्र्ात्तन क्ष च् न ाम्राक्षा र् क्ष ाक्षमः रक्तम क्ष with ा
र्र्तमा क्षच् ल्र्ः ाना ाक्षक्षमम न ा ः ( .हृ.उ.) neonatorum
(Acc. to न with क्ष ा त्र ( ारर ा )
In children during tooth-eruption (dentition), eyes are
र्ाग्ि  प्रक्ष ार with क्षत्र + मि
inflamed with swollen and painful eyelids. Coppery red
ध द्भर् धर् प्रक्षा न with म त्र, म्र त्र, म ी त्र
व्याक्षि) coloured eyes, constant and severe itching, continuous
स्र्र
slimy discharge, photophobia, and inability to see are श्च्र् न with क्षत्र ा , etc.
other features. The child rubs the eyes, orbit, ears, nose  िात्र क्ष क्र र्त ा 
and forehead due to itching. स्न न – र्मन – क्षर्र न – – न
उक्षर्तक् िर्र्तमा रक्त क्षत्र र्िर्तमोक्षर्तक् िमक्षर्तक् िम स्माधम ान ाक्षमर्ा Mild infective  न
न ार्धर् रक्त त्रर् र्तक् ाि धर्तर्क्षर्तक् िर्र्तमा ( .हृ.उ.)  प्रक्ष ार with ैंिर् र्
conjunctivitis
Repeated aggravation of Rakta and Tridosha occurs in  क्षिष्र्िं र् क्ष क्र र्त ा
the eyelid and then get pacified automatically, leaving
behind a mlana (lusterless eyelid).

Rabin Singh
 Shalakya tantra- 1 ϭϵ

च्र धम न र्ा स् त्र प्राप्र् र्र्तमााश्रर्ाः क्ष राः प्त क्षर्त स्र् र्र्तमास् मििं Blepharo  स्न ान – स्र् न – क्षस्नग्ि नस्र् – क्षस्नग्ि िम
ि ार्धर् र् नम ािं ाािनत्रर्तर्िं च्र धम नमश्र क्षर्म न
ा ार्तस्र्ाच्च मः
spasm  िं न, ा , ा with क्षस्नग्ि र्द्व्य
च्र धम िं र् क्षध ( .हृ.उ.)
Vitiated Vata enters the siras of eyelids of sleeping
person and causes difficulty to open the eyelids.
Associated symptoms are pain, foreign body sensation
and lacrimation, and the patient feels better by rubbing
the eyes.

Stye (Hordeolum Externum) 

Hordeolum externum is a suppurative inflammation of one of the Zeis glands.
Etiology  Stye is common in young adults with refractive errors and muscular imbalance and may occur in crops. It is often caused by Staphylococcus
aureus.
Clinical Features  A painful swelling appears on the lid margin. The inflamed gland becomes hard, swollen and tender, and soon an abscess forms.
Treatment 
 Hot compresses are beneficial in the initial stages of the stye, but when the abscess is formed it should be evacuated by a small incision. Application of
antibiotic ointment prevents recurrences.
 If crops of styes occur, diabetes mellitus must be excluded and a course of systemic antibiotics may be prescribed.

Hordeolum Internum 
Hordeolum internum is a suppurative inflammation of the meibomian gland which can occur due to secondary infection of a chalazion.

Chalazion -
Chalazion is a chronic granulomatous inflammation of the meibomian gland.

Rabin Singh
 Shalakya tantra- 1 ϮϬ

Ptosis 
The term ptosis, or more accurately blepharoptosis, refers to drooping of the upper eyelid. It can be unilateral or bilateral, partial or total.

Etiology  Etiological classification includes following types of ptosis:

1. Myogenic (maldevelopment of levator palpebrae superioris)
2. Aponeurotic (most common form of acquired ptosis and caused by stretching and disinsertion of the levator aponeurosis owing to frequent rubbing of the
eyes, wearing rigid gas permeable contact lenses, and traction during ocular surgery etc.)
3. Neurogenic (frequently associated with congenital oculomotor nerve palsy, Horner s syndrome and Marcus Gunn jawwinking syndrome)
4. Mechanical (caused by excessive weight of the upper lid – it may be due to multiple chalazia, neurofibromatosis, excessive cicatrization of tarsal plate in
trachoma, and benign and malignant tumors of the upper lid), and
5. Traumatic (trauma to the LPS muscle or its aponeurosis).

Clinical Features  If the drooping of eyelid covers the pupil the only visual disturbance occurs. To see the objects, head should be tilted back to draw the
lids upwards.Lid covers most of the cornea and palpebral fissure gets narrowed.

Treatment 
 Congenital ptosis  only by operative correction.
a. If a muscle action exists the length of the muscle should be reduced.
b. If levator muscle s action is abolished but superior rectus muscle is normal this muscle is attached to the anterior surface of upper tarsal plate.
c. If both the above muscles are inactive, the frontalis muscle is attached to tarsal plate, by which the lid moves along with contraction of frontalis.
 Aquired ptosis  cause should be treated.

Rabin Singh
 Shalakya tantra- 1 Ϯϭ

Trachoma 
Trachoma is a specific type of contagious keratoconjunctivitis of chronic evolution characterized by follicles, papillary hypertrophy of the palpebral conjunctiva,
neovascularization and infiltration of the cornea (pannus) and, in late stages, conjunctival cicatrization.
Causative organism  Chlamydia trachomatis (Bedsonia group of organism)
Clinical Features  The course of trachoma is arbitrarily divided into four stages by MacCallan 
1. 1st stage  Conjunctival changes (Incipient Trachoma)  Incipient trachoma represents the earliest stage of the disease with minimal papillary
hyperplasia and immature follicles on the upper palpebral conjunctiva associated with micropannus.
2. 2nd stage  Corneal changes (Manifest Trachoma)  Mature soft sagograin-like follicles in the superior tarsal conjunctiva, papillary hypertrophy, gross
pannus and limbal follicles or Herbert s pits characterize this stage of trachoma.
3. 3rd stage  Stage of cicatrization (Healing Trachoma)  Cicatrization or scarring develops usually around the necrotizing trachoma follicles. Besides
scarring, some or all the signs of stage 2 may be present.
4. 4th stage  Stage of complications (Healed Trachoma)  The follicles and papillary hypertrophy disappear, and the palpebral conjunctiva is completely
cicatrized and smooth. The scar may be thin or dense. Pannus resolves and the presence of incomplete or complete Herbert s pits may be seen at the
limbus. (Complications  Entropion, Trichiasis, Xerosis of conjunctiva, Corneal opacities, Corneal ulcer, Chalazion etc.)
Treatment  (i) Painting with CuSO4 if no corneal ulcer / painting with AgNO3 if ulcer present,
(ii) Oral and Local antibiotics, (iii) Atropine 1% ointment if cornea is involved.

Trichiasis 
Trichiasis is a condition where a few cilia (eyelashes) are misdirected backwards (inverted) and they cause injury to cornea.
Etiology  Trichiasis is a condition where a few cilia are misdirected backwards and they rub against the cornea.
Clinical Features  Foreign body sensation or irritation, lacrimation, photophobia and pain are common symptoms of trichiasis. The misdirected lashes may
rub against the cornea or cause corneal erosions and vascularization.
Treatment 
 Misdirected cilia have to be removed by epilation.
 Destruction of hair follicle by diathermy or electrolysis.
 Plastic surgery.

Rabin Singh
 Shalakya tantra- 1 ϮϮ

Entropion 
Entropion is a condition wherein the lid margin is rolled inwards. The inturned eyelashes rub against the cornea and the conjunctiva and cause irritation,
watering and photophobia.
Types  Entopion may occur in 4 forms:
1. Spastic  Spastic entropion occurs due to the spasm of orbicularis oculi, particularly when the eyeball is deeply set, small (microphthalmos) or absent.
2. Cicatricial  Cicatricial entropion is caused by the contraction of the conjunctival scar associated with distortion of the tarsal plate as found in trachoma,
membranous conjunctivitis, chemical burns and trauma.
3. Involutional (senile)  The senile entropion usually occurs in the lower eyelid. It is caused by a number of factors such as horizontal laxity of the eyelid,
disinsertion of eyelid retractors and overriding of the preseptal orbicularis oculi muscle.
4. Congenital  It is rare and often associated with microphthalmos and needs repair.
Clinical Features  Epiphora (watering of eye), pain, discomfort, photophobia, corneal lesions etc.
Treatment 
 Spastic entropion due to bandaging can be relieved by discarding the bandage. Persistent spastic entropion may need an injection of 1 ml of 80% alcohol
subcutaneously along the margin of the lid.
 Cicatricial entropion usully needs surgical repair. E.g. Tarsectomy.

Ectropion 
Rolling out of the lid margin is called ectropion.
Types  Ectropion occurs in five forms:
1. Spastic  seen in children with acute conjunctivitis, associated with blepharospasm.
2. Cicatricial  following wounds, burns, operative scars of eyelids.
3. Senile  lower eyelid gets affected due to laxity of the skin and the muscles in the old age.
4. Paralytic  Paralytic ectropion follows the seventh cranial nerve paralysis (Bell s palsy). Road traffic accident, intracranial surgery and middle ear disease
may implicate the facial nerve.
5. Mechanical  It is caused by the weight of a tumor or granuloma of the lower eyelid.

Rabin Singh
 Shalakya tantra- 1 Ϯϯ

Clinical Features  Watering of eye, conjunctival congestion, exposure keratitis etc.

Treatment 
 Spastic  proper bandaging
 Cicatrical  excision of the scar and skin grafting
 Senile and Paralytic  plastic surgery – repair of the lower lid.

क् नत्रर :
Acc. to श्र  11  5 मा (प्रस् ारर मा, क् ामा, क्ष ामा, क्षिमािं मा, स्नार् मा)- क्षक्त ा- ान-क्ष ि -क्ष रा ा -क्ष राक्ष क्ष ा- ा ग्रक्ष
Acc. to र्ाग्ि  13  11 by श्र + क्ष र र्त ा & क्ष रा ा
Disease Prognosis Clinical features Correlation Treatment
प्रस् ारर मा क्षत्र प्रस् ारर प्रक्ष क्षम ामा क् िा क्षर्स् े न क्षिरप्रििं न म Pterygium  मा न
न ार्धर् ( .उ.)  िं ा िं न ( िं + मर्द् न + स् र + प्रर्ा +
Thin spreading, reddish blue coloured membrane श्मध + र् र्ा etc.)
develops on shukla mandala.  क्ष प् ल्र्ाक्र र ािं न (क्ष प् + क्षत्र ा + ाक्षा
+ ा + ैंिर् + ििं रा स्र्र )
 ष् ाक्र ा (मरर + िस्म + ाम्रिस्म +
िं िस्म + क्षर्र्द्म + ैंिर् + मर्द् न + ा +
स्र ञ्जन + क्षिमस् )
 मरर ाक्र (मरर + क्षर्ि ी + ररर्द्ा स्र्र )
 ष् ाक्र र क्रिर्ा ( ष् ाक्ष +र ािं न +क्ष ा + िं
+ मर्द् न + ैंिर् + रर + मनःक्ष ा +मरर +मि)
क् ामा क् ाख्र्िं म र्क्षध क् िा
श्व िं मक्षम र्िा क्ष र Pterygium  मा न
न ार्धर् ( .उ.) िं ा िं न – क्ष प् ल्र्ाक्र र ािं न – ष् ाक्र ा
A slowly growing, soft, pale white coloured membrane – मरर ाक्र – ष् ाक्र र क्रिर्ा
develops on shukla mandala.

Rabin Singh
 Shalakya tantra- 1 Ϯϰ

क्ष ामा रक्त र्धमािं िं प्र र्म क्ष क् िा ाििंामा क्र क्षध क्ष Pterygium  मा न
(क्ष मा) न ार्धर् ( .उ.) िं ा िं न – क्ष प् ल्र्ाक्र र ािं न – ष् ाक्र ा
Soft, red coloured membrane (resembling the colour of – मरर ाक्र – ष् ाक्र र क्रिर्ा
lotus flower) develops on shukla mandala.
क्षिमािं मा क्षत्र क्षर्स् ेम िं र् र्तप्र ा िं श्र्ार्िं र्ा क्षि मािं ामा क्षर् ा Pterygium  मा न
न ार्धर् ( .उ.) िं ा िं न – क्ष प् ल्र्ाक्र र ािं न – ष् ाक्र ा
Soft, thick, widely spreading chocolate coloured (yakrita – मरर ाक्र – ष् ाक्र र क्रिर्ा
varna) membrane develops develops on shukla
mandala.
स्नार् मा क्षत्र क् र् क्ष क्ष म क्ष र्क्षद्धम स्नाय्र्मेर्तर्क्षि र
रिं प्र ाण् िं Pterygium  मा न
न ार्धर् ( .उ.) िं ा िं न – क्ष प् ल्र्ाक्र र ािं न – ष् ाक्र ा
A hard, wide, yellow coloured membrane resembling – मरर ाक्र – ष् ाक्र र क्रिर्ा
Snayu develops on shukla mandala.
क्षक्त ा क्ष त्त श्र्ार्ाः स्र्ः क्ष क्ष क्षनिाश्च क्ष ध र् र् क्र्तर्ािाः क्ष नर्न Xerophthalmia  क्ष त्त क्षिष्र्ध र् क्ष क्र र्त ा ( – – िं न
ि ार्धर् क्षक्त िंज्ञः ( .उ.)
or Bitot s spots – श्च्र् न – नस्र् etc.) Except-रक्तम क्ष
Blackish white patches or dots spread in shukla
 क्षर्र न with क्षत्र ा / क्ष ल्र्
mandala, like in jala shukti.
 रा प्रर्
Acc. to Vagbhata, eye appears dirty as the mirror with  - िं न 
dust particles. र् र्ाा ािं न (र् र्ा + स् र + प्रर्ा + मक्ता +
िं + र िस्म + स्र् ािस्म + मि)
The patient has pain and burning sensation in the eyes
associated with diarrhea, thirst and fever.
ान रक्त ए र्ः क्षिर मस् क्ष ध ः क् स् िर्क्ष म ानिं र् क्षध Subconjunctival  क्ष त्त & रक्त क्षिष्र्ध र् क्ष क्र र्त ा
ि ार्धर् ( .उ.)
hemorrhage ( ान – रक्तम क्ष – क्षर्र न – नस्र् etc.)
Red coloured dot or patch develops in shukla mandala
 श्च्र् न 𝑐̅ few of the drugs among क्ष ा,
which is painless and red like blood of rabbit.
र्क्षिमि, श्र् न , मि, ैंिर् र् , and म र्द्र्
like ािं , क्षनम र , ाक्ष मस्र्र , मस्
 िं न  िं +क्ष ा+ मर्द् न+मि / िं or
स् र or प्रर्ा or र्क्षिमि +मि / ा +मि /
र ािं न +मि / ैंिर् र् +क्षनमा ( )+मि

Rabin Singh
 Shalakya tantra- 1 Ϯϱ

क्ष ि उर्त न्नः क्ष क्षनि s क्ष ि क् क्ष ध र्ो िर्क्ष क्ष ि ः र्त्तः Pinguecula  क्षिष्र्ध र् क्ष क्र र्त ा Except-रक्तम क्ष
ि ार्धर् ( .उ.)  म िाक्र िं न 
Circular and elevated dots or papules which look whitish ण् +क्ष प् +मस् ा+श्व मरर + ैंिर्+मा िं
स्र्र
like rice flour and fresh like water develops in shukla
mandala.

