vartmgat rog in detail and possible modern comparison

1. वर्त्मगत रोग

2. संख्या
सुश्रुत -21 वाग्भट-24
• लेखन साध्य -9
• भेदन साध्य -3
• छेदन साध्य -3
• अशस्त्रकृ त – 2
• याप्य - 1
• असाध्य - 3
 नन्ेष, वातहत वर्त्म –वातज असाध्य
 पोथकी,प्रक्ललनवर्त्म,लगण- कफज
 अंजनाम्का,क्ललष्टवर्त्म,शोणणताशम –रलतज
 बाकी सभी – सननपात

3. संप्राक्प्त
पृथग्दोषााः स्स्त्ता वा यदा वर्त्मव्यपाश्रयााः |
मसरा व्याप्यावनतष्ठन्ते वर्त्मस्त्वधिक्ूक््छमतााः । ।
वववध्यम ्ांसं रलतं च तदा वर्त्मव्यपाश्रयान |
ववकाराञ्जनयन्र्तयाशु ना्तस्त्ताक्न्नबोित । ।
-पृथग्दोषााः – वात/वपत/कफ स्स्त्ता वा -
त्ररदोष
-स्त्थान/आश्रय - वर्त्मव्यपाश्रयााः
-मसरा व्याप्य वर्त्मस्त्ववनतष्ठन्ते
- दूष्य – ्ांस रलत

4.  वाग्भट – कृ ्छउन््ीलन,उक्र्तललष्ट,कफोक्र्तललष्ट,वपतोंक्र्तललष्ट,पक्ष््शात,पक्ष््ोपरोि,क
ु क
ु णक,अलजी
का वणमन वर्त्मगत रोगों ्े ककया है
 स्स्त्त लेखन साध्य वर्त्मगत रोग है
 सुश्रुत अनुसार कोई वपतज वर्त्मगत रोग नह ं है
 क
ु क
ु णक को वागभट ने वर्त्मगत ्ाना है जबकक सुश्रुत ने अलग से नेरअमभघात ्े वणमन ककया है
 अष्टांग हृदय ने अलजी को संधि व वर्त्म गत दोनों ्े वणमन ककया है ।
EXTRA POINTS

5. उर्तसंधगनी
 स्त्थान –
 ननदान
 संप्राक्प्त
 दोष –
 लक्षण -
 धचककर्तसा – साध्य
 chalazion

6. अभ्यन्तर्ुखी बाह्य उर्तसङ्गे ऽिो वर्त्मनश्च या
ववज्ञेयोर्तसङ्धगनी ना् तद् रूप वपडकाधचता
लक्षण
रलता रलतेन वपटटका तुल्य वपटटका आधचता उर्तसंगाख्या
वाग्भट
ववदेह
• क
ु लक
ु टाण्डरसोप्ं स्त्राव

7. धचककर्तसा
 क्स्त्नग्ि वान्त ववररलतस्त्य
 ननवातातपसद््नन (आप्तैर्दमढं गृह तस्त्य वेश््न्युत्तानानशानयनाः)
 स्त्वेदयेद् वर्त्म
 ननभुमज्य - वा्ाङ्गुष्ठाङ्गुमलक्स्त्थत्
 सुखोदक प्रतप्तेन वाससा सुस्ाटहताः
 प्लोतान्तराभ्यां - अङ्गुल्यङ्गुष्ठकाभ्यां तु ननभुमग्नं वर्त्म यर्तनताः
 न यथा चलनत स्रंसतेऽवप वा - तताः प्र्ृज्य प्लोतेन वर्त्म
शस्त्रपदाङ्ककत्
 मलखेत शस्त्रेण परैवाम,
 ततो रलते क्स्त्थते पुनाः –क्स्त्वन्नं/स्त्वेदन
 प्रनतसारण – ्नोह्वा कासीस व्योषा रमसञ्जन सैन्िवैाः
श्लक्ष्णवपष्टैाः स्ाक्षीक
ै ाः
 प्रक्षालन –उप्ष्णवाररणा
 व्रणवत स्ुपाचरेत - हववषा मसलतं
 स्त्वेदन अवपीडन 3 टदन बाद
लेखन ववधि

