Abhishyanda is the compared with Conjunctivitis in modern science. It's explanation along with treatment is dealt here.

1. WELCOME

2. ABHISHYANDA
VIS-À-VIS
CONJUNCTIVITIS
Dr. Anuj Kumar Singh
Guide- Dr. Veena Shekar
Dept. of Shalakya Tantra

3. Contents
• Introduction
• Nirukthi of abhishyanda
• Nidana
• Samprapthi
• Purvarupa
• Rupa
• Chikitsa
• Modern corelation
• Etiology
• Types
• Signs and symptoms
• Diagnosis
• Treatment
• Discussion
• Conclusion

4. INTRODUCTION
Abhishyanda is one of the sarvagata netra rogas mentioned in
Ayurvedic classics which involves all parts of the eye characterized by
excessive discharge. It is the root cause for all the Netra rogas.
Abhishyanda if not treated properly, may lead to Adhimantha which is
associated with severe pain and sight threatening complications.
Therefore acharya Susruta has emphasized early treatment of
Abhishyanda.
Clinical features of abhishyanda vary depending upon the type of the
dosha involved. It is a Vyadhana sadhya vyadhi and management
includes Raktamokshana, virechana and sekadi kriyakalpas

5. Abhishyanda is compared with Conjunctivitis which is the inflammation
of conjunctiva characterized by conjunctival hyperemia and discharge.
Conjunctivitis is commonly encountered condition in ophthalmology
clinics. It is usually of infective or allergic origin. It may lead to
complications like Keratitis, Marginal corneal ulcer, Dacryocystitis,
sometimes uveitis if the causative organism is highly virulent.
Management of conjunctivitis includes topical treatment consisting of
anti infective (antibiotic, antiviral) and anti allergic drugs.
Systemic treatment is required in severe infective and allergic
inflammatory conditions.

6. निरुक्ति
अभि- Profuse
स्यन्द- स्यन्दिाि् स्रावणाि्I (अ.स.उ. 19/41)
Excessive flow
सवव ऊर्धववजत्रूगि स्रोि स्यन्दिाि्स्यन्द उच्यिे I (अ.स.उ. 19/41)
To ooze or trickle from the channels of urdhwajatru.
अभिष्यन्द- अभिसमन्िाि् स्यन्दनि अश्रुदलानि च्यावयनि I
Abhishyanda is characterized by discharges from all the sides of the eye

7. Why ABHISHYANDA is Significant
Abhishyanda is considered as a causative factor for all the eye diseases
which indicates importance of abhishyanda which must be controlled
in its पूर्वरुप अर्स्था otherwise leads to severe eye diseases.
 प्रायेण सवे ियिामयस्िु िवन््याभिष्यन्द निभमत्त मूला
िस्माि् अभिष्यन्दमुदीयवमाणं उपाचरेदाशु हििाय धीमाि् (सु.उ. ६/५)
 वृर्धदैरेिैरभिष्यन्दैिवराणामक्रियाविाम्
िावन्िस््वधधमन्थस्युिवयिे िीव्रवेदिा: (सु.उ.६-१६)
Abhishyanda if not treated leads to Adhimantha with acute pain.

8. • Many ophthalmic diseases are caused due to abhishyanda which
itself is precipitated due to vitiated rakta. Hence it is needed to
treat the patient immediately to prevent further aggravation of
the disease.
• All the seventy six diseases of the eye can be produced by
untreated Abhisyanda, as it settles in Kapha āsraya of the eye.
 सवेऽक्षिरोगा प्रायेण जायन्िे स्यन्दपूववका
यिश्च रतिं संदूष्य िाििस््वरया जयेि् (अ.स​.उ. १९/५९)
षट्सप्िनिलोचिजा ववकारास्िेषामभिष्यन्द समुद्िवािां
श्लेष्माश्रय्वाहदनि (यो.र. िेत्र)

9. निदाि
प्रसंगाद् गात्रसंस्पशावक्न्िश्वासाि् सििोजिाि्
सिशय्यासिाच्चावप वस्त्रमाल्यािुलेपिाि्
……..िेत्राभिष्यन्द एव च
औपसधगवकरोगाश्च संिामक्न्ि िरान्िरम् सु.नि. ५-३३,३४
Repeated Physical contact, expired air, sharing bed, eating
together,sharing clothes, garlands etc.

10. ववशेष​ निदाि​ of िेत्राभिष्यन्द
• आिारज वविारज आगन्िुज
 शुक्त
 आरनाल
 अम्ल
 क
ु लत्थ
 माष
 उष्ण जल
शशर स्नान​
 स्र्प्नवर्पर्वर्
 अततमैथुन
 सशलल क्रीडा
 ऋतु वर्पर्वर्
 प्रसक्तसंरोदन
 कोप
 शोक
 क्लेश
 अशिघात
 तीक्ष्णाञ्जन
 कीटदंश
 ज्र्राशिताप
 रजोधूम
तनषेर्णात्

11. सामान्य​ िेत्र रोग सम्प्प्राक्प्ि
भसरािुसाररभिदोषैवववगुणैरूर्धववमागिै
जायन्िे िेत्रिागेषु रोगा परमदारुणा (सु.उ. 1 / 20-21)
The vitiated dosas, will course through the vessels and reach
upwards, to produce diseases in different parts of the eye.