क्ष रा ा रक्त ा ािः र नक्ष र म ान रक्तः ध ानः स्म ा िंक्षज्ञ स् Vascular  म क्ष रा  न िं न
न ार्धर् ( .उ.)  र न क्ष रा  न
engorgement
A capillary net (sira jala), which is hard, big, red coloured
due to
and full of blood, appears in shukla mandala.
inflammation
क्ष राक्ष क्ष ा क्षत्र क् स् ाः क्ष क्ष ाः क्ष रार् ा र्ास् ा क्षर् ा क्ष म ाः क्ष रा ाः Episcleritis or  न (like मा)
न ार्धर् ( .उ.)
Phlyctenular  After न  प्रक्ष ार with न र्द्व्य
A white nodule (pidika) encircled with capillary net
kerato
develops near the krishna mandala.
conjunctivitis
Acc. to Vagbhata, nodule resembles the Sarshapa beeja.
ा ग्रक्ष ािंस्र्ाि िर्क्ष क्ष sम क्ष ध ल्र्ः ज्ञर् sम र ा ाख्र्ः Conjunctival  क्षिष्र्ध र् क्ष क्र र्त ा
ि ार्धर् ( .उ.)  िन by क्षर्र न, क्ष र क्षर्र न (नस्र्) etc.
cyst
A hard painless nodule (pidika) resembling the water  क्षारािं न 
bubbles and shining like the bronze develops in shukla न र्र् ( क्व र्र्) get triturated (िार्ना) in

mandala. cow milk for 7 days  prepare क्षार  add

ैंिर् + र्त + र न  use as िं न

Rabin Singh
 Shalakya tantra- 1 Ϯϲ

Pterygium 
Pterygium is characterized by a triangular encroachment of the conjunctiva onto the cornea usually on the nasal side. It is a triangular fold of conjunctiva
consisting of head, neck and a body.
Etiology  Etiology of pterygium is disputed. A number of theories such as primary degeneration of the conjunctiva and the cornea (Fuchs), inflammatory
response of the conjunctiva (Kamel) and irritative reaction to ultraviolet (UV) light have been propagated. Currently, pterygium is believed to be a growth
disorder characterized by conjunctivalization of the cornea due to localized UV rays induced damage to the limbal stem cells.
Clinical Features  Pterygium seldom gives any symptom but its progression may cause astigmatism and its extension in the pupillary area of the cornea
may cause serious visual impairment. Occasionally there may be diplopia due to restricted movements of eyeball.
Treatment 
 Pterygium requires surgical removal, especially if it threatens to encroach onto the pupillary area
 McReynold s transplantation method

Episcleritis 
A self-limiting, transient inflammatory involvement of the superficial layers of the sclera is known as episcleritis. The condition may be unilateral (more than
60%) or bilateral, predominantly affecting the young women.
Etiology  The precise cause is not known but it is considered to be a hypersensitivity reaction to an endogenous tubercular or streptococcal toxin.
Episcleritis may be associated with rheumatoid arthritis, polyarteritis nodosa, spondyloarthropathies and gout.
Clinical Features  Episcleritis manifests in two forms – nodular and diffuse.
1. Nodular Episcleritis  There occurs a pink or purple circumscribed flat nodule situated 2 to 3 mm away from the limbus, often on the temporal side. It is
hard, tender, immobile and the overlying conjunctiva moves freely over it. The nodule seldom undergoes suppuration or ulceration.
2. Diffuse Episcleritis  The inflammatory reaction is confined to one or two quadrants of the eye in diffuse episcleritis. The involved area looks markedly
congested. The condition is benign and the course is usually selflimiting. However, recurrences are frequent.
Treatment 
 Topical and oral NSAIDs is the treatment of choice.
 Severe or recurring disease needs a short course of topical corticosteroids (Hydrocortisone acetate 1% drops / subconjunctival injections).

Rabin Singh
 Shalakya tantra- 1 Ϯϳ

Scleritis 
Scleritis is a chronic inflammation of the sclera proper often associated with systemic diseases.
Etiology  Scleritis is caused by an immune-mediated vasculitis that may lead to destruction of the sclera. It occurs in older age group and affects females
more than males. Herpes zoster is the most important local cause of scleritis. Scleritis is frequently associated with connective tissue or autoimmune
diseases, especially rheumatoid arthritis.
Clinical Features  (i) Pinkish red area with hyperemia of surrounding conjunctiva, (ii) Tha patch of scleritis is slightly elevated and markedly tender,
(iii) Marked pain may radiate to the frntal region, (iv) Lacrimation but no discharge.
Treatment 
Same as episcleritis.

Sub-conjunctival Hemorrhage 
Subconjunctival hemorrhage is bleeding underneath the conjunctiva. It is characterized by a bright red patch appearing in the white of the eye beneath the
clear lining of the eye (conjunctiva).
Etiology  It may result from eye trauma, head injury, severe hypertension, whooping cough, coagulation disorder, or as a side effect of blood thinners such
as aspirin or warfarin.
Management  A Subconjunctival hemorrhage is typically s self-limiting condition that requires no treatment in the absence of infection or significant trauma.
In case of infection, trauma, hypertension etc. treat the cause.

Rabin Singh
 Shalakya tantra- 1 Ϯϴ

ष् नत्रर :
Acc. to श्र  4  व्र क् - व्र क् - ा ा - क्षक्ष ा ार्तर्र्
Acc. to र्ाग्ि  5  क्ष ि- द्ध ि- ा- ा ार्तर्र् ि-क्ष रा ि
Disease Prognosis Clinical features Correlation Treatment
व्र क् रक्त ार्धर् क्षनमि िं क्ष िर् ष् च्र्र् क्षर्द्धिं प्रक्ष िाक्ष र्ि Corneal ulcer  ान
(क्ष ि) (Sometimes ार्धर्, स्रार्िं स्रर् ष् म र् व्र क् म ा रक्षध ( .उ.)  रक्तम क्ष (क्ष राव्यि / ार् र )
or Ulcerative
Small, round ulcers with severe pricking pain and hot  न & श्च्र् न with ाक्ष र + उर्त +
if vrana is not
lacrimation develops in the Krishna mandala. keratitis ा + र्द्ाक्षा + र्क्षिमि + क्षर् ार
nearer to drishti,  ा & ा
not deep rooted,  न िं न with क्ष र + क्ष प् + मरर
no excess + ि
ैं र् / ाम्राक्र ाां न / न ािं न

discharge, no
pain, no extra
growth etc.)
व्र क् रक्त क्ष िं र् ा िार्तर्क्ष प्र स्र्ध ार्तम िं नाक्ष श्रर्क्तम Corneal  रक्तम क्ष
( द्ध ि) ि ार्धर् क्षर् ार् र्ाच् र् नान ारर व्र िं ार्धर् िं र् क्षध  र्मन – क्षर्र न
मि र ा िं िं ििं क्ष र क्षर्त िं ाक्ष र् क्षध च्रम ( .उ.) opacity or
 र् न / क्ष र क्षर्र न नस्र्
It arises as a complication of Abhishyanda in which a Non-  न & श्च्र् न
part of Krishna mandala becomes white like the fresh ulcerated  ा & ा
clouds in the sky (acc. to Vagbhata, it is like shankha)
keratitis  न िं न
associated with mild pain and less lacrimation.
It is a sadhya vyadhi, but may become kricchra-sadhya
when the disease is deeply or widely spreaded and
long standing (chronic).
ा ा रक्त ार्धर् ा र प्रक्ष म ार्ान क्ष क्ष क्ष क्षच् ाश्रः Anterior  स्न ान
क्षर् ार्ा ष् िं प्र र् sभ्र् क्ष िं ा ा ा क्षमक्ष व्यर्स्र् ( .उ.)  रक्तम क्ष
staphyloma
A red painful growth resembling the dried pellet of  न& न
excreta of a goat comes out tearing Krishna mandala or  क्षत्र ा प्रर्
(cornea) associated with red slimy discharge. Iris prolapse

Rabin Singh
 Shalakya tantra- 1 Ϯϵ

क्षक्ष ा ार्तर्र् क्षत्र ार्धर् िंच् ा श्व क्षनिन र्ां र्स्र्क्ष मण् िं Complicated The disease spreads very fast and no relief
मक्षक्ष ा ार्तर्र्माक्षक्ष मक्षर्त िं व्र िं र् क्षध ( .उ.)
ulcerative is observed.
A complication of Abhishyanda in which the Krishna
keratitis or If patient is strong, without complications,
mandala becomes white completely, associated with
Panophthalmitis treatment can be tried like Shukra vyadhi.
severe pain and loss of vision (blindness).
क्ष रा ि क्षत्र + रक्त क्ष रा ििं म ः ास्रस् ज्जििं ष् मण् म Corneal Recently developed Sirashukra in which
ार्धर् ा िं ाम्राक्षिः क्ष राक्षिरर् धर्
vascularization vision is not lost should be treated like
क्षनक्षमत्त ष् ाच् नास्रस्रच्च त्त्र् ( .हृ.उ.)
The Krishna mandala becomes vascularized (occupied Savrana shukra.
क्षर्क्ष ि िं न  श्व म +र्क्षिमि+ ा +ल िं +
by coppery red coloured sira) causing pricking pain,
+ ररर्द्ा+र ािं न  िार्ना in ाक्ष र &
burning sensation, formation of capillary net, cold or hot
fumigated with र्र् or म ी त्र dipped in
and thin or dense lacrimation without specific cause.

Corneal ulcer 
The inflammation of the cornea is known as keratitis. It may be of two types:
1. Ulcerative keratitis wherein the corneal epithelium shows discontinuity, and
2. Non-ulcerative keratitis wherein epithelium is intact.

Corneal ulcer is discontinuity of the corneal epithelium (an open sore on the cornea). Clinically, ulcerative keratitis is divided into two categories: superficial
and deep.
Etiology  Corneal ulcers can be caused by 
a. Bacterial, viral or fungal infections
b. Trauma to cornea by penetrating injuries, misdirected eyelashes, foreign bodies etc.
c. Unhealthy conditions of the corneal epithelium like in glaucoma, corneal edema and keratomalacia etc.
Pathology  The pathogenesis of corneal ulcer may be described under 4 stages 
1. Stage of infiltration  Corneal inflammation begins with local production of cytokines and chemokines inducing diapedesis and migration of neutrophils
into the cornea from the limbal vessels. The epithelium is edematous and raised at the site of infiltration. It undergoes necrosis and ultimately
desquamates.

Rabin Singh
 Shalakya tantra- 1 ϯϬ

2. Stage of progression  The epithelium at the margins of the ulcer swells and overhangs. The floor and the margin of the ulcer are packed with
inflammatory cells and they appear gray.
3. Stage of regression  Infiltration start to disappear.
4. Stage of cicatrization  Healing of the defect occurs by the formation of granulation tissue from the margin of the ulcer. Thus after healing, cornea
becomes opaque (non-transparent) at the site of ulceration.
Clinical Features  Pain or discomfort or burning sensation in the eye, lacrimation, photophobia, headache, blurred vision, blepharospasm etc.
Treatment 
 Local & systemic broad spectrum antibiotics.
 1% Atropine ointment application
 Dark glasses should be used (no bandaging)

Corneal opacities 
Corneal opacity occurs due to scarring of the cornea, making the cornea appear cloudy or white.
According to the density opacities of cornea are as following  1. Nebula (slight discolouration), 2. Macula (brown opacity), 3. Leucoma (white opacity).
Etiology  Causes of corneal opacities  healed corneal ulcer, healed keratitis, healed penetrating injury to cornea, degenerative changes of cornea etc.
Clinical Features  If the opoacity is in the pupillary area it causes visual disturbances.
Treatment 
 Antibiotic, antifungal, or steroidal eye drops
 Phototherapeutic keratectomy (laser surgery)
 Corneal transplant

Uveitis 
The uveal tract is a vascular membrane, therefore, the inflammatory process tends to affect the uvea as a whole and does not remain confined to a single
part. This is especially true for the iris and the ciliary body, hence, the inflammation of the iris (iritis) is almost always accompanied with some inflammatory
reaction of the ciliary body (cyclitis) and vice versa. (Owing to the segmental blood supply of the choroid, the choroidal lesions are often restricted to isolated
sectors)
Depending on onset, pathology and etiology, uveitis can be classified in the following ways 

Rabin Singh
 Shalakya tantra- 1 ϯϭ

1. Based on Onset  a. Acute b. Chronic

2. Based on Pathology  a. Suppurative b. Nonsuppurative (i. Nongranulomatous ii. Granulomatous)
3. Based on Etiology 
a. Infectious uveitis
i. Bacterial – Tuberculosis, Leprotic, Gonococcal
ii. Spirochetal – Syphilis, Lyme disease, Leptospirosis
iii. Viral – Herpes, Cytomegalovirus disease
iv. Fungal – Presumed ocular histoplasmosis syndrome, Candidiasis
b. Parasitic uveitis
c. Lens-induced uveitis
d. Uveitis of unknown etiology
e. Uveitis associated with systemic diseases
i. Joint disorders – Ankylosing spondylitis, Juvenile rheumatoid arthritis, Reiter s syndrome
ii. Skin disorder – Behçet s disease
iii. Respiratory disorder – Sarcoidosis
iv. Gastrointestinal disorder
f. Uveitis associated with malignancy
g. Uveitis associated with ocular ischaemia
h. Idiopathic uveitis
Clinical Features 
Redness of the eye, blurred vision, photophobia, blacked out sclera, floaters (floaters are dark spots that float in the visual field), headache etc.
Treatment 
 Antibiotic, antifungal, or steroidal eye drops (e.g. moxifloxacin + loteprednol etc.)
 Oral antibiotics
 Antimetabolite medications, such as methotrexate are often used for recalcitrant or more aggressive cases of uveitis.
In case of herpetic uveitis, antiviral medications, such as valaciclovir or aciclovir can be used.

Rabin Singh
 Shalakya tantra- 1 ϯϮ

Acute Iridocyclitis 
Iridocyclitis is a type of anterior uveitis that involves the iris and ciliary body. Symptoms include pain and redness in the eye, increased sensitivity to light
(photophobia), and blurred vision.
Treatment 
 Steroid eyedrops (e.g. dexamethasone, hydrocortisone, prednisolone, or loteprednol)
 Oral steroid pills / steroidal eye injections
 Symptomatic treatment

Staphyloma 
A staphyloma is an abnormal protrusion of the uveal tissue through a weak point in the eyeball. Staphyloma is defined as an ectatic cicatrix of the cornea or
the sclera in which the uveal tissue is incarcerated. It occurs due to weakening of the outer tunic of eye by an inflammatory or degenerative condition. Trauma
and sustained increase in the intraocular pressure are the other contributory factors. Anatomically, staphyloma is classified into following five categories:
1. Anterior (corneal)
2. Intercalary
3. Ciliary
4. Equatorial, and
5. Posterior.
Treatment 
 Prompt treatment of scleritis and control of raised intraocular pressure may prevent staphyloma formation in large number of cases.
 Localized staphylomas can be repaired by scleral grafting.
Staphylectomy or enucleation may be performed in a blind disfiguring eye.