8. असृगास्रावरटहतं कण्डूशोफवववक्जमत् ||
स्ं नखननभं वर्त्म मलणखतं सम्यधगष्यते ||
लेखन – सम्यक योग
• रलत्क्षक्ष स्रवेत स्त्कन्नं
• राग शोफ पररस्राव नतम्रं व्याध्यननजमयाः
• वर्त्म श्यावं गुरु स्त्तब्िं कण्डू हषो उपदेहवत
• धचककर्तसा - स्त्नेहनयर्तवा पुनामलमखेत
दुमलमणखतं वर्त्म
• व्यावतमते यदा वर्त्म
• पक्ष्् चावप वव्ुह्यनत
• सरुक स्राव बहुलं तद अनतस्राववतं
• धचककर्तसा –स्त्नेह स्त्वेदाटदररष्टाः स्त्यात क्र्स्त्तर
अननलापहाः
अनतमलमणखतं वर्त्म

9. लगण
 स्त्थान –
 ननदान
 संप्राक्प्त
 दोष –
 लक्षण -
 धचककर्तसा – साध्य
 chalazion

10. लक्षण
अपाकाः कटठनाः स्त्थूलो ग्रक्न्थवमर्त्मभवोऽरुजाः |
सकण्डूाः वपक््छलाः कोलप्र्ाणो लगणस्त्तु साः ||
ग्रक्न्थाः पाण्डुर अरुक पाकाः क
ं डु्ान कटठनाः कफात ।
कोल्ाराः स लगणाः
वाग्भट
धचककर्तसा
रोचनाक्षारतुर्तथानन वपप्पल्याः क्षौद्र्ेव च |
प्रनतसारण्ेक
ै क
ं मभन्ने लगण इष्यते ||
्हर्तयवप च युञ्जीत क्षाराग्नी ववधिकोववदाः ||
 भेदन
 प्रनतसारण –एक
े क
ं
 ्हती लगण ग्रक्न्थ – क्षार अक्ग्न क्म भेदन क
े बाद

11. क
ु क्म्भका
 स्त्थान –
 ननदान
 संप्राक्प्त
 दोष –
 लक्षण -
 धचककर्तसा – साध्य
 Chalazion/internal hordeolum

12. लक्षण
क
ु म्भीकबीजप्रनत्ााः वपडका यास्त्तु वर्त्मजााः
आध््ापयक्न्त मभन्ना यााः क
ु म्भीकवपडकास्त्तु तााः
कृ ष्णााः वपतेन बह्वयो अंतवमर्त्म क
ुं म्भीकबीजवत ।
आध््ायनते पुनेमभमन्नााः वपटटका क
ुं भीक संज्ञीका ।।
धचककर्तसा
- लेखन

13. Also called a tarsal or meibomian cyst.
It is a chronic non-infective granulomatous inflammation of the
meibomian gland.
CHALAZION
Etiology
 More common in children and young adults
 Eye strain due to muscle imbalance or refractive errors.
 Habitual rubbing of the eyes
 Chronic blepharitis and diabetes mellitus
 Metabolic factors.
Predisposing factors

14. non-infective granulomatous inflammation of the meibomian gland.
Pathogenesis
mild grade infection of the meibomian gland
proliferation of the epithelium and infiltration of
the walls of the ducts
Duct blocked
retention of secretions (sebum)
Enlargement of gland

15. Symptoms
• Painless swelling in the lid
• feeling of mild heaviness.
Signs
• firm to hard, non-tender swelling present slightly away from
the lid margin
• It usually points on the conjunctival side, as a red,purple or
grey area, seen on everting the lid.
• the main bulk of the swelling project on the skin side.
• Multiple chalazia may be seen involving one or more eyelids
Clinical picture

16. • Complete spontaneous resolution may occur rarely.
• Often it slowly increases in size and becomes very large.
• large chalazion of the upper lid may press on the cornea and cause
blurred vision from induced astigmatism.
• A large chalazion of the lower lid may cause eversion of the punctum
or even ectropion and epiphora.
• it may burst on the conjunctival side, forming a fungating mass of
granulation tissue.
• Secondary infection leads to formation of hordeolum internum.
• Calcification may occur, though very rarely.
• Malignant change into meibomian gland arcinoma may be seen
occasionally in elderly people.
Clinical course and complications

17. Intralesional injection
• long-acting steroid (triamcinolone) is reported to cause resolution in about
50 percent cases, especially in small and soft chalazia.
Incision and curettage
Treatment
Conservative treatment
• Hot fomentation
• Topical antibiotic eyedrops
• Oral anti-inflammatory drugs.
Diathermy
• A marginal chalazion is better treated by diathermy.