12. अभिष्यन्द सम्प्प्राक्प्ि
अचक्षुष्र् & रक्त-वपत्त प्रकोपक​ आहार, वर्हार
वपत्त प्रधान दोष​प्रकोप & अग्ननमाद्र्
Vitiated दोष’s reach ऊर्धर्वजत्रु through शसरा s
नेत्रर्ह​ स्रोतो स्र्दद &
दोषाश्रर् in कफ प्रधान स्थान in चक्षु
अधधमदथ​
सञ्चय
प्रकोप
प्रसर
स्थािसंश्र
य
व्यति
िेद​
ऊर्धर्वजत्रु स्रोतो स्र्दद
अभिष्यन्द(राग,स्राव,िोद etc.)
रति
& स्थानिक
दोष दुक्ष्ि
निज आगन्िुज निदाि

13. Types of Abhishyanda
अभिष्यन्द
तनज
र्ातज
वपत्तज
कफज
रक्तज​
आगदतुज​​

14. अभिष्यन्द पूववरूप
 ित्राववलं ससंरम्प्िं अश्रु कण्डूपदेिवि्
गुरुषा िोदरागाद्दै जुष्िं चाव्यति लिणै (S.U 1/21)
Eye seems to be filled with tears, mild swelling, Itching sensation,
Increase of excretory discharges, redness, heaviness, burning
sensation and pain in the eye.
 स शूलं व्मवकोषेषु शूकपूणावभिमेव च (सु.उ. १/२२)
Slight pain in the lids, Foreign body sensation.
 Based on दोष predominance-
 If र्ात प्रधान – तोदाददशििः (Pain in eyes)
 If वपत्त प्रधान- उषाददशििः (Burning sensation in eyes)
 If कफ प्रधान-गुरुत्र्ाददशििः (Heaviness of eyes)
 If रक्त प्रधान - रागाददशि: (Redness of eyes) (डल्हण,सु.उ१/२१)

15. आम -निराम लिण in िेत्र​
 आम लिण-
उदीणव वेदिं िेत्र राग शोफ समक्न्विम्I
घषव निस्िोद शूलाश्रुयुतिमामाक्न्विं ववदु II (यो.र./िे.रो.२२)
 निराम लिण-
मन्दवेदििा कण्डू संरम्प्िाश्रुप्रशान्ििा I
प्रसन्िवणविा चाक्ष्णो निरामस्य च लिणम्II (यो.र./िे.रो २३)

16. अभिष्यन्द​ लिण
 निस्िोदिस्िम्प्िि रोमिषवसंघषवपारुष्य भशरोभििापा
ववशुष्किाव भशभशराश्रुिा च वािाभिपन्िे ियिे िवनि (सु.उ.६/६)
According to Vagbhata (A.S.U. 18/1)
Added symptoms are-
• नासानाहोऽल्पशोफता
• शङ्खाक्षक्षभ्रूललाटस्र् तोदस्फ
ु रण िेदनम्
• शीतमच्छं चाश्रु (Clear cold discharge)
• ग्स्ननधोष्णैश्चोपशमनं (Relief with oily, hot measures)
वािज अभिष्यन्द

17. वपत्त ज अभिष्यन्द​
 दाि प्रपाको भशभशराभििन्दा धूमायिं बाष्प समुच्रयाश्च I
उष्णिा पीिकिेत्रिा च वपत्त ाभिपन्िे ियिे िवक्न्ि (सु.उ. ६/७)
According to Vagbhata (A.S.U.18/7)-
Added symptoms are-
• शोफिः श्र्ार्ता र्त्मवतोर्वदहिः (Eye lids become
swollen and blackish externally)
• अदतिःक्लेद (Mucopurulent discharge )
• रागिः
• क्षारोक्षक्षत क्षत अक्षक्षत्र्ं (Feeling of alkali burnt wound in eye)

18. कफज अभिष्यन्द​
उष्णाभििन्दा गुरुिाऽक्षिशोफ कण्डूपदेिौभसििाऽनि शै्यम्
स्िावो मुिु वपक्च्िल एव चावप कफाभिपत्रे ियिे िवक्न्ि (सु.उ. 6/8)
According to Vagbhata (A.S.U. 18/10)
Added symptoms are-
• जाड्र्ं (Feeling of illness)
• तनद्रा (Excessive sleep)
• अनदनाशिनददनं (Loss of
appetite)
• सादद्रग्स्ननध र्हुश्र्ेत
वपच्छार् दूवषकाश्रुता
( Copious, white, dense, unctuous,

19. रतिज अभिष्यन्द
 िाम्राश्रुिा लोहिििेत्रिा च राज्य समन्िाि् अनि लोहििाश्च I वपत्त स्य
भलङ्गानि च यानि िानि रतिाभिपन्िे ियिे िवक्न्ि (सु.उ. 6/9)
 According to Vagbhata (A.H.U. 18/12)
Added symptoms are-
• रक्ताश्रुराजी दूवषका (Tears, blood vessels, exudates become red).
• रक्तमण्डलदशवनम ् (Objects appear reddish).
.