Rabin Singh
 Shalakya tantra- 1 ϯϯ

र्ा नत्रर :
Acc. to श्र  17  4 क्षिष्र्ध (र्ा , क्ष त्त , , रक्त )-4 क्षिमध (र्ा , क्ष त्त , , रक्त )-3 क्षक्ष ा ( - - ष् ाक्षक्ष ा )- ाक्षिमध -र्ा र्ाार्- धर् र्ा -
म ार्धर्क्ष -क्ष र र्त ा -क्ष रा ा
Acc. to र्ाग्ि  16  17 – 2 (क्ष र र्त ा -क्ष रा ा) = 15 + 1 ( क्षक्ष ा ार्तर्र्) = 16
Disease Prognosis Clinical features Correlation Treatment
क्षिष्र्ध र्ोर्धर्ा त्र स्र स्र्िं ना स्र्ध उच्र् ( .हृ.उ.) Conjunctivitis
The disease is called Abhishyanda because of dosha –
syandana i.e. exudation (discharge). In this disease
watery or sticky discharge comes from all angles of the
eye ( क्षि-all angles; स्र्ध -discharge).
र्ा र्ा क्षनस् निं स् मिनर म ा िं ा ा ष्र् क्ष र क्षि ा ाः Sub-acute  स्न न ( रा / क्षत्र ा / म /
क्षिष्र्ध व्यिन- ार्धर् क्षर् ष् िार्ः क्ष क्ष राश्र ा र्ा ाक्षि न्न नर्न िर्क्षध क्षर् ार धिाक्र क्ष द्ध )
( .उ.) Catarrhal  म स्र्
Pricking pain in the eyes, stiffness, horripilation, foreign conjunctivitis  रक्तम क्ष – क्षस्नग्ि क्षर्र न – क्षस्
body sensation, roughness, headache, dryness and cool  श्च्र् न  क्ष ल्र्ाक्र िं म क्वा / क्षनम त्र+ ध्र /
नत्रल िं / ण् ार म क्ष द्ध ग्ि / र ािं न र्द्र्
lacrimation.
 िं न  र्क्षिमि+ ररर्द्ा+ र ी+ र् ा + ा ग्ि /
स्र् ा रर +क्ष प् + ण् + ा ग्ि
 क्ष ा  िि ध्र / िि र ी /
र ािं न+स् र + रर + क्ष न+क्षनम त्र+क्ष र
क्ष त्त क्ष त्त ा प्र ा क्ष क्ष राक्षिनध ा िमार्निं ाष् मच्रर्श्च Acute  िं न (for म ा न)
क्षिष्र्ध व्यिन- ार्धर् उष् ाश्र ा नत्र ा क्ष त्ताक्षि न्न नर्न िर्क्षध
catarrhal /  स्न ान – रक्तम क्ष – क्षर्र न
( .उ.)
 क्ष त्त क्षर् ार् / क्ष त्त र स् ाक्षन क्ष क्र र्त ा
Burning sensation in the eyes, suppuration, smoky muco-
  ध न+र्क्षिमि+क्षनम त्र+र ािं न+ ैंिर्+
sensation, hot lacrimation, yellowish eyes, and patient purulent  श्च्र् न  क्षनम त्र+ ध्र+स्त्र ग्ि
feels happy with cool touch or cool medication. conjunctivitis  िं न  ा ष् or म स्र्र +मि+ ा रा /
क्षत्रर् or र्क्षिमि+मि+ ा रा / रर + स्त्र ग्ि
 क्ष ण्  म ी or म ाक्षनम त्र क्ष ण्
 क्ष ा  ध न + ाररर्ा +मिंक्ष ष्ठा + +र्क्षिमि
+ र + ध्र + ामािं + रर

Rabin Singh
 Shalakya tantra- 1 ϯϰ

उष् ाक्षिनध ा ाsक्षक्ष

क्ष ः ण्
ाsक्ष र्तर्म Acute muco-  क्ष राव्यि – स्र् – र् न – नस्र् – िम
क्षिष्र्ध व्यिन- ार्धर् स्रार् महुः क्ष क्षच् एर् ाक्ष
ाक्षि न्न नर्न िर्क्षध  क्ष श्च्र् न
purulent
( .उ.) िि ैंिर्& ध्र+ र् रािं न+
conjunctivitis
Heaviness, edema or swelling in the eyes, itching  क्ष ा
sensation, sticking of eyelids together, slimy or sticky  िं न  ैंिर्+ल िं +क्षत्र ा+र्क्षिमि /
र ी+ ररर्द्ा+र्क्षिमि / क्षारािं न
discharge, and patient feels happy with hot touch or hot
 क्ष ण्  क्ष ग्र त्र ल् / क्षनम त्र+ ण् + ैंिर्
medication.  क्ष ा  र ािं न / ण् + र ी /
ण् + रर
रक्त क्षिष्र्ध रक्त ाम्राश्र ा क्ष नत्र ा राज्र्ः मध ा क्ष क्ष ाश्च Acute muco-  स्न न – स्र् – रक्तम क्ष – क्षर्र न – क्ष र क्षर्र न
व्यिन- ार्धर् क्ष त्तस्र् ल िं ाक्षन र्ाक्षन ाक्षन रक्ताक्षि न्न नर्न िर्क्षध  क्षत्र ा+ ध्र+र्क्षि+मस् ा+ ा रा+
( .उ.) purulent
 प्र  न र्त +उ र + ा ररर्द्ा +
Signs & symptoms are same as Pittaja abhishyanda; the conjunctivitis + ध्र +र्क्षिमि +मस् ा + ि
special symptoms are red eyes, red lacrimation, and red  श्च्र् न स्त्र ग्ि / ग्ि or /
capillary net appearance. क्षत्र ा+ ा रा+
 िं न ा + ान +श्र ी +िा ी
+ म ी +क्ष ल्र् + + ध्र+मिंक्ष ष्ठा+ मि or
क्षर
 क्ष ा  न र्त +मस् ा + ा ररर्द्ा
+र्क्षिमि + ध्र + ि
(Similar treatment for  रक्त क्षिष्र्ध , रक्त
क्षिमध , क्ष र र्त ा , and क्ष रा ा)
क्षिमध उर्त ाट्य र्ार्तर् ां नत्रिं क्षनमाथ्र् ा Glaucoma
क्ष र sिां िं क्षर् ा क्षिमध िं स्र् क्ष ः ( .उ.)
Adhimantha is characterized by severe pain in the eyes as
if eyeball is plucked out or severe twisting pain is present
either in eyeball or left or right half of forehead along with
other symptoms in accordance to dosha.
र्ा क्षिमध र्ा क्षिमध िर्त्तत्र ार् नार्निं भ्रमः Acute  र्ा क्षिष्र्ध र् क्ष क्र र्त ा
व्यिन- ार्धर् रण्र्र् मथ्र्ध ा ाक्षक्षभ्रर्ा र्ः ( .हृ.उ.)
congestive
Karna nada (tinnitus), giddiness, and churning type of pain
in head, eye and root of the nose. glaucoma

Rabin Singh
 Shalakya tantra- 1 ϯϱ

क्ष त्त क्षिमध क्ष त्त ज्र् ङ् ार ी ााििं र् क्ष ण् मप्रिम Acute  क्ष त्त क्षिष्र्ध र् क्ष क्र र्त ा
व्यिन- ार्धर् क्षिमध िर्न्नत्रम ( .हृ.उ.)
congestive
Pain or burning sensation as if caustic alkali or burning coal is
applied to eye, eyelids suppurated and and its margins glaucoma
excessively swollen, and eye appears like a piece of liver
(reddish brown / chocolate colour).
क्षिमध क्षिमध न िं ष् मन्न िं क् मण् म Chronic  क्षिष्र्ध र् क्ष क्र र्त ा
व्यिन- ार्धर् प्र नाक्ष ार्धमानिं ािं ाक्षमर्क्ष म ( .हृ.उ.)
congestive
Sunken cornea, bulged sclera, lacrimation, distension or
glaucoma
edema of nose, and foreign body sensation in eyes.
रक्त क्षिमध रक्त मध sक्षक्ष ाम्र र्ाध मर्त ा न मान Congestive  रक्त क्षिष्र्ध र् क्ष क्र र्त ा
व्यिन- ार्धर् रा धि क्षनििं ामर्क्ष स् ानाक्षमम glaucoma or
क्षनमिररिाििं ष् मग्धर्ाि ानम ( .हृ.उ.)
Eye becomes red and discharges red secretions; there is Secondary
severe pain like plucking out or pricking etc. Red glaucoma
discolouration of the eye resembles flower of Bandhuka
(noon-flower), Tenderness, and the Krishna mandala appears
as Arishta-fruit dipped in the blood and patient sees all the
objects shining like fire.
क्षक्ष ा क्षत्र ण् ाश्रर् ः क्व म र क्षन्निः panophthalmitis  स्न न – स्र् न – क्ष राव्यि
व्यिन- ार्धर् ा िं ा ाम्रर्तर् क्षनस् रर्ः ( .उ.)   िि श्व ध्र + उष्
Eye becomes reddish brown like a pakwa Udumbara phala,  श्च्र् न  ा ररर्द्ा + प्र ण् र क्वा
and associated with itching, lacrimation, burning sensation,  िं न  ािंस्र्म + / ैंिर्+स्त्र ग्ि /
मि ार + रर + मि
stickiness, sensitivity, pricking pain, heaviness, and red
edema with frequent sticky hot or sticky cool discharge.
क्षत्र नाक्षन ल िं ाक्षन नत्र ा र्तर् ( .उ.) End  क्षक्ष ा र् क्ष क्र र्त ा
क्षक्ष ा व्यिन- ार्धर् Except shopha (edema / inflammation), all the symptoms of
ophthalmitis
sashopha akshipaka are seen in ashopha akshipaka.
Vagbhata called it Alpa shopha akshipaka.

Rabin Singh
 Shalakya tantra- 1 ϯϲ

ष् ाक्षक्ष ा र्ा र् क्ष िं ा क्षर्र्तमा क्षर् न ाक्षर् ानिं र् Xerophthalmia  ान – र्न र् ा

ि ार्धर् ा िं र् प्रक्ष िन ष् ाक्षक्ष ा िं क्षक्ष ( .उ.)
or uveitis or  िं or नस्र्
Eyelids become hard / stiff, rough, dry and thickened;
advanced state  रर with ैंिर् र् + ष् क्ष र
opening and closing of lids become difficult
 क्ष ा with िि ध्र
( च्र धम नम नम) and when attempted causes pricking of Trachoma
 िं न 
and piercing type of pain due to friction; eye looks dirty ण् +स्त्र ग्ि+
lusterless with blurring of vision. न र् ा+ ण् or ैंिर्
ाक्षिमध र्ा ार्धर् उ क्ष ा क्षक्ष र् ाक्षिमध र्ा ार्तम ः ा र्क्ष प्र ह्य Atrophic bulbi or  ार्धर्
ाक्षि ग्राक्षिर ार्धर् ए ाक्षिमध ः नाम र ः ( .उ.) But can be treated like र्ा क्षिष्र्ध
Phthisis bulbi
If vataja adhimantha is ignored the entire eyeball क्ष क्र र्त ा
undergoes deterioration and becomes shrunken with
severe pain. This stage is intractable.
र्ा र्ाार् र्ा क्ष्मिर्ाक्षक्षभ्रर्माक्षश्र स् र्त्राक्षन ः िं रक्ष प्र िः Ocular /  र्ा क्षिष्र्ध र् क्ष क्र र्त ा
( क्षन र्ाार्) व्यिन- ार्धर् र्ाार् श्चाक्ष ः र क्ष िं र्ा र्ाार्म ा रिं क्ष ( .उ.)
periorbital pain
The vitiated vata causes severe pain, sometimes in the
eye lashes, sometimes in the eye brows, sometimes in due to chronic
the eye ball, is known as vata-paryaya or anila-paryaya glaucoma or
(shifting pain). Trigeminal
neuralgia
धर् र्ा र्ा र्स्र्ार् ाक्ष र नस् मधर्ा र्ाsप्र्क्षन sधर् र्ा Referred pain in  र्ा क्षिष्र्ध र् क्ष क्र र्त ा
व्यिन- ार्धर्
र्ाार्द् sक्ष भ्रक्षर् न र्ा मधर् र्ा म ा रिं क्ष ( .उ.) the eye
The vitiated vata located in back of neck, causes severe
pain in the eyes or eye brows by spreading from
peripheral parts like ears, head, neck, jaws etc. (referred
pain in the eye from other parts)

Rabin Singh
 Shalakya tantra- 1 ϯϳ

म ार्धर्क्ष क्ष त्त म न िक्तन क्षर् ाक्ष ना िं ा र्ा एर् नत्रम Allergic  क्ष त्त क्षिष्र्ध र् क्ष क्र र्त ा, except-रक्तम क्ष
ि ार्धर् ाक्षधर् िं क्ष ः न र ा म ार्धर्क्ष िं र् क्षध
chemosis  क्षत्र ा / क्ष ल्र् ान (for क्षर्र न)
( .उ.)
 of र् र्ा र्द्व्य
Due to excessive intake of amla rasa and vidahi (katu,
lavana rasa), eye becomes inflamed, edema of eye ball
occur with bluish red lines.
क्ष र र्त ा रक्त र् ना र्ाsक्ष र् ना र्ा र्स्र्ाक्षक्षराज्र् क्ष िर्क्षध ाम्राः Allergic  रक्त क्षिष्र्ध र् क्ष क्र र्त ा
व्यिन- ार्धर् महुर्र्ारज्र्क्षध ाः मध ा व्याक्षिः क्ष र र्त ा क्ष प्रक्र िः  स्न न – रक्तम क्ष
conjunctivitis
( .उ.)  िं न with मि+
or Angio-
Eye suddenly becomes red and spread with capillary net,
neurotic
may or may not contain the pain and the disease subsides
oedema of
naturally.
the eye
क्ष रा ा रक्त म ा क्ष र र्त ा उ क्षक्ष स् ार् र स् क्ष राप्र ाः Acute orbital  रक्त क्षिष्र्ध र् क्ष क्र र्त ा
व्यिन- ार्धर् ाम्राच् मस्रिं स्रर्क्ष प्र ा िं ा न क्न र्तर्क्षिर् क्षक्ष िं  िं न 
cellulitis
( .उ.) ाक्ष +मि
If Sirotpata is neglected, coppery red coloured steaks / ा + ैंिर्+मि
network increases more resulting in red sticky discharge
from eye along with loss of vision.

Conjunctivitis  Inflammation of cunjunctiva is characterized by redness of the eye and conjunctival discharge.
Conjunctivitis is usually of two types  1. Infectious, and 2. Noninfectious.
The noninfectious conjunctivitis may further be subdivided into:
a. Allergic
b. Toxic
c. Traumatic
d. Secondary, and
e. Idiopathic.