18. It is a suppurative inflammation of the meibomian gland associated with blockage of the
duct.
Etiology.
primary staphylococcal infection of the meibomian gland or due to secondary
infection in a chalazion (infected chalazion).
Clinical picture.
Symptoms
• similar to hordeolum externum, except that pain is more intense, due to the swelling
being embedded deeply in the dense fibrous tissue.
Sign
• it can be differentiated from hordeolum externum by the fact that in it, the point of
maximum tenderness and swelling is away from the lid margin
• pus usually points on the tarsal conjunctiva (seen as yellowish area on everting the lid)
and not on the root of cilia. Sometimes, pus point may be seen at the opening of
involved meibomian gland.
INTERNAL HORDEOLUM

19. Treatment.
• It is similar to hordeolum externum,
• pus is formed, it should be drained by a vertical incision from the tarsal conjunctiva.

20.  स्त्थान –
 ननदान
 संप्राक्प्त
 दोष –
 लक्षण -
 धचककर्तसा – साध्य
 STYE
अञ्जननाम्का

21. दाहतोदवती ताम्रा वपडका वर्त्मसम्भवा |
्ृद्वी ्न्दरुजा सूक्ष््ा ज्ञेया साऽञ्जननाम्का
लक्षण
्ध्ये वा वर्त्मनो अंते वा क
ं डूषा रुगवती क्स्त्थरााः
्ुदग ्ारा असृजा ताम्रााः वपटटका अंजनम्का (वा)
धचककर्तसा
• सम्यक स्त्वेदन
• भेदन
• ननष्पीडन
• प्रनतसारण - मशला एला मसंिुत
• अंजन – द पमशखोंदभव

22. • It is an acute suppurative inflammation of gland ofthe Zeis or Moll.
Etiology
Predisposing factors.
 It is more common in children and young adults and in patients with eye
strain due to muscle imbalance or refractive errors.
 Habitual rubbing of the eyes or fingering of the lids and nose,
 chronic blepharitis and diabetes mellitus are usually associated with
recurrent styes. excessive intake of carbohydrates and alcohol also act as
predisposing factors.
Causative organism commonly involved is Staphylococcus aureus.
EXTERNAL HORDEOLUM (STYE)

23. Stage of cellulitis is characterised by localised, hard, red, tender
swelling at the lid margin associated with marked oedem
Symptoms
• acute pain associated with swelling of lid,
• mild watering
• photophobia
Signs
Stage of abscess formation is characterised by a visible pus point on the
lid margin in relation to the affected cilia.

24. • Hot compresses 2-3 times a day are very useful in cellulitis
stage.
• When the pus point is formed it may be evacuated by epilating
the involved cilia.
• Surgical incision is required rarely for a large abscess.
• Antibiotic eyedrops (3-4 times a day) and eye ointment (at bed
time) should be applied to control infection.
• Anti-inflammatory and analgesics relieve pain and reduce
oedema.
• Systemic antibiotics may be used for early control of infection.
• In recurrent styes, try to find out and treat the associated
predisposing condition
Treatment

25.  स्त्थान –
 ननदान
 संप्राक्प्त
 दोष –
 लक्षण -
 धचककर्तसा – साध्य
 Tracoma
पोथकी

26. स्राववण्याः कण्डुरा गुव्यो रलतसषमपसक्न्नभााः |
वपडकाश्च रुजावर्तयाः पोथलय इनत सक्ञ्ज्ञतााः |
लक्षण
• स्राविण्यो बहुस्रािााः
• रुजाित्य इति कफजा अवि िेदनायुक्िा इत्य
सुश्रुत
पोथलयाः वपटटकााः श्वेतााः सषमपाभााः घनााः कफात
वागभट

27. धचककर्तसा
• लेखन
• प्रनतसारण – शुण्ठी सेंिव
• प्रक्षालन – उष्ण अंबु

28. Previously known as Egyptian ophthalmia
The word 'trachoma' comes from the Greek word for 'rough' which
describes the surface appearance of the conjunctiva in chronic
trachoma.
It is a chronic keratoconjunctivitis,
Primarily affecting the superficial epithelium of conjunctiva and
cornea simultaneously.
It is characterized by a mixed follicular and papillary response of
conjunctival tissue.
It is still one of the leading causes of preventable blindness in the
world.
TRACHOMA