20. अभिष्यन्द धचक्रक्सा
• प्राग्रूप एव स्यन्देषु िीक्ष्णं गण्डूष िाविम्
कारयेदुपवासं च कोपादन्यत्र वािजाि् (अ.हृ.उ. 16/1)
Management during purvarupa avastha by-
• Tikshna gandusha (Except Vata roga)
• Tikshna navana (Except Vata roga)
• Upawasa (Except Vata roga)
• लङ्घि आलेपि स्वेद भसराव्यध ववरेचिै I
उपाचरेि् अभिष्यन्दािञ्जि आश्च्योििाहदभि II (चिदत्त िे.रो.५९/१)

21. अभिष्यन्द धचक्रक्सा in आम अवस्था
 अक्षि क
ु क्षििवा रोगा प्रनिश्याय व्रण ज्वरा:I
पञ्चैिे पञ्चरात्रेण प्रशमं याक्न्ि लंघिाि् II(च.द./ िे. रो. 3)
Langhana for five days is told in these disorders to reduce Ama from
the body.
 स्वेद प्रलेप नितिकान्ि सेको हदिचिुष्ियम्
लङ्घिञ्चाक्षिरोगाणामामािां पाचिानि षट्
अञ्जिं पूरणं तवाथपािमामे ि शस्यिे I (च​.द​./ िे.रो.४)
• स्र्ेद, प्रलेप, ततक्तकादन, सेक and period of four days act as आम
पाचन in अक्षक्ष रोग​’s
• अञ्जनं, पूरणं, क्र्ाथपान are to be avoided during आम अर्स्था

22. िवाभिष्यन्द धचक्रक्सा
(च​.द.५९)
 िेत्र पूरण
• With आमलकी स्र्रस followed by सेक
with शशग्रु पत्र स्र्रस
 आश्च्योिि-
• दार्ी क्र्ाथ​, रसाञ्जन mixed with स्तदर् to subside दाह, र्ेदना,
अश्रुस्रार्​
 बबडालक-
• शार्रक लोध्र or हररतकी fried with घृत is applied
• गैररक चददन शुण्ठी खदटका -र्चा

23. • आश्च्र्ोतन with त्रत्रफला. (शा.उ. १३/१९)
• शशग्रुपल्लर्रस mixed with honey. (अ.ह्र.उ.१६/९)
• आश्च्र्ोतन with दारुहररद्रा boiled in water and reduced to 1/8th
and added with honey. (A.S.19/10)
 सेक
• ​शशग्रु पत्र स्र्रस (ग​.तन./ने.रो.१४१)
• दार्ी क्र्ाथ added with मधु (ग​.तन./ने.रो. १६३)
सामान्य​ अभिष्यन्द धचक्रक्सा
 आश्च्योिि

24. अञ्जि –
हररद्र, मधुक
ं , पथ्र्ा and देर्दारु processed in अज क्षीर​ (Su.U.9/14)
 बबडालक
चददनं, मधुक
ं , लोध्रं, जातीपुष्प and गैररक त्रर्डालक reduces दाह &
तोद​. (र्ो.र./ने.रो.)
 तवाथ- आमलकी(12), वर्शितकी (6), हररतकी (3 ) are used to make
क्र्ाथ and given for पान​. (ग​.तन.ने.रो १६१)

25. वािज
वपत्त ज​
कफज​
पुराण
घृिपाि
शक
व राक्न्वि
घृिपाि
व्योष भसद्ध
िारावचूर्णवि
घृिपाि
रतिमोिण क्स्िग्धं
ववरेचयेि ्
सामान्य दोषज धचक्रक्सा in अभिष्यन्द
(अ.ह्र.उ.१६/१८)

26. ववभशष्ि अभिष्यन्द धचक्रक्सा
 वािज अभिष्यन्द
 स्िेिपाि- With पुराण घृत
-उत्तर िग्क्तक​ घृतपान of त्रत्रफला क्र्ाथ शस्ध घृत (सु.उ. 9/3-4)
भसरामोि
शसरामोक्षेणेत्र्त्र शसरा औपनाशसक्र्ा लालाट्र्ा र्ा आपांनर्ा र्ा I (ड. -
सु.उ. ९-३)
Indicated to subside pain.
बक्स्ि- स्नेह र्ग्स्त in धातु क्षर्​
-तनरुह र्ग्स्त in मलार्ृत्त र्ात (ड.- सु.उ. ९/३)
-
 पुिपाक- स्नैदहक पुटपाक​ eg. withअज मांसरस (सु.उ.९/१०)

27.  धूमपाि -स्नैदहक
ं धूम ।
 आश्च्योिि -एरण्ड पत्र,मूल and त्र्क् processed in अज क्षीर​ (सु.उ.9/11)
-आनूपमांस क्र्ाथ with sour drugs. (अ.स​.उ.१९/२०)
- कोष्ण क्र्ाथ​ of त्रर्ल्र्ाददपञ्चमूल, र्ृहती, एरण्ड, शशग्रु
(शा.उ.१३/१७)
Cloth dipped in चतुिःस्नेह​ should be kept over eyes. (S.U.9/5)
-