Rabin Singh
 Shalakya tantra- 1 ϯϴ

Infectious Conjunctivitis 
A wide variety of etiological agents, bacteria, virus and fungi, can cause infection in the conjunctiva.
a. Acute Catarrhal or Mucopurulent Conjunctivitis  Acute catarrhal conjunctivitis is an acute infective type of conjunctivitis characterized by hyperemia of
the bulbar conjunctiva and papillary hypertrophy of the palpebral conjunctiva associated with mucopurulent discharge.
b. Acute Purulent Conjunctivitis  Acute purulent conjunctivitis is also known as acute blenorrhea and is marked by a profuse purulent discharge. It occurs
in two forms  1. Purulent conjunctivitis of newborn (ophthalmia neonatorum), and 2. Purulent conjunctivitis of adult.
c. Acute Membranous Conjunctivitis  Acute inflammation of the conjunctiva associated with the formation of a membrane or pseudomembrane on the
palpebral conjunctiva characterizes acute membranous conjunctivitis.
d. Herpes Simplex Virus Conjunctivitis  Acute conjunctivitis may also be caused by herpes simplex virus (HSV) type 1 and 2. Herpes simplex virus type 1
causes an acute unilateral blepharoconjunctivitis with vesicular lesions on the lids, intense papillary hypertrophy of the conjunctiva and classical dendritic
lesion on the cornea. The virus can also produce a follicular conjunctivitis.
Herpes simplex virus type 2 conjunctivitis is essentially a venereal infection acquired by direct contamination of eye from birth canal.
e. Acute Adenovirus Conjunctivitis  Adenoviruses are known to produce acute follicular conjunctivitis as seen in pharyngoconjunctival fever (PCF) and
epidemic keratoconjunctivitis (EKC).
f. Chronic Conjunctivitis  Chronic conjunctivitis may occur as a legacy from an inadequately treated acute conjunctivitis or as simple chronic conjunctivitis
or specific granulomatous conjunctivitis.
Simple Chronic Conjunctivitis  Simple chronic conjunctivitis is marked by congestion of the posterior conjunctival vessels and papillary hypertrophy of
the palpebral conjunctiva associated with burning or grittiness in the eye.
Angular Conjunctivitis  Intense itching, conjunctival congestion towards the inner and outer canthi, excoriation of the skin of lid margins at the angle and
scanty mucopurulent discharge characterize angular conjunctivitis.
g. Follicular Conjunctivitis  The inflammatory reaction of the conjunctiva to noxious agents usually manifests in two forms – an acute generalized papillary
hyperplasia (vascularization with epithelial hyperplasia) and a localized aggregation of lymphocytes (follicles) in the subepithelial adenoid layer. The
follicles in the conjunctiva may be found in acute conjunctivitis, chronic conjunctivitis, as a result of allergic or toxic response to the drugs such as topical
atropine and pilocarpine, and in benign folliculosis of unknown etiology.

Rabin Singh
 Shalakya tantra- 1 ϯϵ

Clinical Features 
Redness of the eye, swollen conjunctiva, thick yellow discharge that crusts over the eyelashes, itchy eyes, burning eyes, blurred vision, photophobia etc.
Treatment 
 Local and systemic antibiotic, antifungal, or antiviral drugs as per need
(Ciprofloxacin / moxifloxcin eyedrops with or without dexamethasone)
 Antihistamine or corticosteroid in allergic condition
 Hygiene

Glaucoma 
The term glaucoma refers to a group of conditions that have a characteristic optic neuropathy associated with visual field defects and elevated intraocular
pressure.
Normally the rate of aqueous formation and the rate of aqueous outflow are in a state of dynamic equilibrium and, thus, maintain a normal intraocular
pressure which ranges between 12 and 20 mm Hg. Intraocular pressure (IOP) is basically determined by three factors 
1. The rate of aqueous humor production
2. Resistance to aqueous outflow across the trabeculum, especially in the juxtacanalicular meshwork, and
3. The level of episcleral venous pressure.
Factors responsible for rise of intraocular pressure 
a. Increased aqueous production
b. Decreased aqueous outflow due to obstruction of its drainage
c. Increased blood volume or decreased venous outflow
d. External pressure on the eyeball
Classification of Glaucomas 
1. Developmental glaucomas
a. Congenital glaucoma (Buphthalmos)
b. Infantile glaucoma

Rabin Singh
 Shalakya tantra- 1 ϰϬ

c. Juvenile glaucoma
d. Developmental glaucoma associated with congenital anomalies
2. Primary open-angle glaucoma (POAG)
a. Primary open-angle glaucoma with high pressure
b. Primary open-angle glaucoma with normal pressure
3. Primary angle-closure glaucoma (PACG)
4. Secondary glaucomas
Developmental glaucoma  The term developmental glaucoma includes primary congenital glaucoma and glaucoma associated with ocular or systemic
developmental anomalies.
Congenital glaucoma  Glaucoma that manifests at birth or during the first year of life.
Infantile glaucoma  When glaucoma occurs within first few years of life.
Juvenile or childhood glaucoma  When glaucoma occurs between 3 and 16 years of age, it is labeled as juvenile or childhood glaucoma.
Secondary infantile glaucoma  When the rise of IOP is associated with inflammatory and neoplastic conditions of the eye or metabolic disorders, it is called
secondary infantile glaucoma.

Clinical Features 
Open-angle glaucoma  Patchy blind spots in peripheral or central vision, frequently in both eyes; Tunnel vision in the advanced stages.
Acute angle-closure glaucoma  Severe headache, eye pain, blurred vision, halos around lights, photophobia, discharge etc.
Treatment 
 Anti-glaucoma medications
Prostaglandin analogue – e.g. Latanoprost, Travoprost, or Unoprostone isopropyl eyedrops
blockers – e.g. Timolol, or Betaxolol eyedrops
-adrenergic agonists – e.g. Apraclonidinre, or Brimonidine eyedrops etc.
 Surgery (Canaloplasty / Trabeculectomy / Argon laser trabeculoplasty ALT)
 Beta-blockers and carbonic anhydrase inhibitors are often used to reduce IOP in the preoperative period

Rabin Singh
 Shalakya tantra- 1 ϰϭ

Dry Eye Syndrome 

Deficiency of tears or instability of tear film causes dry eye syndrome which is a leading cause of ocular discomfort.

Etiology and Types  Dry eye syndrome (DES) occurs in different forms and may have the following causes 
1. Aqueous tear deficiency  commonly found in keratoconjunctivitis sicca (KCS). The sicca may occur in many conditions such as Sjögren s syndrome,
sarcoidosis, atrophy or hypoplasia of lacrimal gland and Riley-Day syndrome.
2. Mucin deficiency  The mucin layer deficiency decreases the wettability of the ocular surface. It causes instability of the tear film and decrease in the tear
film break-up time. The important causes of mucin deficiency are: (i) hypovitaminosis A, (ii) excessive conjunctival scarring due to trachoma and membranous
conjunctivitis, (iii) mucocutaneous disorders – ocular pemphigoid, erythema multiforme and Stevens-Johnson syndrome, and (iv) chemical burns and injuries.
3. Lipid deficiency  The lipid deficiency can occur in the patients with chronic blepharitis and acne rosecea.
4. Impaired lid function or blinking  Normal blink reflex maintains a normal tear film. Decreased blinking, incomplete closure of lids (Bell s palsy), dellen,
pterygium, ectropion of the lower eyelid and neuroparalytic keratitis may adversely affect the tear film stability.
5. Irregularity of the corneal surface  Irregularity of corneal surface (epitheliopathy) produces irregularity of the tear film.

Clinical Features  Ocular discomfort, foreign body sensation, burning, blurred vision, photophobia, heaviness of lids, mucous discharge, redness and
inability to open eyes in the light etc. The bulbar conjunctiva looks dry and lusterless. In advanced cases superficial punctate keratitis, corneal mucous
plaque, marginal corneal thinning, bandshaped keratopathy and corneal ulcer may develop.

Treatment 
Four approaches are commonly used in its management:
1. Supplementation of tears
2. Preservation of existing tears
3. Stimulation of tears, and
4. Treatment of inflammatory process.

Rabin Singh
 Shalakya tantra- 1 ϰϮ

क्षि नत्रर :
Acc. to श्र  12  र्ा ल िं ना – क्ष त्त ल िं ना – ल िं ना – रक्त ल िं ना – क्षन्न ा ल िं ना (क्ष क्षमर- ा -ल िं ना are the progressive stages of the
disease) – ररम ाक्षर् – क्ष त्तक्षर् ग्ि क्षि – िष्मक्षर् ग्ि क्षि – िम ी – ह्रस्र् ाड्य – न ाधर्धर् – मि रर ा
Acc. to र्ाग्ि  27  6 types of क्ष क्षमर (र्ा -क्ष त्त - -रक्त - िं ा - क्षन्न ा ) – 6 types of ा – 6 types of ल िं ना – क्ष त्तक्षर् ग्ि क्षि – म क्षर् ग्ि क्षि – उष् क्षर् ग्ि
क्षि – ाधि (नक्ताधर्धर्) – िम ी – ह्रस्र् ाड्य – न ाधर्धर् – मि रर ा – र् ा ल िं ना
Disease Prognosis Clinical features Correlation Treatment
प्र म ार्धर् क्ष रान ाररक्ष म प्र मिं िं क्षश्र Initial  स्न न – स्र् न
ि i.e. क्ष क्षमर व्यक्तम क्ष िं व्यक्तमप्र्क्षनक्षमत्त ः ( .हृ.उ.)  क्ष राव्यि
refractive
When the vitiated dosha reach first patala through sira,  क्षर्र न
( ाक्षश्र ) generate pathology there and cause mild blurring of error  रा प्रर्
vision. Clear objects also appear blurred without any  क्षत्र ा प्रर्
reason.
क्षि र् ार्धर् प्राप्त क्षि र्िं मि मक्ष श्र्क्ष Progressive
ि i.e. ि िं र्त्ना ा न्निं र क्ष्मिं नक्ष
राक्षध स् िं िं क्षर् र्ाा न मधर् refractive
क्ष क्षमर मण् िंस् ान मण् ान र् श्र्क्ष error
(मािं ाक्षश्र ) क्षिि िं क्षिमर्धर्स् हुिा हुिा क्षस्
or Choroiditis
िरभ्र्ध र ह्रस्र्र्द्धक्षर् र्ार्म ( .हृ.उ.)
When vitiated dosha reach second patala, abhuta i.e.
non existing figures like flies, mosquitoes, hair etc. are
seen but bhuta i.e. existing near objects are seen with
difficulty. Very minute and very distant objects are not
seen. Distant object appears nearer and nearer object
appears far away. If dosha are arranged in a circular
manner, all objects look circular. If dosha get
accumulated in the center, diplopia develops. If dosha
get scattered in many places, many images of a single
object are seen (polyopia). If the pathology reaches
deeper, large object looks smaller (micropsia) and small
object looks larger (macropsia).

Rabin Singh
 Shalakya tantra- 1 ϰϯ

र् र्ाप्र् प्राप्न क्ष ा ािं र् ाक्षश्र Immature

ि i.e. ा न र्धर्ाम क्ष नािस् न ार् मम
cataract or
र् ार् ा रज्र् क्षि ीर् िमा ( .हृ.उ.)
(म क्षश्र ) Ametropia
When dosha reaches third patala the disease is called
kacha. The patient is able to see the upper quadrant
objects but unable to see the lower quadrant objects.
Images are not clear and look masked. Darker pupillary
discolouration, due to more and more aggravated dosha,
causes more and more gradual diminution of vision.
ा ार्धर् ाप्र् क्ष मा स्र् ा िं ः Mature  स्त्र मा in
ि i.e. ल िं ना िं म ः र्ान ा र् क्षिमण् म ( .हृ.उ.)
cataract
Triteeya patalagata dosha (i.e. kacha), if neglected,
ल िं ना
( स्थ्र्ाक्षश्र ) invades the fourth patala and obscure the drishti from all
sides causing loss of vision. The power of the eye by
which the objects are visualized is called linga and it is
lost in this stage. Hence it entitled as Linganasha .

Rabin Singh
 Shalakya tantra- 1 ϰϰ

र्ा क्ष क्षमर र्ा ार्धर् त्र र्ा न क्ष क्षमर व्याक्षर्द्धक्षमर् श्र्क्ष Refractive  स्न न – रक्तम क्ष
ाक्षर् ा ािा िं प्र न्निं क्ष महुः
error or  क्षर्र न with क्षत्र ा / म / एरण्
ा ाक्षन ान म ान रश्मींश्च क्षक्ष sत्र ( .हृ.उ.)
immature  नर्ा न & क्षन क्षस्
Due to vata, objects look broken or curved, moving,
 नस्र्  / र्धर्तर्ाक्र / क्षत्रर् /
unstable, dirty and red coloured. Sometimes objects cataract
processed with मद्ग ी, श्व धिा,
appear normal and sometimes cobweb, hair, flies and क्ष ा and ार्र
strolls like things are seen which actually do not exist.  ा with क्ष र र् ा
 ा with ािं मािं + ैंिर्+ र्िं + +मि
 िं न  ध्र-, ष् ा-, क् - र् ा + र्क्षिमि
/ प्रर्तर्ािं न with स्र ञ्जन or र् रािं न dipped
in क्षत्र ा क्वा , मािं र , & क्ष र
 Orally  रा / क्षत्र ा + र्क्षिमि ा
+ मि / क्ष र र् ा / म ी ार्
र्ा ा र्ा र्ाप्र् ा ि ा श्र्र्तर्ास्र्मनाक्ष म Refractive  रक्तम क्ष is contraindicated
धर्द् ा न र्तर्िं र्िमज्र्क्ष मधर् ( .हृ.उ.)
error or  स्र ञ्जन should be kept in the mouth of
If vataja timira is ignored, vataja kacha (aruna kacha) is
immature ष् ा for a month, then it is collected
generated in which the drishti mandala appears red.
and ैंिर् र् + ा ष् स्र्र are added
Patient visualizes face without nose, single object like cataract
to it  use as िं न
moon, lamp appears multiple. Straight line appears wavy.
 Above स्र ञ्जन  िार्ना in ग्ि for 3
(Non-existing things are visualized, one thing appears
days  use as िं न
many, straight things appear curved etc.)

र्ा ल िं ना र्ा ार्धर् र्द्धः ा िं र्ाार्द् िमार् ाक्षमर् Cataract  ार्धर्

स् िा ािािं क्षर्स् ाां क्ष्मािं र्ा ानाम
ल िं ना ः ... ( .हृ.उ.)
If vataja kacha is neglected, drishti seems to be covered
by dust and smoke, also appears clear red coloured and
either contracts or dilates, ultimately losing the vision.

Rabin Singh
 Shalakya tantra- 1 ϰϱ

क्ष त्त क्ष क्षमर क्ष त्त ार्धर् क्ष त्त क्ष क्षमर क्षर् र्त क्ष म Refractive  स्न न – रक्तम क्ष (क्ष राव्यि)
क्ष क्ष क्ष क्षत्तरर त्राििं प्रार् न िं श्र्क्ष ( .हृ.उ.)
error or  क्षर्र न with क्षत्र ा / क्षत्रर् ा
Patient gets hallucinations of self-illuminating bodies like
immature  नस्र्  क्ष र र् ा / ा ल्र्ाक्र
lightening, fire, flies, and all objects look bluish resembling  क्ष र ,म & र्र्तमा
cataract
peacock and titira bird.  ा with ािं मािं +क्ष र र् ा+मिरर्द्व्याs
 िं न 
र्र् ा िं न with ाररर्ा+ +उ र+ ध न+ ध्र
ाां न with त्र+ना र+ ार+ म + रर
र क्रिर्ािं न with र ािं न+क्ष ा+मनःक्ष ा+र्क्षिमि
 Orally क्षत्र ा ा + / क्षत्र ा ार् +
/ processed with ा + ार्र +
ा + रर् + क्ष ा + क्षत्र ा
क्ष त्त ा क्ष त्त र्ाप्र् ा ा न ािा ा र् श्र्क्ष Refractive  रक्तम क्ष is contraindicated
ेध ररर् ाक्षिमर ींर्द्िनिंक्ष ( .हृ.उ.)
error or  स्र ञ्जन or र ाञ्जन with म श्रिं & र् राञ्जन
Objects and drishti (pupil) appear bluish. Sun, moon, fire
immature are useful
appears as if surrounded by rainbow haloes due to
cataract
accumulation of water droplets in between lens fibers.