29. Causative organism
• Chlamydia trachomatis
• Presently, 11 serotypes of chlamydia, (A, B, Ba, C, D, E, F, G, H, J and
K) have been identified
Predisposing factors
 Age. usually contracted during infancy and early childhood.
 2. Sex. females
 Race. Jews and comparatively less common among Negroes.
 Climate. Trachoma is more common in areas with dry and dusty weather.
 Socioeconomic status. The disease is more common in poor classes
 Environmental factors - dust, smoke, irritants, sunlight etc.
Etiology

30. Modes of infection.
 Direct spread of infection may occur through contact by air-borne or water-borne
modes.
 Vector transmission of trachoma is common through flies.
 Material transfer
• Material transfer can occur through contaminated fingers of doctors, nurses and
contaminated tonometers.
• Other sources of material transfer of infection are use of common towel,
handkerchief, bedding and surma-rods.

31.  Trachoma is a worldwide disease but it is highly prevalent in North Africa, Middle
East and certain regions of Sourth-East Asia.
 It is believed to affect some 500 million people in the world.
 Trachoma is responsible for 15-20 percent of the world's blindness, being second
only to cataract.
Prevalence
Clinical profile of trachoma
• Incubation period - 5-21 days
• Natural history - development of acute disease in the first decade of life
which continues with slow progression, until the disease becomes inactive in
the second decade of life. the peak incidence of blinding sequelae is seen in
the fourth and fifth decade of life.

32. Symptoms
In the absence of secondary infection –
• symptoms minimal include mild foreign body sensation in the eyes, occasional lacrimation, slight stickiness
of the lids and scanty mucoid discharge.
In the presence of secondary infection
• Typical symptoms of acute mucopurulent conjunctivitis develop.
Signs
 Conjunctival signs
• Congestion of upper tarsal and forniceal conjunctiva.
• Conjunctival follicles -Look like boiled sagograins and are commonly
seen on upper tarsal conjunctiva and fornix
• Papillary hyperplasia. Papillae are reddish, flat topped raised areas which
give red and velvety appearance to the tarsal conjunctiva - Leber cells
• Conjunctival scarring (Fig. 4.12), which may be irregular, star-shaped or
linear. Linear scar present in the sulcus subtarsalis is called Arlt's line.
• Concretions may be formed due to accumulation of dead epithelial cells
and inspissated mucus in the depressions called glands of Henle.

33. Corneal signs
• Superficial keratitis - upper part.
• Herbert follicles -present in the limbal area
• Pannus -infiltration of the cornea associated with vascularization is seen in upper
part. The vessels are superficial and lie between epithelium and Bowman's
membrane
- Progressive pannus, infiltration of cornea is ahead of vascularization.
- Regressive pannus (pannus siccus) vessels extend a short distance beyond the area
of infiltration.
• Corneal ulcer may develop at the advancing edge of pannus.
• Herbert pits are the oval or circular pitted scars
• Corneal opacity may be present in the upper part.

34. pannus
Herbert pits

35. four stages:
• Stage I (stage of infiltration)-It is characterized by hyperaemia of
palpebral conjunctiva and immature follicles.
• Stage II (stage of florid infiltration) -It is characterized by appearance
of mature follicles, papillae and progressive corneal pannus.
• Stage III (stage of scarring)-scarring of palpebral conjunctiva.
• Stage IV (stage of sequelae)-The disease is cured but sequelae due to
cicatrisation give rise to symptoms.
Grading of trachoma
McCallan's classification

36. WHO classification(FISTO Classification)
TF: Trachomatous inflammation-follicular.
• stage of active trachoma with predominantly follicular inflammation.
• To diagnose this stage at least five or more follicles (each 0.5 mm or more
in diameter) must be present on the upper tarsal conjunctiva
TI : Trachomatous inflammation intense
• This stage is diagnosed when inflammatory thickening of the upper tarsal
conjunctiva obscures more than half of the normal deep tarsal vessels .
TS: Trachomatous scarring
• This stage is diagnosed by the presence of scarring in the tarsal conjunctiva.
• scars are easily visible as white, bands or sheets (fibrosis) in the tarsal
conjunctiva