28. -सेक​-
• एरण्ड त्र्क्, पत्र and मूल processed in अज क्षीर in
सुखोष्ण form. (शा.उ.१३/५)
• पररषेक with पर्िः and सैदधर्म्can be done
हररद्रा, दारुहररद्रा शस्ध क्षीर​ added with
सैदधर् (शा.उ.१३/७)
 स्िेिि िस्य- Taila processed with Shalaparni,
ksheera and madhura gana dravyas (सु.उ.9/10)

29.  अञ्जि
-स्नेहाञ्जन with सवपव kept in copper vessel and
added with सैदधर् (Dalhana,S.U.9/16)
-Equal parts of र्ृहती, एरण्डमूलत्र्क्, शशग्रुमूल, सैदधर्
are macerated with अज पर्​ and र्ततवs are prepared.
(A.S.U.19/69)
वपक्ण्डक -ग्स्ननधोष्णा वपग्ण्डक made out of एरण्ड
त्र्क्, पत्र and मूल (शा.उ.१३/२५)
आिार-
ग्राम्र्, आनूप, औदक मांसरस,
ग्स्ननध फलरस ,क्षीर (सु.उ.9/7)

30. वपत्त ज अभिष्यन्द धचक्रक्सा
 स्िेिि- शक
व र mixed घृत पान । (अ.सं.उ. १६/१८)
 रतिमोिण- Snehana is followed by raktamokshana by
siravedha (अ.सं.उ. १९/५८)
 - After स्नेहन, क्र्ाथपान of त्रत्रफला, काश्मर्व, शक
व रा with
त्रत्रर्ृत्चूणव​ for वर्रेचन. (अ.सं.उ. १९/५९)
 सेक-Water processed with चददन, तनम्र्पत्र, मधुक,
दारुहररद्रा and added with सैदधर् and मधु​ I(र्ो.र​.ने.रो.)

31. *िस्य-
-With साररर्, काश्मरी, शक
व र in इक्षुरस I (अ.सं.उ. १९/२६)
-नस्र् with क्षीर सवपव (ghee made out of milk)
(सु.उ.१०/६)
*अञ्जि-रसक्रक्रर्ा made out of श्र्ाम त्रत्रर्ृत् and मधुक
added with शक
व र& मधु
-रसक्रक्रर्ा made out of पलाश or शल्लकी
added with शक
व र& मधु (Su.U.10/7)
आश्च्योिि- Kwatha of मधुक and दारुहररद्रा added with sharkara.
(A.S.U19/30)
-मधुक, लोध्र with घृत​ for आश्च्र्ोतन (Su.U 10/12)

32. कफज अभिष्यन्द धचक्रक्सा
 अपिपवण – For 3 days followed by intake of ततक्त घृत​
 स्िेिपाि​ followed by रतिमोिण (ड.)
 स्वेदि- तगर, त्रर्ल्र्, अक
व , कवपत्थ and ​​​तनगुवण्डी should be used.
 िस्य- अर्पीड नस्र् eg. With Bhringaraja (सुश्रुत)
 अञ्जि​-
• पथ्र्ा,हररद्रा, मधुक (Su.U.11/7)
• flowers of जातत,शोिाञ्जन, करञ्ज​.(सु.उ.११/८)
 धूम​पाि​- with र्र् मदनफल िूजवपत्र शशमपत्र​ smeared with घृत​(A.S.U.
19/77)

33.  आश्च्योिि- शशग्रुपल्लर्रस to reduce pain ,
foreign body sensation and edema.(अ.सं.उ. १९/ ७३)
• कोष्ण आश्च्र्ोतन with नागर, त्रत्रफला, तनम्र्,
र्ासा and लोध्र​ रस​ (A.H.U16/17)
 बबडालक- Application of हररतकी, नागर, रसाञ्जन, स्र्णव गैररक
(A.S.U.19/4)
 कवलग्रि​- With तीक्ष्ण द्रव्र्​s eg. Trikatu kwatha(A.S.U.19/86)
 रुि पुिपाक​- तगर, दारुहररद्रा, क
ु ष्ठ, एलादद गण द्रव्र् added with
मधु and घृत (A.S.U 19)
 वपक्ण्ड- Made out of तनम्र्पत्र .(शा.उ.१३ २७) and शशग्रुपत्र ।
(र्ो.र​.ने.रो)

34. रतिज अभिष्यन्द धचक्रक्सा
 ......क्स्िग्धान्कौम्प्िेि सवपवषा रसैरुदारैरथवा भसरामोिेण योजयेि्
(S.U.12/4)
स्नेहपान with क
ु म्ि सवपव (100 years old) or मांसरस​
and then रतिमोिण followed by वर्रेचन​ and शशरोवर्रेचन​
रतिज अभिष्यन्द should be managed as pitta abhishyanda. (अ.स​.उ.१९/३५)
 प्रलेप- शतधौत घृत mixed with नीलोत्पल, उशीर, दारुहररद्र,
कालीर्क, मधुक, मुस्ता, लोध्र, प्मक applied around eyes. (S.U 12/7)