क्ष त्त ल िं ना क्ष त्त ार्धर् ििं न ा क्षनरा ा क्षस्नग्िा ल िं ना ः ( .हृ.उ.) Cataract  ार्धर्
Patient s drishti mandala appears bluish like honey bee,
lusterless and unctuous / glossy. The vision gets lost.

Rabin Singh
 Shalakya tantra- 1 ϰϲ

क्ष क्षमर ार्धर् न क्ष क्षमरप्रार्ः क्षस्नग्ििं श्व िं श्र्क्ष Refractive  स्न न – रक्तम क्ष (क्ष राव्यि)
िं ध ध मः म ररर् ाक्ष म ( .हृ.उ.) error or  क्षर्र न with क्वा of + रर ी+ ण् +क्ष प्
Patient generally complains that all objects look unctuous immature +क्षत्रर् + ध / क्षत्रर् क्ष द्ध
cataract  क्ष् नस्र् with क्ष processed with
and white like shankha, moon, flower of kunda and kumuda
उ र+ ध्र+क्षत्र ा+क्षप्रर्िं
(lotus).  ा with processed with क्ष र र्क्ष ार्
+ ररर्द्ा + उ र
 िम with क्षर् िं + ा ा+ ामा ा+ िं +उ र
 ा with ािं मािं +क्ष प् + ैंिर्+मि
 िं न  र क्रिर्ा of मनःक्ष ा + क्षत्र + िं +
ा + ैंिर् + मि
ा र्ाप्र् ा क्षनष्प्रिधि ा प्र ा ररर्ाक्ष म Refractive  र क्रिर्ािं न 
क्ष ािा ा क्षिः ... ( .हृ.उ.) + मर्द् न + र् रािं न + क्ष प् + मरर
error or
+ म म + मि
Celestial bright objects like sun, moon, stars, lamp etc. immature
appear dull and lusterless. Drushti appears white. cataract
ल िं ना ... स्र्ालल् िं ना क्ष्र् Cataract  स्त्र क्ष क्र र्त ा  In normal season, after
स्त्र- ार्धर् म ाः क्षि ः क्षस्नग्ि ा ना नः
न proper snehana and svedana, व्यिन मा
क्ष ध ा स्र्र् ः क्ष न क्षिं स् ः (puncturing) is done.
उष् िं मार्ाक्ष ार्ार्ािं रर ाक्ष The instrument used for Vyadhana is called
िं ध ध म स् र म क्षक् मा ( .हृ.उ.) as Yava vakra shalaka and the puncturing
Physical dense kapha is seen in the inner portion of dristhi area is called as Daiva krita chhidra where
i.e. mature cataract which is responsible for loss of vision. It the blood vessels are absent. Proper
appears like a drop of water on moving leaf of lotus. It puncturing is with specific sound and water
contracts in light and dilates in dark. Drishti (pupillary-) bubbles come out. After puncturing, gentle
discolouration looks like white like shankha, moon, flower of pressure with blunt end of shalaka expel the
kunda and kumuda, sphatika. kapha dosha.
Stanya parisheka and Kapha-vatahara mridu
sveda should be done afterwards.

Rabin Singh
 Shalakya tantra- 1 ϰϳ

रक्त क्ष क्षमर रक्त ार्धर् रक्तन क्ष क्षमर रक्तिं म ि िं श्र्क्ष ( .हृ.उ.) Refractive  क्ष त्त क्ष क्षमरर् क्ष क्र र्त ा
 िं न  र्द्क्षाक्र र्र् ा िं न  र्द्ाक्षा+उ र+
All objects look red with black background. (defective colour error or
ध्र+र्क्षिमि+ िं + ाम्र+ + ध न+ ा
assessment) immature क्ष र
cataract  नस्र्  / ा ल्र्ाक्र /
क्षर् ारर धिाक्र / क्ष र र् ा
रक्त ा रक्त र्ाप्र् ा न रक्ता ष् ा र्ा क्षिस् ा श्र्क्ष ( .हृ.उ.) Refractive  रक्त क्ष क्षमरर् क्ष क्र र्त ा
Objects and drishti (pupil) appear red or black. (polychromatic error or  रक्तम क्ष is contraindicated

lusters) immature
cataract
रक्त ल िं ना रक्त ार्धर् ल िं ना sक्ष ा क्षनष्प्रिा ाना ( .हृ.उ.) Cataract  ार्धर्
Drishti mandala appears blackish, or red and lusterless
(corneal haziness) with loss of vision.
िं ा & िं ा क्षन्न ा क्षर् ा िं ी ा क्ष ान Cataract  All the treatments can be applied
क्षन्न ा क्ष क्षमरा न स्माच्च ः स्र्ा व्यक्ता क्ष ः ( .हृ.उ.) according to need
क्ष क्षमर, ा , क्ष क्षमर र् ि
ा क्ष त्र रा ः प्र ार्
 िं न  processed with उ र क्वा +
ल िं ना Mixed symptoms of doshas are observed. Vision is sometimes
क्ष प् + ैंिर् र् + मि
clear, sometimes blurred / hazy / covered in samsargaja or
 नस्र्  र्क्षिमि ाक्र  र्क्षिमि+ क्षर् िं
sannipataja timira. + मरर + र् ा + क्ष + ग्ि
In samsargaja or sannipataja kacha and linganasha, drishti-
mandala and objects appear multicoloured.
ररम ाक्षर् क्ष त्त-रक्त क्ष त्तिं र्ाा ररम ाक्षर् मर्च् ा िं रक्त ा Eales  क्ष त्त & रक्त क्ष क्षमरर् क्ष क्र र्त ा
ार्धर् ा क्र स् ध माक्र र्तर्क्षमर् श्र्क्ष
disease
क्षर् ीर्ामा ान र्ाक्षािंस् क्षिरर् ( .उ.)
When vitiated pitta is mixed with teja of rakta, causes the
parimlayi disease. The trees appear full of fire, flies and full of
aura. All directions look yellowish and bright like rising sun.

Rabin Singh
 Shalakya tantra- 1 ϰϴ

क्ष त्तक्षर् ग्ि क्षि क्ष त्त क्ष त्तन िन न लििं ा िर् स्र् नरस्र् क्षिः Day blindness  क्ष त्त र क्ष क्र र्त ा
ि ार्धर् ाक्षन ाक्ष मधर् र्ः मानर्ः क्ष त्तक्षर् ग्ि क्षिः  क्ष त्त क्षिष्र्ध र् क्ष क्र र्त ा
due to central
प्राप्त र्िं िं क्र र्ा न श्र्क्षन्नक्ष र् क्ष ( .उ.)
When vitiated pitta reaches drishti mandala, the drishti cataract
mandala becomes yellowish and patient also perceives all
the objects as yellow. When it occupies the third patala,
patient is unable to see objects in day time, but can see in
the night. (Pitta gets aggravated in day time due to
warmth of the sun but gets pacified due to coldness in the
night.)
क्षर् ग्ि क्षि ा नरः िष्मक्षर् ग्ि क्षिस् ाधर्र् क् ाक्षन क्ष मधर् Night  र क्ष क्र र्त ा
ि ार्धर् क्षत्र क्षस् ः नक्ताधर्धर्मा ा र्क्ष प्र ह्य  क्षिष्र्ध र् क्ष क्र र्त ा
blindness
क्र र्ा र्ाान क्षर क्ष ाक्ष ाल् िार्ा ( .उ.)
When vitiated kapha reaches drishti mandala, the drishti
mandala becomes whitish and patient also perceives all
the objects as white. When it occupies the third patala,
gets solidified due to the cold in the night and obstructs
drishti causing night-blindness. Patient can visualize at
day time due to kapha-vilayana by warmth of sun.
ाधि े sस् मस् धर्स् िस् स् मिमा ः Night  िा र् (liver of iguana lizard) is divided
(नक्ताधर्धर्) स् र्क्षध ि िं ा ाधिः रः blindness and powder of pippali is stuffed into it
क्र र्ा र रस् िा भ्रिा क्षि ाधम ाः
followed by cooking by putapaka vidhi.
क्षर् न ना र्च् क्षध व्यक्तमत्राक्षनन ानम ( .हृ.उ.)
Pippali powder is then removed and the
The vitiated doshas cause the drishti inactive and covered
liver is consumed for 3 days.
at night so cannot visualize the things (night-blindness),
The same steamed pippali, macerated in
but at day time doshas are dissolved due to warmth of
honey, is used as anjana.
sun, so only can visualize at day time.
 Liver of goat can also be used.

Rabin Singh
 Shalakya tantra- 1 ϰϵ

उष् क्षर् ग्ि क्षि क्ष त्त- प्रिान उष् प्तस्र् ा र्ाररक्षनमज्जना Loss of luster of  िम ी / िमर र् क्ष क्र र्त ा
क्षत्र + रक्त क्षत्र रक्त िं क्त र्ार्तर्ष्म र्धर्ां sक्षक्ष  क्ष त्त- -रक्त र िन & मन
shukla portion
( ार्धर् in initial ा मक्ष निं क् म धर्ाक्षर् ानम  क्षष्र् िं न, नस्र् etc.
रात्रार्ाधर्धर्िं ार् क्षर् ग्ि ष् न ा स्म ा ( .हृ.उ.) with affection of
stage)
Due to उष् ाक्षि प्तस्र् प्रर् ा etc. causes (exposure to photosensitive
cold immediately after exposure to heat), the tridosha layer of retina
and rakta get vitiated, the vitiation reaches the head,
eyes, and so the person visualizes the things imperfectly
at day time and cannot visualize at night.
म क्षर् ग्ि क्षि क्ष त्त- प्रिान ि मम ा ना ः ास्रर्ाा क्षिराक्ष ा Turbid or cloudy म क्षर् ग्ि, क्ष त्तक्षर् ग्ि, उष् क्षर् ग्ि & िमर are
क्षत्र + रक्त क् ण् ा क्षर् ग्िाम न ा स्म ा ( .हृ.उ.) having common treatment principles.
/ smoky vision
( ार्धर् in initial Tridosha and rakta get vitiated due to excessive  क्ष त्त-रक्त क्षिष्र्ध र् / क्ष त्त क्षर् ार्
stage)
consumption of amla padartha. This deranges the drishti क्ष क्र र्त ा
causing collection of exudation and dirt in drishti
mandala, itching sensation and visual errors.
िम ी र्ा ाक्र ज्र्रार्ा क्ष र क्षि ा रभ्र्ा ा र्स्र् नरस्र् क्षिः Smoky vision /  स्न न – क्षर्र न
(िमर) ( ार्धर् in initial िम ान श्र्क्ष र्ािार्ािंस् िं िम ीक्ष र् क्षध र म ( .उ.)  with र्द्व्याs
haziness
stage)
Drishti is vitiated due to grief, fever, overstrain,  िं न स्र् ा रर + ा + +क्र ग्ि+
headache and also due to shiro-roga, causing smoky or  नस्र् म ा + ा र + नध ा +मिंक्ष ष्ठा + ार्ी
hazy appearance of drishti and patient visualizes the +र्क्षिमि + ग्ि + +
things smoky or hazy.
ह्रस्र् ाड्य क्ष त्त ार्धर् ह्रस्र् ाड्य क्र र् च्रा ह्रस्र्ाक्षन ाक्ष र्न श्र् Retinitis  ार्धर्
( .उ.)
pigmentosa
Patient visualizes the objects smaller in size and that too
with great difficulty in day time due to pitta vitiation.
न ाधर्धर् क्षत्र ार्धर् न स्र्र् र्स्र् क्षनक्ष ा म ः Pseudoglioma /  क्षन्न ाक्ष क्ष क्षमरर् क्ष क्र र्त ा
(र्ाग्ि -र्ाप्र्) न ाधि त्राक्षनन क्ष त्रिं श्र्क्ष न क्षनक्ष ( .हृ.उ.)  Orally 
retinoblastoma
When drishti vitiated by tridosha, becomes bright like र् ा + क्षत्रर् + रक्त ध न + िक्षनम + क्षनम +
mongoose (reddish-brown in colour) and objects appear ररर्द्ा + र्ा ा  make decoction and
as multi-coloured in day time along with night-blindness. consume after meal

Rabin Singh
 Shalakya tantra- 1 ϱϬ

मि रर ा र्ा ार्धर् क्षिर्र्ा ा श्व न िा िं च्र् sभ्र्ध र श्च र्ाक्ष Shrinkage of  ार्धर्
ार् ा ा मक्षक्षर िं मि रर क्ष प्रर् क्षध ज्ज्ञाः ( .उ.) eyeball –
Vitiated vata deranges the drishti mandala causing secondary to
shrinkage of the eye ball with irregular size and shape chronic
associated with severe pain. iridocyclitis
र् ा ार्धर् र्ाल् र्तर्स्र् श्र् मद्ि म Macular /  क्ष त्त र क्ष क्र र्त ा
ल िं ना िास्र्रिं िास् राक्र र्ा र्ा ा ा नर्नाक्षश्र ाः  क्षर्र न
eclipse burn
र्ाक्षध ः िं ष्र् क्षि मक्ष ानाम 
र् र्ार् ाा क्षस् क्षम ािं प्र क्ष स् ाक्षमर्ाव्य ाम  िं न 
र् ा र्तर् ल िं ना ः ... ( .हृ.उ.) स्र् ा rubbed in
If a person, with less satva or weak mind, suddenly र + + ग्ि
witnesses some terrifying objects or wonders or the eyes र क्रिर्ािं न of रर + ा त्र
get exposed to bright things like sun etc. then vata and
other dosha get vitiated and destroys the teja of drishti
causing painless blindness.
Externally the drishti appears clear and shining like
vaidurya (cat s eye gemstone), and stable (non-reacting
pupil).

Refractive errors 

Refraction  is the method by which the light rays after travelling the refractive media falling on retina (fovea centralis) for visual perception.
Refractive media  cornea, aqueous humour, pupil, aqueous humour, lens, vitreous humour, and retina.
Refractive error  is an abnormal refractive condition of the eye in which the parallel rays from a distant object are brought to focus either before or beyond
the retina, also called ametropia. It is of 4 types 
1. Myopia (short sighted / nearsightedness)
2. Hypermetropia (long sighted / farsightedness)
3. Presbyopia
4. Astigmatism

Rabin Singh
 Shalakya tantra- 1 ϱϭ

Myopia (nearsightedness)  It is a refractive error of the eye in which, with the accommodation at rest,
the parallel rays from a distant object are brought to focus in front of the retina.
Hypermetropia (farsightedness)  It is a refractive error of the eye in which, with the accommodation at
rest, the parallel rays from a distant object are brought to focus beyond the retina.
Presbyopia  It is a physiological phenomenon in which long-sightedness caused by loss of elasticity of
the lens of the eye, occurring typically in old age.
Astigmatism  It is a refractive error of the eye in which the refraction differs in different meridians of the
eye (e.g. normal in one meridian and myopic or hypermetropic in another meridian).
Anisometropia  It is the condition in which the two eyes have unequal refractive power. Each eye can
be nearsighted (myopia), farsighted (hyperopia) or a combination of both which is called as antimetropia.