35. सेक
• लोध्र, त्रत्रफला, र्ग्ष्ट, शक
व र and मुस्ता are taken in समिाग and
added in शीताम्र्ु for सेक (ग​.तन.ने.रो. १३८)
 िस्य- घृतमण्ड, शक
व र, मधुक, नीलोत्पल with स्तदर् (A.S.U. 19/58)
 स्िेिि- Intake of ततक्त घृत (च​.द​.)
 In severe pain-मृदु स्र्ेद,जलौकार्चरण all around eyes. (S.U.12/8)
 आश्च्योिि-Mixture of musta and yashtimadhu churna
wrapped in a cloth and soaked in rain water. (S.U.12/10)
 अञ्जि -सैदधर्, कतक, रसाञ्जन and कासीस​​​ are triturated with मधु
(S.U.12/23)

36. शमिौषधी in अभिष्यन्द
• Pathyadi kashaya
• Patoladi kashaya
• Mahavasakadi kwatha
• Vasaguduchyadi kwatha
• Vasanimbadi kashaya
• Shadanga guggulu
• Amalaki rasayana
• Drakshamalaki lehya
Commonly used
Topical applications
•Kataka drops
•Sphatika drops
•Ophthacare drops
•I tone drops
•Rasanjana drops
•Sphatika Rasanjana drops
•Pindi with Kumari
Shigru patra
Shigru patra, Nimba patra
•Seka with Triphaladi kwatha,
Darvyadi kwatha, Yashtyadi
ksheerapaka

37. CONJUNCTIVITIS
• Conjunctivitis is the inflammation of conjunctiva characterized
by conjunctival hyperemia and discharge which can be watery,
mucoid, mucopurulent or purulent.
• It is the most common cause of Red eye.
• Popularly called as ‘Pink eye’.

38. Conjunctiva and its parts
• Conjunctiva is a thin transparent
mucous membrane lining the
inner surface of eyelids and
anterior surface of eyeball.
1- Palpebral or tarsal conjunctiva :
lines the eyelids .
2- Bulbar conjunctiva : covers the
eyeball, over the sclera.
3- Fornix : Forms the junction
between the bulbar and palpebral
conjunctivas.

39. Functions of conjunctiva
• 1. It acts as a defensive barrier
against infections.
• 2. Secretions from goblet and
accessory lacrimal glands are
essential components of tear film
• 3. Mucin produced from goblet cells
lubricates the eye ball
 Applied aspects of Conjunctiva
• Adenoid layer develops 3 months
after birth, hence follicular reaction
of conjunctiva will not be found in
new born.

40. ETIOLOGY
• Conjunctiva may be affected by one of the following ways.
• Exogenous
Contact with micro-
organisms, allergens,
foreign body or
chemicals
•Endogenous
Due to endogenous
allergens
• Local Spread of
infections from
neighbouring structures-
Skin, lacrimal sac, lids and
nasopharynx

41. Classification of Conjunctivitis
Infective
Bacterial
Chlamydial
Non-
Infective
Allergic
Viral
Granulomatous
Toxic
Cicatrical
(Autoimmune)
Based on etiology
Traumatic
Ophthalmia neonatorum
(A separate entity)

42. SIGNS OF CONJUNCTIVITIS
Discharge Hyperemia
Chemosis
Pseudo membrane Follicles Papillae
Symptoms-
1. Grittiness
2. Pricking pain
3. Lacrimation
4. Burning
5. Itching
6. Photophobia

43. Infective conjunctivitis
• Flies
• Poor hygienic
conditions
• Hot dry climate
Modes of
infection
• Exogenous
infections:
directly, vector
transmission,
material
transfer.
• Local spread:
infected lacrimal
sac, lids and
nasopharynx.
• Endogenous
infections:
blood.
Causitive
organisms
• Staphylococcus
aureus
• Streptococcus
pneumoniae
• Haemophilus
influenzae
• Moraxella
lacunata
• Neisseria
gonorrhea
Predisposing
factors
 Bacterial conjunctivitis

44. PATHOGENESIS
Conjunctival response
Cellular response
Vascular response
Congestion and increased permeability of vessels associated with
proliferation of capillaries
Infiltration of conjunctiva with polymorphonuclear cells and other
inflammatory cells
Discharge or exudates(consists of tears, mucus, inflammatory,
desquamated epithelial cells, fibrin and bacteria)
*Oedema of the conjunctiva,Superficial epithelial cells
degenerate, Increase in number of goblet cells.

45. • Redness
• Foreign body sensation
• Burning sensation
• Mucopurulent
discharge
• Mild photophobia
Symptoms Signs
• Mucopus flakes in the
fornices
• Conjunctival congestion
• Chemosis
• Fine papillary reaction.
Acute bacterial Conjunctivitis-Most common

46. Clinical features Acute
conjunctivitis
Acute anterior
uveitis
Acute
Congestive
glaucoma
Conjunctival
Congestion
Superficial,
More marked in
Fornices
Circumcorneal Circumcorneal
Vision Good Impaired Poor
Pain Mild ocular
discomfort
Moderate Severe pain
Media Clear Hazy due to Keratic
precipitates and
aqueous flares
Hazy due to
corneal oedema
Differential diagnosis of Red eye

47. Hyperacute conjunctivitis
• It is commonly caused by Neisseria gonorrhea which is capable of
invading intact corneal epithelium.
Clinical features Lab Investigations
•Conjunctival hyperemia
• Chemosis
• Profuse purulent
discharge
• Pseudomembrane
formation
•Lymphadenopathy
•Gram staining of
corneal smear shows
gram negative
diplococci
• Culture and
sensitivity of the
discharge

48. • Chronic Bacterial Conjunctivitis
Conjunctivitis of more than 4 weeks duration is considered as chronic
• Signs and Symptoms-
1.Mild chronic redness
2. Foreign body sensation
3.Burning sensation
4.Mucoid discharge
Signs-
•Congestion of bulbar conjunctiva near
the angles
• Excoriation of skin at canthi
• Foamy mucopurulent discharge at the
angles
Angular Conjunctivitis
It is a subacute or chronic conjunctivitis involving conjunctiva
and the skin of the lid margins near the angles of the eye.
It is commonly caused by Moraxella axenfeld.

49. Treatment of bacterial conjunctivitis
• Topical antibiotics like Chloramphenicol,
Ciprofloxacin, Ofloxacin,Gatifloxacin eye drops.
• Irrigation of conjunctival sac with sterile saline.
• Topical ointment includes Ofloxacin,
Ciprofloxacin, or Tobramycin .
• Use of dark goggles
• Anti-inflammatory and analgesic drugs.
• Systemic therapy in Gonococcal conjunctivits
with Cephalosporins, Quinolones
• Frequent handwashing and avoidance of sharing
towel, handkerchief.
• Avoid applying bandages and using steroids .

50. Ophthalmia neonatorum
Clinical features
• Bilateral eyelid oedema
• Discharge- usually
mucopurulent and in
gonococcal infection it will
be purulent
• Papillary conjunctival
reaction
• Gram stain of exudate
for diplococci (gonococcal
infection).
• Giemsa stain for
inclusion bodies
(chlamydia)
• Culture and sensitivity
• PCR
Investigations
It is a neonatal conjunctivitis which develops within 2 weeks of birth as a
result of infection transmitted from mother to infant during delivery
Etiology • Neisseria gonorrhea • Chlamydia trachomatis

51. Complications Treatment
•Keratitis
•Corneal ulcer
• Corneal opacity
•Povidone-iodine 2.5%
• Erythromycin 0.5%
ointment or tetracycline
1% ointment

52. CHLAMYDIAL CONJUNCTIVITIS
• It is caused by Chlamydia trachomatis, an obligate intracellular
bacteria
• It’s accurate diagnosis is based on laboratory investigations.
TRACHOMA
• Trachoma is a chronic kerato conjunctivitis caused by
Chlamydia trachomatis. It is one of the causes of preventable
blindness in the world.
• Transmission- Commonly direct transmission from eye or
nasal discharge particularly through flies.

53. Clinical features
• Conjunctival scarring in
chronic cases
• Trichiasis
•Mixed follicular and
papillary response with
mucopurulent discharge
•Superficial epithelial
keratitis and pannus
formation
Complications
•Cicatricial
entropion
•Corneal
vascularization
• Corneal
opacification

54. Diagnosis
• Conjunctival smear stained with
giemca stain for detection of inclusion
bodies, iodine stain
• • Direct fluorescent antibody cytology
(DFA)
• ELISA for chlamydial antigens
• PCR
• Direct monoclonal fluorescent
antibody microscopy
Treatment
Topical –
tetracycline 1% •
Systemic antibiotic
(erythromycin or
tetracycline

55. ADULT INCLUSION CONJUNCTIVITIS
• It is an oculogenital infection causing acute follicular
conjunctivitis, common in sexually active young adults.
• Etiology-Serotype D-K of chlamydia trachomatis
Clinical features
Transmission
•Contaminated
fingers or through
contaminated
water of
swimming pool
•Mucopurulent discharge
• Large follicles
•Pre auricular
lymphadenopathy.
Treatment
•Tetracycline 1% eye
ointment
• Antibiotics like
Tetracycline,
Erythromycin and
Doxycycline.

56. Viral Conjunctivitis
Etiology
• Adenovirus
• Herpes simplex
• Herpes zoster
• Molluscum contagiosum
• Enterovirus

57. Signs
• Follicles involving palpebral conjunctiva and
fornix
• Conjunctival hemorrhage in severe cases
• Pseudomembrane lining the palpebral
conjunctiva and lower fornix
• Tender preauricular lymphadenopathy
• Conjunctival cytology with Giemsa stain
• PCR
• Viral culture
Diagnosis
•Corneal involvement-keratitis ,Superficial
punctate keratitis (SPK)
• Focal white sub epithelial & anterior stromal
opacities

58. Treatment of Viral conjunctivitis
• The infection is self-limiting which usually
resolves within 2 weeks of onset of
symptoms.
• Symptomatic treatment with artificial tears
and cold compresses .
• Decongestants lubricant eye drops to reduce
discomfort
• Sunglasses to decrease glare.
• For keratitis weak steroids such as
flurometholone or loteprednol (0.5%) are
indicated.