Correction of refractive error 

 Concave lens (-) of proper power or contact lens for myopia
 Convex lens (+) of proper power or contact lens for hypermetropia
 Cylindrical lens of proper power for astigmatism
 Nutritious food or vitamin supplements
 Eye exercises
 Hygienic measures

Cataract 
Any opacity in the lens or its capsule is knon as cataract. Cataracts vary in degree of density and site and assume various forms. Clinically, cataract may be
classified on the basis of morphology or underlying etiology.
Morphological Classification  Depending on the location and configuration of opacities, cataract can be classified as:
1. Capsular (anterior, posterior, bipolar)
2. Subcapsular (anterior, posterior)
3. Cortical

Rabin Singh
 Shalakya tantra- 1 ϱϮ

4. Supranuclear
5. Nuclear
6. Lamellar (zonular)
7. Sutural
8. Coralliform.
Etiological Classification 
1. Congenital or developmental  Punctate, anterior polar, posterior polar, central nuclear, sutural, coralliform, zonular, coronary, membranous
2. Senile  Cortical, posterior subcapsular, and nuclear
3. Complicated  Uveitis, high myopia, retinitis pigmentosa, retinal detachment, glaucoma, ocular ischemia
4. Metabolic  Diabetes mellitus, tetany, galactosemia, Lowe s syndrome, Wilson s disease
5. Traumatic  Concussion injuries, penetrating injuries
6. Radiational  X-rays, gamma rays, neutrons, infrared, ultraviolet rays, microwave, laser radiations
7. Dermatogenic  Atopic dermatitis, Rothmund s syndrome, Werner s syndrome
8. Maternal infections  Congenital rubella, congenital toxoplasmosis, congenital cytomegalovirus disease, syphilis
9. Toxic  Corticosteroids, miotics, chlorpromazine
10. Cataract associated with systemic diseases  Dystrophia myotonica, Down s syndrome
Clinical Features 
The main symptom is blurry vision. Having cataract can be like looking through a cloudy window.
Inability to see in dim light & seeing halos around light
Treatment 
 Each case of cataract must be thoroughly evaluated for the extent of visual impairment and its effect on day-to-day working of the patient.
 Cataract surgery
a. Extraction of lens  (i) Intracapsular lens extraction, (ii) Extracapsular lens extraction
b. Intraocular lens implantation (I.O.L.)

Rabin Singh
 Shalakya tantra- 1 ϱϯ

Eale s disease 
Eale s disease is an idiopathic peripheral retinal vasculopathy characterized by inflammation, ischemia, retinal neovascularization and is hallmarked by
recurrent vitreous hemorrhage.
Treatment 
 Medical treatment  Local & systemic corticosteroid
 Laser photocoagulation of the retina is indicated in stage of neovascularization
 Vitreoretinal surgery is required for nonresolving vitreous hemorrhage and tractional retinal detachment.

Hypertensive retinopathy 
High blood pressure can cause damage to the retina s blood vessels, limit the retina s function, and put pressure on the optic nerve, causing vision problems.
This condition is called hypertensive retinopathy.
Hypertensive retinopathy is classified into five grades according to modified Scheie s classification. It includes the changes of arteriosclerosis also.
 Grade 0  No changes
 Grade 1  Visible arteriolar narrowing
 Grade 2  Obvious arteriolar narrowing with localized irregularities
 Grade 3  Besides grade 2 changes, there are multiple flame-shaped hemorrhages, cotton-wool spots and/or exudates.
 Grade 4  It is also known as malignant hypertension. In addition to grade 3 changes, the presence of the papilledema (optic disk edema) is an
important feature. Papilledema is often accompanied with retinal edema and, in longstanding cases, with macular star.
Treatment 
 A major aim of treatment is to prevent, limit, or reverse target organ damage by lowering the patient s high blood pressure.
 Antihypertensive medications
 Symptomatic treatment

Rabin Singh
 Shalakya tantra- 1 ϱϰ

Diabetic retinopathy  Diabetic retinopathy is a diabetes complication that affects eyes. It s caused by damage to the blood vessels of the retina. At first,
diabetic retinopathy may cause no symtoms or only mild vision problems. Eventually, it can cause blindness.
Diabetic retinopathy is conventionally divided into two broad categories 
1. Nonproliferative (background) diabetic retinopathy, and
2. Proliferative diabetic retinopathy.
Nonproliferative Diabetic Retinopathy  is the most common type of diabetic retinopathy wherein the lesions are intraretinal and confined to the posterior
pole. It is characterized by multiple microaneurysms, venous dilatation, hard exudates, dot and blot and flame-shaped hemorrhages and retinal edema.
Proliferative diabetic retinopathy  develops in about 5% of diabetic population. Proliferative changes are a response to the release of vascular endothelial
growth factor (VEGF) from ischemic retina. In PDR the changes are preretinal as well as vitreal. Neovascularization of the optic disk (NVD) and
neovascularization elsewhere (NVE), posterior detachment and collapse of the vitreous, vitreoretinal fibrovascular bands and vitreous hemorrhage
characterize proliferative diabetic retinopathy.
Treatment 
 Medical treatment of DR is aimed at prevention of retinopathy. Tight glycemic control is associated with reduction in development of retinopathy. Good
metabolic control and proper management of hypertension prevent the progression of DR.
 There are three major treatments for DR 
i. Laser surgery
ii. Inj. Corticosteroid or anti-VEGF agents into the eye
iii. Vitrectomy

Age related Macular degeneration  AMD is a common eye condition and a leading cause of vision loss among people age 50 and older. It causes damage
to macula, a small spot near the center of thte retina and the part of eye needed for sharp, central vision, which helps to see objects that are straight ahead.
Treatment 
 A combination of antioxidant vitamins (500 mg vitamin C, 400 IU vitamin E and 15 mg beta carotene) and zinc (80 mg zinc oxide and 2 mg cupric oxide to
prevent zinc induced anemia) supplementation to decrease disease progression and visual loss according to the Age-Related Eye Disease Study.
 Laser therapy.

Rabin Singh
 Shalakya tantra- 1 ϱϱ

Strabismus 
Strabismus, also known as crossed eyes, is a condition in which the eyes do not properly align with each other when looking at an object.
(Normally, the image of an object of regard falls on the fovea of each eye, but certain eyes are so positioned that the image falls upon the fovea of one eye
but not on the fovea of the other. This condition where there is misalignment of the visual axes of the two eyes is called strabismus or squint.)
Etiology  Strabismus can occur due to muscle dysfunction, farsightedness, problems in the brain, trauma, or infections. Risk factors include premature birth,
cerebral palsy, and a family history of the condition.
Clinical Features  misalignment of the eyes, double vision (diplopia) eye strain etc.
Treatment 
Strabismus is usually treated with a combination of eyeglasses, vision therapy and surgery, depending on underlying reason for the misalignment.

Retinitis pigmentosa 
A genetic disorder of the eyes that causes loss of vision.
A bilateral progressive loss of vision beginning with night-blindness and associated with bone corpuscular pigment deposits, narrowed arteries and optic
atrophy characterize primary pigmentary retinal degeneration often referred as retinitis pigmentosa.
Clinical Features  Defective vision in twilight or night-blindness is the most prominent symptom of the disease. Later, progressive contraction of the visual
field handicaps the patient even in moving around. Ophthalmoscopic examination may not reveal any sign initially. A small irregular pigment mottling is found
in the equatorial zone, from here the pigmentary changes extend both towards the posterior pole and the ora serrata. As the disease progresses,
characteristic small jet-black pigments resembling bone spicules with spidery outlines appear in the entire retina especially along the course of the retinal
veins
Treatment 
There is no specific therapy for retinitis pigmentosa. Low vision aids may be tried in patients with subnormal vision. Advanced cases are advised vocational
rehabilitation and mobility training.

Rabin Singh
 Shalakya tantra- 1 ϱϲ

Night blindness 
Night blindness (Nyctalopia) is an inability to see clearly in dim light or night.
Etiology  It is a symptom of several eye diseases. Night blindness may exist from birth, or be caused by injury or malnutrition (for example, Vitamin A
deficiency). The most common cause of nyctalopia is retinitis pigmentosa, a disorder in which the rod cells in the retina gradually losse their ability to respond
to the light. Other causes include myopia, cataract, glaucoma etc.
Treatment  Treat the cause

Amblyopia 
Amblyopia, also called lazy eye, is a disorder of sight due to the eye and brain not working well together. It is the most common cause of decreased vision in
a single eye among children and younger adult.
Etiology  Amblyopia can result from any condition that prevents the eye from focusing clearly. Amblyopia can be caused by – strabismus; refractive error in
the two eyes differs and remains uncorrected for a long time; congenital or traumatic cataract; corneal opacity or developmental vitreoretinal disorders etc.
Treatment 
 Treat the cause, e.g. correction of refractive errors etc.
 Visual therapy, perception training etc.

Central serous retinopathy 

Central serous retinopathy (CSR), also known as central serous chorioretinopathy (CSCR), is an eye disease which causes visual impairment, often
temporary, usually in one eye.
Etiology  CSR is a central serous detachment of the neurosensory retina occurring in young males due to a defect in the pumping function of retinal
pigment epithelium (RPE) associated with leakage of fluid from the choriocapillaris into the subretinal space.
Clinical Features  Blurring of vision, distortion of objects and seeing a black shadow before the eye are common symptoms. The macular area looks
edematous with loss of foveal reflex. A shallow localized detachment of the sensory retina at the posterior pole is seen with indirect ophthalmoscope.
Treatment 
 The condition is often transient and tends to resolve leaving minute yellow deposits in the deeper layers.
 Laser photocoagulation is indicated in patients with recurrent attacks or if the disease persists for 4 months or longer.

Rabin Singh
 Shalakya tantra- 1 ϱϳ

Optic neuritis 
Optic neuritis is a demyelinating inflammation of the optic nerve. It is also known as optic papillitis (when the head of the optic nerve is involved) and
retrobulbar neuritis (when the posterior part of the nerve is involved). The most common cause is multiple sclerosis or ischemic optic neuropathy (blood clot).
Clinical Features  Major symptoms are sudden loss of vision (partial or complete), sudden blurred or foggy vision, and pain on movement of the affected
eye. Other early symptoms are reduced night vision, photophobia and red eyes.
Treatment 
 In the first episode of optic neuritis with no history of multiple sclerosis and MRI confirmation of demyelination, the Optic Neuritis Treatment Trial (ONTT)
recommends the use of pulsed methyl prednisolone 1 g intravenous daily for 3 days followed by oral prednisolone 1 mg/kg body weight daily for 11 days.
 In most MS-associated optic neuritis, visual function spontaneously improves over 2-3 months, and there is evidence that corticosteroid treatment does
not affect the long term outcome.

Optic atrophy 
Optic atrophy is the final common morphological endpoint of any disease process that causes axon degeneration in the retinogeniculate pathway.
Treatment 
 The management goal is to intervene before optic atrophy is noted or to save remaining function.
 Treatment depends on the underlying cause for optic nerve damage.

ाह्य नत्रर ( ध ):
Acc. to श्र  2  क्षनक्षमत्त ल िं ना – क्षनक्षमत्त ल िं ना
Disease Prognosis Clinical features Correlation Treatment
क्षनक्षमत्त ार्धर् क्षनक्षमत्त स् त्र क्ष र क्षि ा ाज्ज्ञर्स्र्तर्क्षिष्र्ध क्षन ानश्च ( .उ.) Optic neuritis  ार्धर्
ल िं ना Headache, inhaling poisonous gas, smelling poisonous
flower or touching it will precipitate linganasha having
features of Abhishyanda.

Rabin Singh
 Shalakya tantra- 1 ϱϴ

क्षनक्षमत्त ल िं ना ार्धर् रर् ा धिर्ाम र ा ािं ध ाननाक्ष िास्र्रा ाम Macular /  ार्धर्

( र् ा ) धर् क्षिमान स्र् र्स्र् ल िं ना स्र्तर्क्षनक्षमत्त िंज्ञः
eclipse burn
त्राक्षक्ष क्षर्स् िक्षमर्ािाक्ष र् र्ार् ाा क्षर्म ा क्षिः ( .उ.)
If a person suddenly witnesses some terrifying objects or
wonders like devarshi, gandharva etc. or the eyes get
exposed to bright things like sun etc. then vata and other
dosha get vitiated and destroys the teja of drishti causing
painless blindness.
Externally the drishti appears clear and shining like
vaidurya (cat s eye gemstone), and stable (non-reacting
pupil).

नर्नाक्षि ा 1st is क्षर् र्ा क्ष र् र्ा न ामक्षि ा ा क्षिः ( .उ.) Injuries of  नस्र्
( क्षि ा ा क्षि 
injured- ार्धर् Due to any injury or trauma to drishti, diminution or loss of eyeball  रर
/ क्षि ा vision is known as abhighataja linganasha.  उ ार
ल िं ना ) Injuries to the eyeball are of two types   व्र र
2nd is  क्ष त्त-रक्त क्षिष्र्ध र् क्ष क्र र्त ा
1. म ा – visible or direct injury
injured-  Orally  / ा + ाक्ष र + मि +
2. म ा – invisible or indirect injury
च्र ार्धर् न र्त + र् + ऋ ि
Clinical features  severe pain, oedema, hyperaemia,
congestion of vessels, subconjunctival haemorrhage,
3rd & 4th photophobia, lacrimation or discharge, headache, foreign
injured- ार्धर् body sensation, dim / hazy vision or loss of vision occurs
depending upon the severity of the injury.

Rabin Singh
 Shalakya tantra- 1 ϱϵ

Xerophthalmia 
Xerophthalmia caused by a severe vitamin A deficiency is described by pathologic dryness of the conjunctiva and cornea. The conjunctiva becomes dry, thick
and wrinkled. If untreated, it can lead to corneal ulceration and ultimately to blindness as a result of corneal damage.
Classification  For diagnostic and therapeutic purposes, the following WHO classification of xerophthalmia is used 
i. XN  Night-blindness
ii. X1A  Conjunctival xerosis
iii. X1B  Bitot s spots
iv. X2  Corneal xerosis
v. X3A  Corneal ulceration/keratomalacia affecting less than one-third corneal surface
vi. X3B  Corneal ulceration/keratomalacia affecting more than one-third corneal surface
vii. XS  Corneal scar due to xerophthalmia
viii. XF  Xerophthalmic fundus
Treatment 
 The epithelial xerosis in infants can be prevented by administering prophylactic vitamin A in mothers during pregnancy. Breastfeeding should be
encouraged. Proper treatment of gastrointestinal disturbance, particularly worm infestations, is necessary.
 In mild to moderate degree of xerophthalmia, dietetic correction with the inclusion of vitamin A rich green vegetables, carrot, butter, egg, fish, cod-liver or
halibut-liver oil, gives satisfactory results.
 The WHO recommended a dose of 200000 IU of vitamin A in 3 doses for the management of clinical xerophthalmia

Other malnutritional eye disorders 

Virtamin B1 deficiency disorders  Beri beri, Toxic retino neuropathy etc.
Virtamin B2 deficiency disorders  Vascularising keratitis, Burning sensation in the eyes, Photophobia etc.
Virtamin B12 deficiency disorders  Peripheral neuritis etc.
Virtamin C deficiency disorders  Scurvy, Ocular hemorrhages, Chronic inflammation etc.
Virtamin D deficiency disorders  Rickets, Osteomalacia, Tetany, Myopia, Cataract etc.
Virtamin K deficiency disorders  Intra ocular hemorrhages.