59. Allergic conjunctivitis
* It is the inflammation of the conjunctiva caused by
hypersensitivity reaction to allergens.
* Both IgE and cell mediated immune mechanisms play a role.
Types
• Simple allergic conjunctivitis
• Vernal keratoconjunctivitis
• Atopic keratoconjunctivitis
• Giant papillary conjunctivitis
• Phlyctenular keratoconjunctivitis
• Dermatoconjunctivitis

60. Simple allergic conjunctivitis- appears in two forms
• Seasonal allergic conjunctivitis- It is a
response to seasonal allergens such as
pollens mostly during spring and summer
• Perennial allergic conjunctivitis- – It is an
inflammatory response to allergens, such
as house dust, animal dander and mite. It
is chronic, less common and occurs
throughout the year.

61. PATHOLOGY
• Vascular response
• Sudden vasodilation and increased vessels
permeability
• Cellular response
• Infiltration of eosinophils, mast cells releasing
histamines and histamine like substances.
• Conjunctival response
• Conjunctival edema and papillary hyperplasia

62. Symptoms
• Intense itching
• Watery mucus,
stringy
discharge
• Mild
photophobia
Signs
• Hyperemia
• Chemosis
• Mild papillary
reaction
• Oedema of lids

63. Symptoms
It is a bilateral recurrent allergic inflammation of the conjunctiva in which
IgE and cell mediated immune mechanism play an important role.
Vernal Keratoconjunctivitis
• Intense itching
• Lacrimation
• Photophobia
• Foreign body
sensation
• Burning sensation
• Mucoid discharge
Predisposing factors
• Age and sex- 4 to 20
years; more common in
boys.
• Season- More common
in summer
• Climate- More prevalent
in tropics.

64. Signs
• Palpebral form-Presence of
hard, flat topped, papillae
arranged in a ‘cobble-stone’
fashion.
• Bulbar form- Dusky red
triangular congestion of
bulbar conjunctiva and
accumulation of gelatinous
thickened tissue around
limbus.
• Mixed form- Combined
features of both palpebral
and bulbar forms.

65. Vernal Keratopathy
Corneal involvement in VKC may be primary
or secondary due to extension of limbal
lesions. It involves lesions like:
• a) Punctate epithelial erosions involving
superior cornea
• b) Shield ulcer –A shallow transverse ulcer
in the upper part of cornea resulting due
to epithelial macroerosions.
• c) Vernal corneal plaques – Due to
coating of macroerosions with mucus.

66. Atopic Keratoconjunctivitis
• It is associated with atopic dermatitis or eczema.
Symptoms
• Itching
• Dry sensation
• Mucoid
discharge
• Photophobia
Signs
• Inflamed lid margins
• Scarring of tarsal conjunctiva
• Papillary conjunctivitis
• May be associated with
Keratoconus
• Peripheral vascularisation

67. Giant papillary conjunctivitis
* Conjunctivitis with formation of very large sized papillae.
Symptoms
• Itching
• Foreign body
sensation
• Contact lens
intolerance
Signs
• Papillary
hypertrophy
(0.5 to 1mm in
diameter) in
superior tarsal
conjunctiva
with
hyperemia

68. Phlyctenular Keratoconjunctivitis
• It is an allergic response of conjunctival and corneal
epithelium to endogenous allergens, characterized by
formation of nodules on the conjunctiva or cornea.
Etiology
• It is a delayed
hypersensitivity
(Type- IV cell
mediated) response
• Tuberculous
proteins
• Staphylococcus
proteins.
Symptoms
• Mild discomfort
• Irritation
• Reflex watering
Signs
• Presence of small,
one or more
pinkish or white
nodules
surrounded by
hyperemia near
the limbus.

69. Investigations
1. Chest Xray,
Mantoux test to
rule out
tuberculosis.
2. Stool
examination to
rule out any
parasitic
infestations.
3. Systemic and
ENT
examinations to
rule out any
infections.

70. Contact dermatoconjunctivitis
Etiopathogenesis Clinical features
• Eczematous reaction of
skin of eye lids
• Conjunctival hyperemia
with papilllary
response.
• Delayed hypersensitivity
(Type IV) response to
prolonged contact with
chemicals and drugs like-
• Cosmetic applied to eye or
face
• Ophthalmic medications
such as atropine, neomycin,
penicillin, gentamycin and
soframycin.

71. Treatment of Allergic conjunctivitis
 Elimination of allergens if possible
 Local treatment –
• Topical anti histamine drugs,
• Mast cell stabilizers,
• Topical vasoconstrictors like Naphazoline, antizoline.
• Topical NSAIDs, topical steroids,
• Topical immunomodulatory drugs (cyclosporine and tacrolimus),
• Topical mucolytics(acetylcysteine)
 Systemic treatment - Systemic anti histaminic drugs and oral steroids
 Surgical treatment – Surgical excision is indicated for large papillae.
 General measures –
• Dark goggles to prevent photophobia
• Cold compresses

72. Trends in prevalence and treatment of ocular allergy
• Topical immunomodulatory drugs (cyclosporine and tacrolimus)- for
refractory VKC cases.
• Levocabastine - In well established assays of antihistamine activity,
levocabastine was found to be the most potent antihistamine
compound available, being 15,000 times more potent than
chlorpheniramine.
• Immunotherapy-
a. Subcutaneous
b. Sublingual

73. Differentiating features of common types of conjunctvitis
Clinical
features
Bacterial Viral Allergic
Main symptom Ocular discomfort Ocular discomfort Itching
Discharge Purulent Watery Ropy/watery
Follicle Absent Present + Absent
Papillae May/may not
present
Absent Present ++

74. Complications of conjunctivitis
Marginal corneal ulcer
Dacryocystitis
Uveitis Blepharitis
Corneal opacity

75. Discussion
• Abhishyanda mentioned as aupsargika roga in
ayurvedic classics indicates that it is of infective origin.
• Exposure to Raja (pollen, dust) dhooma (toxic fumes),
abhighata(trauma),keetadamsha (insect bites) are some of the
causes of non infective conjunctivitis.
• Sroto syanda and sravana i.e oozing or trickling of srotasas
mentioned in pathogenesis of abhishyanda can be taken as
increased permeability of capillaries due to vasodilatation
leading to exudation which is mentioned under pathogenesis of
conjunctivitis.

76. • Hyperemia, discharge are common clinical features seen in both
abhishyanda and conjunctivitis. The nature of discharge depends on
the type of inflammation or the type of dosha involved.Other
common features found in both are Toda(pricking sensation),
sangharsha(foreign body sensation),daha (burning sensation) and
kandu(itching sensation).
• Conjunctivitis is usually diagnosed by clinical features and
history.Investigations like conjunctival smear test, culture of the
discharge are required in severe infections,( eg. Gonococcal
conjunctivitis) Chlamydial infections, Opthalmia neonatorum and for
research purposes.

77. • Abhishyanda if not controlled leads to Adhimantha and in
conjunctivitis, severe infection with highly virulent organism can lead
to Keratitis, corneal ulcer,uveitis and sight threatening complications
if not tackled properly.
• Abhishyanda is a vyadhna sadhya vyadhi and the management
includes topical as well as purificatory therapies according to the
different stages (Ama and pakva avastha) whereas in conjunctivitis
topical, antibiotic (bacterial and chlamydial infections), antiviral (viral
conjunctivitis) and topical anti histamines and mast cell stabilizers
(allergic conjunctivitis) are administered. Systemic antibiotics, anti
viral drugs and oral steroids (allergic conjunctivitis) are required in
severe inflammatory conditions with complications.

78. • According to acharyas Abhishyanda should be tackled in premonitory
stage itself to prevent complication.
• According to Yogaratnakara, 5 days of langhana is advised as
Abhishyanda takes ashraya in kapha sthana in netra.
• Langhana, swedana, seka, bidalaka or lepa, pindi are indicated in
Amavastha
• Anjana, Tarpana are to be administered in pakwa avastha.
• Tarpana given in pakwa avastha of abhishyanda nourishes the ocular
tissues and improves immunity of conjunctiva and prevents recurrent
inflammatory reactions.
• Steroids used in viral conjunctivitis may prolong the course of the
disease and in allergic conjunctivitis may lead to complications like
cataract and glaucoma.

79. •Herbal drugs beneficial in all types of conjunctivitis
having antimicrobial and anti allergic activity
Shigru Patra DaruHaridra
Guduchi
Triphala
Amalaki

80. Conclusion
• Abhishyanda can be correlated to conjunctivitis due to similarities
found in pathogenesis as well as in clinical features.
• Vataja Abhishyanda can be correlated to Subacute catarrhal
conjunctivitis, Allergic conjunctivitis. Pittaja Abhishyanda to Acute
catarrhal conjunctivitis or Acute purulent conjunctivitis. Kaphaja
Abhishyanda to Acute mucopurulent conjunctivitis, Allergic
conjunctivitis and Raktaja Abhishyanda to Acute mucopurulent
conjunctivitis.
• Abhishyanda can be successfully managed with wide range of
treatment modalities depending on the stages.

81. • Timely administration of Raktamokshana and virechana prevents
complications like Shukra or keratitis since vitiated Rakta is involved
in all types of abhishyanda.
• Topical ocular therapeutics used to treat Abhishyanda are safe and
effective in counteracting the disease, improve local ocular
immunity. Therefore beneficial in tackling allergic conjunctivitis and
can successfully replace immune therapy which is developing as a
recent trend.
• Since it is the root cause of most of the eye diseases, treatment of
abhishyanda depending on stages not only cures the disease, also
prevents other eye diseases arising out of it

82. THANK YOU