Rabin Singh
 Shalakya tantra- 1 ϲϬ

Ocular trauma 
Injuries of the eyes can be grouped under the following categories 
1. Mechanical injuries, 2. Chemical injuries, 3. Thermal injuries, 4. Electrical injuries, 5. Radiational injuries.
Clinical Features  Redness and pain of the affected eyes due to hemorrhage and increased intraocular pressure.
Complications  Multiple complications can occur following eye injury  corneal scarring (opacities), cataract, post traumatic glaucoma, uveitis, vitreous
hemorrhage, hyphema, iridodialysis, retinal detachment etc.
Treatment 
Black eye  Cold compress, bandage, eyedrops etc.
Subconjunctival hemorrhage  Naturally disappears within 2 or 3 weeks, Local eyedrops like argyrols is useful.
Rupture of cornea and sclera  Suturing & ulcer therapy.
Hyphema and raised intraocular pressure  Paracentesis to drain the pus.
Corneal abrasions without glaucoma  1% Atropine sulphate drops (mydriatics), Hydrocortisone drops and Antibiotics are useful.

Eye bank 
An eye-bank is a non-profit organization that retrieves and stores eyes for cornea transplantation and research.
Recovery of eye tissue  Recovery refers to the retrieval of organs and tissue from a deceased organ donor. When an organ donor dies, consent for
donation is obtained either from donor registry or from the donor s next to kin. Eyes should be recovered (harvested) within 6 hours of donor s death. The
entire eye, called the globe, may be surgically removed, or only the cornea may be excised in-situ and placed in storage media. Corneas can be preserved for
two weeks for a viable transplantation.
Keratoplasty (corneal transplantation)  In keratoplasty, the opaque corneal disk is replaced by a corresponding sized graft taken from the healthy cornea of
a donor. The keratoplasty is usually of two types – lamellar (partial-thickness graft) and penetrating (full-thickness graft).

Rabin Singh
 Shalakya tantra- 1 ϲϭ

Examination of Eyeball 
The examination of eyeball chiefly contain 3 headings 
1. History taking  The detailed, present, past history and family history give a clue for diagnosis.
2. Objective examination  (a) Examination of the appendages and anterior segment of the eyeball (eyelids, lacrimal apparatus, conjunctiva, cornea,
sclera, anterior chamber, iris, pupil and lens).
(b) Examination of posterior segment of eyeball with ophthalmoscope, e.g. vitreous, retina, choroid, optic disc etc.
(c) Examination of eyeball with special optical instruments like corneal microscope, slit lamp, gonioscope, transilluminator etc.
3. Functional examination of eyeball  Recording of estimation of function of eyes separately 
(a) Acuity of vision  Both the distant and near vision are tested. Distant vision is recorded with Snellen s chart, and Near vision is recorded with Jaeger s
test types etc.
(b) Colour vision test  Test of colour vision is essential for certain occupations such as sailors, Railway engine driver etc. This can br tested by various
methods but the most common method is by means of Isihara chart.
(c) Field of vision  The examination of central field and peripheral field of vision is essential. Central field is estimated by Bjerrum s screen and
peripheral field of vision is estimated by perimeter.

 HISTORY TAKING
1) Name, age, sex, occupation and address should be asked. It is helpful for the diagnosis.
e.g. (a) After 40 yrs of age some diseases come like senile cataract, presbyopia and also retinopathies. (b) Stye & meibomian cyst are common in the young.
(c) Xerosis and vitamin deficiencies are common in the poor.
2) Chief complaints, associated complaints, H/o present illness, H/o past illness, Family history, personal history etc. should be asked in detail.
3) Questions in relation to vision 
i. Mode of onset of the disease whether gradual or sudden.
ii. Duration of the disease whether acute or chronic.
iii. Whether it is primary or secondary.
iv. Whether it is uniocular or binocular.

Rabin Singh
 Shalakya tantra- 1 ϲϮ

vi. Dim vision whether in day time (Hemeralopia) or at nights (Nyctlopia). Any double vision (Diplopia), or multi vision (Polyopia). Any haloes around the light
(commonly seen in acute and subacute conjunctivitis, closed angle glaucoma and in lenticular opacities). Any spots or floating objects seen in front of
eyes (in aqueous precipitations, keratic precipitate and in vitreous hemorrhage). Any distortion of objects (known as metamorphopsia, seen in choroiditis
and retinitis). Whether objects appearing smaller than the normal (known as micropsia, seen in choroiditis and retinitis). Whether objects appearing bigger
than the normal (known as macropsia, seen in choroiditis and retinitis). Whether difficulty in vision for distant objects (Myopia), or near objects
(Hypermetropia). Any glasses (spectacles) used before.
4) Questions with regards pain in the eyeball 
Mode of onset, Duration, Mild /moderate /severe pain, Time of day when worse, Associated symptoms like nausea, vomiting, giddiness etc.
5) Headache  Location, Whether site of pain is fixed or altering, Duration, Mild /moderate /severe pain, Associated symptoms.
6) Watering of the eyes  Duartion, Constant or intermittent, Time of day when worse, Relation to close work /travelling in fast vehicle /after cinema show
/after reading or sewing /after seeing bright things, Any associated redness.
7) Discharge of the eyes  Nature of the discharge whether mucoid /mucopurulent /purulent, Onset, Duration etc.
8) Photophobia present or not.
9) History of trauma
10) While taking history, the doctor should observe foe the ptosis, proptosis, axis of the eyeball, watering, palpebral fissure, head posture etc.

 OBJECTIVE EXAMINATION
(i) Examination of the head  for it s (a) configuration, (b) position (i.e. head tilt or head turn)
(ii) Examination of the face  (a) any asymmetry, (b) signs of paralysis, (c) skin changes etc.
(iii) Examination of eyebrows  for (a) loss of hair, (b) depigmentation, (c) any elevation from hyperaction of frontalis muscle.
(iv) Examination of orbit  for (a) deformity, (b) fullness in any part etc.
(v) Examination for the position of eyeball in the orbit  for (a) smaller eyeball – microphthalmos, (b) bigger eyeball – macrophthalmos, (c) shrunken eyeball –
phthisis bulbi, (d) sunken eyeball – enophthalmos, (e) protruded eyeball – exophthalmos, (f) deviated axis of eye – squint or strabismus, (g) oscillating or
pulsating eyeball – nystagmus, (h) congestion and discolouration should also be noted.

Rabin Singh
 Shalakya tantra- 1 ϲϯ

(vi) Examination of Eyelashes ( क्ष्म)  Eyelashes should be examined for the following 
1. Absence of eyelashes is known as madarosis ( क्ष्म ा ), 2. Partial or total absence, 3. Congenital or acquired should be noted, 4. Irregular, hard and
misdirected eyelashes, is known as trichiasis ( क्ष्म ), 5. Any matting of eyelashes with conjunctival sticky discharge should be noted.

(vii) Examination of Eyelid margin ( क्ष्मर्र्तमा क्षधि) 

1. Inflammation of eyelid margin is known as Blepharitis ( क्षमग्रक्षध ) – the lid margin appears with ulcers, crusts, scales etc. 2. Thickening of lid margin is
known as Tylosis, 3. Hyperemia of lid margin is known as milphosis, 4. Inversion (rolling inwards) of lid margin is known as entropion, 5. Eversion (rolling
outwards) of lid margin is known as ectropion, 5. Small cystic swelling develops at the root of the eyelashes (on the lid margin) due to obstruction in the
channels of zeis gland, it is known as zeis cyst or external hordeolum or stye.

(viii) Examination of Eyelids (र्र्तमा) 

1. Examination of the skin of the eyelids 
 It is very thin, loose without subcutaneous fat so having more prone to edema due to injury.
 Trauma to eyelid may cause swelling and ecchymosis or black eyelid.
 Ulcers, scars, depigmented lesions, burns etc. are to be examined
2. Applied examination of muscles of eyelids 
 Facial nereve palsy causes Lagophthalmos (improper closure of eyelid) due to failure of the function of orbicularis oculi muscle.
 Oculomotor nerve palsy causes Ptosis (improper opening or drooping of eyelid) due to failure of the function of levator palpebrae superioris muscle.
3. Examination of the glands of eyelids 
 Zeis gland inflammatory condition is seen due to obstruction in its duct, by which a small cystic swelling is seen in the lid margin, is known as zeis
cyst or external hordeolum or stye ( िं ननाक्षम ा – मि ा).
 A cyst may form due to obstruction in the gland or its duct, is known as Meibomian cyst or Tarsal cyst or Chalazion (उर्त िंक्ष न – – र्र्तमा).

Rabin Singh
 Shalakya tantra- 1 ϲϰ

(ix) Examination of Conjunctiva 

1. Fornix and palpebral conjunctiva  (a) Hyperemia (redness – due to increased vascularity followed by some lesion inflammatory or traumatic), (b) Anemia
(loss of blodd – pale conjunctiva), (c) Follicles (sand particles like eruptions, localized aggregation of lymphocytes in the subepithelial adenoid layer of the
conjunctiva), (d) Papillae (hypertrophic folded epithelium with core of blood vessels by which conjunctiva appears velvety), (e) Cicatrical changes (contraction
of the tissue due to scar tissue formation), (f) Subconjunctival hemorrhage, (g) hemorrhagic lesions, (h) Congestion, (i) Discharge, (j) Adhesions etc.
2. Bulbar conjunctiva  (a) Hyperemia (redness), (b) Chemosis (swelling of the conjunctiva), (c) Anemia, (d) Foreign bodies, (e) Subconjunctival hemorrhage
(Arjuna), (f) Congestion, (g) Discharge (watery /mucoid /mucopurulent /purulent), (h) Follicles, (i) Papillae, (j) True membrane or false membrane formation,
(k) Triangular conjunctival layer formation towards cornea due to degenerative changes is known as pterygium (Arma), (l) A small raised yellowish white
nodule occurring iin bulbar conjunctiva in horizontal meridian a little distance away from limbus accurs due to allergy and degenerative changes is known as
pinguecula (Pistaka, Balasa grathita).

(x) Examination of Lacrimal apparatus 

1. Lacrimal sac area (just below the inner canthus) should be examined for any swelling or fistula that may be due to dacryocystitis.
2. By pressing over the sac area if pus regurgitates through punctum it is of dacryocystitis.
3. In acute dacryocystitis sometimes Lacrimal fistula also seen at the same site.
4. Watering of eyes if occurs due to obstruction in lacrimal apparatus is known as epiphora (Netra srava).

(x) Examination of Cornea 

1. Examination of minute cornea ulcers, scratches, foreign bodies etc. should be examined in bright room with magnifying corneal loupe if they are not
visualized by corneal loupe, by the following methods those should be detected 
(a) 2% Fluorescein drops should be put in eye, normal corneal epithelium cannot respond to the above medicine but the injured epithelium (2nd layer
exposure happens) responds and become green colour, like this the smallest scratches, ulcers, penetrating type of foreign bodies are detected.
(b) An instrument known as placidos disc is used to detect the scratches or smallest, invisible injuries of cornea those derange the surface of cornea.
(c) In anterior synechia, anterior staphyloma, iris prolapse etc. diseases due to contact of iris with cornea, there are chances for vascularization of cornea.
(d) The colour and depth of corneal opacity should be estimated. Nebula – slight discolouration with involvement of superficial epithelium of cornea, Macula –
brown discolouration with moderate thickness of the corneal opacity, Leucoma – white corneal opacity with maximum thickness.

Rabin Singh
 Shalakya tantra- 1 ϲϱ

(xi) Examination of Sclera and Episclera 

Inflammation of sclera is known as scleritis. Inflammation of episclera is known as episcleritis. Thinning of sclera at limbal area may cause staphyloma
through which iris protrudes out. Sclera should be checked out for foreign bodies, congestion, edema and pigmentory changes.

(xii) Examination of pupil 

Pupil constricts in bright illumination and dilates in the dim illumination. It is normally circular but seen irregular in uveal tract lesions and synechia.

(xiii) Examination of lens 

In transillumination test – (a) When the lens is transparent nothing can be seen behind the pupil except a black shade. (b) When lens becomes opaque,
brown or white colour opacities are seen behind the pupil. (c) In Senile Lental Sclerosis also lens appears brown or white in transillumination test.
The different types of cataract can be easily diagnosed by ophthalmoscopy.

(xiv) Estimation of intra ocular pressure 

(a) Digital Tonography  by palpation of the eyes with fingers. Patient is asked to look down then the sclera is palpated through the upper lid beyond the
tarsal plate. The tension is judged by the amount of fluctuation obtained.
(b) By Schiotz tonometer  intraocular pressure is recorded with the help of tonometer. The normal intraocular pressure is 18 to 25 mmHg. If it increases, a
disease is caused, known as Glaucoma.

Ophthalmoscopy  Ophthalmoscope is used for the examination of posterior segment of the eyeball. Ophthalmoscopy is highly important diagnostic
procedure not only in the diseases of eye but also in the many diseases of visceral organs (systemic lesions).

 FUNCTIONAL EXAMINATION
Visual acuity commonly refers to clarity of vision. Visual acuity depends on optical and neural factors, i.e., (i) the sharpness of the retinal focus within the eye,
(ii) the health and functioning of the retina, and (iii) the sensitivity of the interpretative faculty of the brain.
Distant vision is recorded with Snellen s chart, and Near vision is recorded with Jaeger s test types, Snellen s test types, printer s type of N series.

Rabin Singh
 Shalakya tantra- 1 ϲϲ

Snellen s chart  It is used to measure visual acuity, commonly used for testing distant vision.
The Snellen s chart is placed 6 m or 20 ft distance from the patient, the patient is asked to sit on a stool facing the chart from
6 m distance and asked to read the prints of the chart by closing one eye. The chart contains different sized prints in 7 or 8
lines, from bigger size to smaller, from top to downwards.
The each line is marked with some specific number, they are (from top to bottom) 60, 36, 24, 18, 12, 9, 6, 5.
If the patient is able to read upto 6 number row, his vision is 6/6 – normal.
If the patient is able to read only 1st line his vision is 6/60
If the patient is able to read upto 2nd line his vision is 6/36
If the patient is able to read upto 3rd line his vision is 6/24
If the patient is able to read upto 4th line his vision is 6/18
If the patient is able to read upto 5th line his vision is 6/12
If the patient is able to read upto 6th line his vision is 6/9
If the patient is able to read upto 7th line his vision is 6/6 (normal)
If the patient is able to read upto 8th line his vision is 6/5 (best vision)

Rabin Singh
 Shalakya tantra- 1 ϲϳ

नत्रर थ्र्ा थ्र्  ( .हृ.उ.16/61-65)

थ्र्  (Do s) थ्र्  (Don ts)
र्ा ा क्षन र् स्र्स् sक्ष नर्नक्षप्रर्ः रा र्र् िम ाक्ष क्षि र्द्र्ान र्ज्र्ेि िंर िम ाार्धर् नाक्षन
मद्गा न क्ष त्तघ्नान िरर र् ःा ररप् ान ा िं र्क्षर्ििं मािं िं ािं िं ाक्ष मिं क्ष ाम िि क्र र्ास्र्प्नराक्षत्र ा र ा ान
धिर् क्षत्र ािं र्द्ाक्षािं र्ारर ान नाि म त्रिं त्रा िं क्षर्क्षिर्द्द िनम क्षर् ाक्ष क्षर्िमि रिं र्च्च ा ारि म

नत्र क्रिर्ा ल् 
Acc. to र  3  क्ष ा – श्च्र् न – िं न
Acc. to श्र  5  – श्च्र् न – िं न – ा – ा
Acc. to ारिं िर  7  – श्च्र् न – क्ष ण् – क्ष ा – िं न – ा – ा

 Medicine is poured on closed eyes continuously, from 4-angula height, for a specific time according to dosha.
S.N. Types Dosha-predominance Duration / time Nature of medicine
1 स्न न र्ा प्रिान प्र 400 मात्रा ा / रानन ष् – क्षस्नग्ि – मिर म र् र्द्व्य
2 र क्ष त्त & रक्त प्रिान प्र 600 मात्रा ा / मर्धर्ानन – मिर क्ष क्त ार् र्द्व्य
3 न प्रिान प्र 300 or 200 मात्रा ा / र्ाानन ष् – क्ष क्त ार् र्द्र्

श्च्र् न  the medicated drops are put into eyes from 2-angula height. The medicine has to be kept in the eyes for 100 matra-kala, afterwards eyes should
be cleaned with lukewarm water, advised not to see the bright things.

S.N. Types Dosha-predominance Dosage of medicine Nature of medicine

1 स्न न र्ा प्रिान प्र 10 drops ष् – क्षस्नग्ि – मिर म र् र्द्व्य
2 र क्ष त्त & रक्त प्रिान प्र 12 drops – मिर क्ष क्त ार् र्द्व्य
3 न प्रिान प्र 7 to 8 drops ष् – क्ष क्त ार् र्द्र्

क्ष ण्  Medicated paste is kept in a fresh thin cloth and applied on the eyes for a specific time.
In र्ा नत्रर  क्षस्नग्ि उष् र्द्व्य प्रर्
In क्ष त्त नत्रर  र्द्व्य प्रर्
In नत्रर  क्ष उष् र्द्व्य प्रर्

Rabin Singh
 Shalakya tantra- 1 ϲϴ

क्ष ा  External application of the medicated paste only to the eyelids (except eyelashes).
In र्ा नत्रर  क्षस्नग्ि उष् र्द्व्य प्रर्
In क्ष त्त नत्रर  र्द्व्य प्रर्
In नत्रर  क्ष उष् र्द्व्य प्रर्

िं न 
Application of medicine to the internal surface of lid margin from kaneenika-sandhi to apanga-sandhi, with the help of anjana-shalaka.
On the basis of action:
S.N. Types Dosha-predominance Nature of medicine Examples
1 म िं न स्न न र्ा प्रिान प्र मिर म क्षस्नग्ि र्द्व्य – – र् ा – मज्जा processed with ा ल्र्ाक्र र्न र् र्द्व्य –
or प्र ा न for क्षिप्र ा न (soothing) र्क्षिमि – ररर्द्ा – र ी – र् ा – ाक्ष म – क्ष ग्र – मिंक्ष ष्ठा.
र क्ष त्त & रक्त प्रिान प्र क्ष क्त ार् क्षस्नग्ि र्द्व्य – क्षत्र ा – िं र्ल् – क्षनम – ररर्द्ा – ध न – ार – र्क्षिमि

2 क्ष् िं न न प्रिान प्र र् क्ष् र्द्र् क्ष प् – मरर – ण् – क्षत्र ा – धिर् र् – मि – मर्द् न –
ा – रर – िस्म – ाम्र िस्म – िं िस्म – प्रर्ा िस्म

On the basis of formulations:

S.N. Types Sub-types Examples
1 र ा (for म ा र ) न / र / प्र ा न ञ्जन with र् ी prepared of क्षत्र ा + र्त + ा + धिर् र् used in क्षमग्रक्षध
र ा मर्द् नाक्र र् ी ( मर्द् न + िं + क् ाण् र्तर् +क्ष ग्र ) used in ि
नक्ताधर्धर्ना र् ी (र ािं न + ररर्द्ा + ा ररर्द्ा + ा त्र +क्षनम त्र)
2 र क्रिर्ा (for मर्धर्म र ) न / र / प्र ा न र क्रिर्ा ञ्जन with क्षत्र ा or ा ष् or ामा ा prepared in ाम्र ात्र in प्रक्षक् न्नर्र्तमा
र क्रिर्ा ष् ाक्र र क्रिर्ा ( ष् ाक्ष +र ािं न +क्ष ा + िं + मर्द् न + ैंिर् + रर + मनःक्ष ा +मरर +मि) in मा
र क्रिर्ा ञ्जन with ष् ा र् ा + िं + क्षनमा useful in धर्धर्
3 ा (for ल् र ) न/र / प्र ा न ा ाां न with मर्द् न + ैंिर् + िं िस्म + मद्ग + श्व मरर used in क्षक् न्नर्र्तमा
ाां न with क्ष र + क्ष प् + मरर + ैंिर् used in व्र क्

Rabin Singh
 Shalakya tantra- 1 ϲϵ

क्षनर्तर् िं नप्रर्  Netra is a Tejo-dhatu pradhana organ and it is the seat of Alochaka pitta. Because of the opposite quality Kapha-sanchaya leads to
various Netra-rogas. Hence for keeping the eyes healthy, daily application of prasadana anjana / Sauveeranjana is beneficial. Alternatively Rasanjana can
be used once a week or after 5 to 8 days for Kapha-sravana  र् रािं निं क्षनर्तर्िं क्ष मक्ष् ः प्रर् र्
िं रात्रsिरात्र र्ा स्रार् ा ां र ािं नम (र् .र)

Anjana should be applied after purification of body by shodhana (vamana-virechana-nasya-siravyadha etc.)

The eyes should be free from Ama, then only after Ashchyotana Anjana should be applied.

िं न क्षन ि (Contraindications)  श्रम –र् ार्र ि –उ ार् ा –र न –म ान –ि ि –िर् –ज्र्र –क्ष रस्नान –नत्रा ा – र्न –क्ष ा ा – र् ा – ा र –नस्र् –र न –िम ान etc.

क्षक्ष ा 
Placing of medicated oil / ghee over the eyes in a bridge made around the eyes, for a specific time. It gives nourishment to the eyes and cure vata pitta
vikaras.

ा र्क्षि ( ि-िार ा ):
र्ा नत्रर  1000 मात्रा ा नत्रर  600 मात्रा ा र्र्तमा नत्रर  100 मात्रा ा क् नत्रर  500 मात्रा ा क्षि नत्रर  800 मात्रा ा
क्ष त्त नत्रर  800 मात्रा ा स्र्स्  500 मात्रा ा क्षधि नत्रर  300 मात्रा ा ष् नत्रर  700 मात्रा ा र्ा नत्रर  1000 मात्रा ा

Indications of tarpana: ामर् ा – स् ब्ि ा – ष् ा – क्ष ा – क्षि ा – र्ा क्ष त्त क्षर् ार – र न र्र्तमा – च्र धम न – क्ष र र्त ा – क्ष रा ा– ान – क्षिष्र्ध – क्षिमध etc.
Contraindications of tarpana: र् न
ा – क्ष उष् क्ष ऋ – क्ष ध ा – र् – भ्रम – – र् ना – – रा – उ र्द्र् etc.

ा 
Here, instead of medicated oil / ghee, juices of mamsa, matsya and different herbs extracted by puta-paka vidhi are used.

ा ा :
स्न न ा (for र्ा नत्रर )  200 मात्रा ा र ा (for क्ष त्त -रक्त नत्रर )  300 मात्रा ा न ा (for नत्रर )  100 मात्रा ा

Rabin Singh
 Shalakya tantra- 1 ϳϬ

न ार्धर् नत्रर  11  5 types of मा – क्ष रा ा – क्ष राक्ष क्ष ा – र्ा – र्र्तमा ा – ष् ा – र्र्तमा ा
र्ा मा प्रिान मा श्चा मा
• Snehapana – Vamana – Virechana • If eyelid is hard, Lekhana is done with shastra. • After coagulation of bleeding or exudations,
• Eyelid should be everted for mridu • If eyelid is soft, Lekhana is done with rough leaves like Mridu-sveda and Pratisarana. After 5 to 10 min
sveda with a soft cloth by dipping in Gojihva or Shephalika. eye should be cleaned with lukewarm water.
lukewarm water. • Lekhana procedures commonly associate with • Ghrita seka and Bandhana.
• Everted eyelid should be firmly pracchana, chhedana, bhedana etc.
gripped to conduct Lekhana karma In Utsangini, Kumbhika, Vartmasharkara  Chhedana –
successfully. Lekhana (in pakwa granthi Bhedana)
In Vartmabandha, Klishtavartma, Bahalavartma, Pothaki 
Prachhana – Lekhana
In Syavavartma, Kardamavartma  Superficial Lekhana

ि न ार्धर् नत्रर  5  िं ननाक्षम ा – – क्ष र्र्तमा – क्षमग्रध – िष्म ना

र्ा मा प्रिान मा श्चा मा
• Snehana – Swedana – Sharira • Bhedana (incision) with Vreehi-mukha shastra to • Pratisarana and Bandhana.
shodhana evacuate the pus. • Pratisarana with 
• Preparation of the patient • In painless bigger shleshmopanaha, Lekhana is done In Anjananamika – Manahshila, Ela, Tagara,
before Bhedana. Sindhava lavana, Madhu
• In bleeding type of upanaha, Pracchana is done before In Lagana – Gororchana, Yavakshara, Tuttha,
Bhedana. Pippali, and Madhu
In Bisavartma – Saindhava, Kasisa, Pippali,
Pushpanjana, Manahshila, Ela, Mdhu or Ghrita
In Krimi-granthi – Manahshila, Ela, Tagara,
Sindhava, Madhu
In Shleshmopanaha – Pippali, Saindhava, Madhu

Rabin Singh
 Shalakya tantra- 1 ϳϭ

न ार्धर् नत्रर  9  उर्त िंक्ष न – मि ा – ी – र्र्तमा ा रा – र्र्तमा – र्र्तमा धि – क्षक् िर्र्तमा – म

ा र्र्तमा – श्र्ार्र्र्तमा
र्ा मा प्रिान मा श्चा मा
• Snehana – Swedana – Sharira Chhedana karma (Excision therapy) of Arma  • Pratisarana with Yavakshara, Shunthi,
shodhana – Shiro shodhana – • Mridu sveda at the lesion. Pippali, Maricha, Lavana etc.
Lavana pratisarana • Separation of arma from the floor with badisha (hooks) and • Mridu sveda – Ghita seka – Bandhana.
• Preparation of the patient thread.
• Elevation of arma with muchundi (forceps).
• Arma is separated and cut at the Krishna mandala, then the
flap is lifted towards Kaneenika sandhi and 3/4th part of arma
is cut with mandalagra shastr by leaving the 1/4th part as
residue to prevent the complications like Nadivrana,
Raktasrava and Drishtinasha.
• The residual part of arma should be scraped out by the
application of Lekhana anjana.

व्यिन ार्धर् नत्रर  15  र्ा – क्ष र र्त ा – क्ष रा ा– क्षक्ष ा – क्षक्ष ा – 4 types of क्षिष्र्ध (र्ा -क्ष त्त - -रक्त ) – 4 types of
क्षिमध (र्ा -क्ष त्त - -रक्त ) – धर् र्ा – क्षन र्ाार्
ल िं ना स्त्र क्ष क्र र्त ा (व्यिन मा) 
र्ा मा प्रिान मा श्चा मा
• Snehana – Swedana – Sharira • The instrument used for Vyadhana is called as Yava vakra • Stanya parisheka
shodhana shalaka and the puncturing area is called as Daiva krita • Kapha-vatahara mridu sveda
• Preparation of the patient chhidra where the blood vessels are absent. Proper • After gentle pressure on eyeball with
puncturing is with specific sound and water bubbles come out.
• Indications of Kaphaja Linganasha blunt end of shalaka to expel the kapha
After puncturing, gentle pressure with blunt end of shalaka
shastra chikitsa  dosha, blowing out the nose by closing
expel the kapha dosha.
 Completely formed or pakwa the opposite nostril (ucchingham) to expel
• Signs of adequate vyadhana karma  (i) no pain, (ii) some
drishti (mature cataract) out the residual kapha.
specific sound comes during puncturing, (iii) water bubble like
 Hard (not semisolid)
dosha comes out through punctured area, (iv) drishti prapti

Rabin Singh
 Shalakya tantra- 1 ϳϮ

Classification of Netraroga according to doshas 

र्ा क्ष त्त रक्त क्षन्न ा ाह्य Total
10 10 13 16 25 2 76

र्ा नत्रर  10
ार्धर् 5 र्ा क्षिष्र्ध – र्ा क्षिमध – ष् ाक्षक्ष ा – धर् र्ा – क्षन र्ाार् (5 र्ा )
र्ाप्र् 1 र्ा ा (1 क्षि )
ार्धर् 4 मि रर ा (1 क्षि ) – ाक्षिमध (1 र्ा ) – क्षनम – र्ा र्र्तमा (2 र्र्तमा )

क्ष त्त नत्रर  10

ार्धर् 6 क्ष त्त क्षिष्र्ध – क्ष त्त क्षिमध – म ार्धर्क्ष (3 र्ा ) – क्षक्त ा (1 क् ) – िम ी – क्ष त्तक्षर् ग्ि क्षि (2 क्षि )
र्ाप्र् 2 ररम ाक्षर् ा – न ा (2 क्षि )
ार्धर् 2 क्ष त्त स्रार् (1 क्षधि ) – ह्रस्र् ाड्य (1 र्ा )

नत्रर  13
ार्धर् 11 उ ना – क्षमग्रक्षध (2 क्षधि ) – क्षक् न्नर्र्तमा – – ी (3 र्र्तमा ) – क् ामा – क्ष ि – ा ग्रक्ष (3 क् )– क्षिष्र्ध – क्षिमध
(2 र्ा ) – िष्मक्षर् ग्ि क्षि (1 क्षि )
र्ाप्र् 1 ा (1 क्षि )
ार्धर् 1 नत्रस्रार् (1 क्षधि )
रक्त नत्रर  16
ार्धर् 11 र्ा (1 क्षधि ) – क्षक् िर्र्तमा – िं ननाक्षम ा (2 र्र्तमा ) – क्ष रा ा – ान – क्ष मा (3 क् )– र् ा ि (1 ष् ) – रक्त क्षिष्र्ध – रक्त
क्षिमध – क्ष र र्त ा – क्ष रा ा (4 र्ा )
र्ाप्र् 1 रक्त ा (1 क्षि )
ार्धर् 4 रक्त स्रार् (1 क्षधि ) – क्ष ा ा (1 र्र्तमा )– ा ा – व्र ि (2 ष् )

क्षन्न ा नत्रर  25
ार्धर् 19 उर्त िंक्ष न – मि ा – र्र्तमा ा रा – ोर्र्तमा – ष् ा ा – र्र्तमा ा – क्षक् न्न र्र्तमा – र्र्तमाार् िंि – र्र्तमा – श्र्ार्र्र्तमा – क्ष र्र्तमा – र्र्तमा म
ा (12 र्र्तमा )–
क्षक्ष ा – क्षक्ष ा (2 र्ा ) – र्ा ( क्षधि ) – प्रस् ारर मा – क्षिमािं मा – स्नार् मा – क्ष राक्ष र ा (4 क् )
र्ाप्र् 2 क्ष्म (1 र्र्तमा ) – र्ा ा (1 क्षि )
ार्धर् 4 र्स्रार् – (2 क्षधि )–न ाधर्धर् (1 क्षि ) – क्षक्ष ा ार्तर्र् (1 ष् )

Rabin Singh