37. TT: Trachomatous trichiasis
• TT is labelled when at least one eyelash rubs
the eyeball.
CO: Corneal opacity.
• This stage is labelled when easily visible corneal opacity.
• The definition is intended to detect corneal opacities that cause
significant visual impairment (less than 6/18)

38. • Sequelae in the lids - trichiasis ,entropion, tylosis (thickening of lid margin),
ptosis,madarosis and ankyloblepharon.
• Conjunctival sequelae - concretions,pseudocyst, xerosis and symblepharon.
• Corneal sequelae - corneal opacity, ectasia,corneal xerosis and total corneal
pannus (blinding sequelae).
• Other sequelae - chronic dacryocystitis, and chronic dacryoadenitis.
Sequelae of trachoma

39. Diagnosis
The clinical diagnosis of trachoma is made from its typical signs
1. Conjunctival follicles and papillae
2. Pannus progressive or regressive
3. Epithelial keratitis near superior limbus
4. Signs of cicatrisation or its sequelae
Clinical grading of each case should be done as per WHO classfication into
TF, TI, TS, TT or CO.
Laboratory diagnosis.
1. Conjunctival cytology. showing plasma cells and Leber cells
2. Enzyme-linked immunosorbent assay (ELISA)
3. Polymerase chain reaction (PCR)
4. Serotyping of TRIC agents is done by detecting specific antibodies using
micro immunofluorescence (micro-IF) method.

40. Treatment of active trachoma
Management
Topical therapy regimes
• 1 percent tetracycline or 1 percent erythromycin eye ointment 4 times a
day for 6 weeks
• The continuous treatment for active trachoma should be followed by an
intermittent treatment especially in endemic or hyperendemic area.
Systemic therapy regimes
• Tetracycline or erythromycin 250 mg orally, four times a day for 3-4
weeks
• doxycycline 100 mg orally twice daily for 3-4 weeks
• single dose of 1 gm azithromycin
Combined topical and systemic therapy regime

41. Prophylaxis
Hygienic measures.
Early treatment of conjunctivitis. Every case of conjunctivitis should be
treated as early as possible to reduce transmission of disease.
Blanket antibiotic therapy (intermittent treatment).
• WHO has recommended this regime to be carried out in endemic areas to
minimize the intensity and severity of disease.
• The regime is to apply 1 percent tetracycline eye ointment twice daily for 5
days in a month for 6 months.

42. Treatment of trachoma sequelae
1. Concretions should be removed with a hypodermic needle.
2. Trichiasis may be treated by epilation, electrolysis or cryolysis
3. Entropion should be corrected surgically.
4. Xerosis should be treated by artificial tears.

43.  स्त्थान –
 ननदान
 संप्राक्प्त
 दोष –
 लक्षण -
 धचककर्तसा – साध्य
 Concretions
वर्त्मशक
म रा

44. वपडकामभाः सुसूक्ष््ामभर घनामभर अमभसंवृता |
वपडका या खरा स्त्थूला सा ज्ञेया वर्त्मशक
म रा |
लक्षण
वर्त्मन अन्ताः खरा रूक्षा वपट कााः मसकतोप्ााः(वाग्भट)
धचककर्तसा
• लेखन क्म
• छेदन पश्चायत

45. Etiology.
• Concretions are formed due to accumulation of inspissated mucus and dead epithelial cell
debris into the conjunctival depressions called loops of Henle.
• Commonly seen in elderly people as a degenerative condition and also in patients with
scarring stage of trachoma.
• The name concretion is a misnomer, as they are not calcareous deposits.
Clinical features.
• Concretions are seen on palpebral conjunctiva, more commonly on upper than the lower.
• They may also be seen in lower fornix.
• These are yellowish white, hard looking, raised areas, varying in size from pin point to
pin head.
• may produce foreign body sensations and lacrimation
• Occasionally they may even cause corneal abrasions.
Treatment.
• It consists of their removal with the help of a hypodermic needle under topical
anaesthesia
CONCRETIONS

46.  स्त्थान –
 ननदान
 संप्राक्प्त
 दोष –
 लक्षण -
 धचककर्तसा – साध्य
 Gaint papillary conjuctivitis
बहल वर्त्म

47. वर्त्म उपचीयते यस्त्य वपडकामभाः स्न्तताः |
सवणाममभाः स्ामभश्च ववद्याद्बहलवर्त्म तत
लक्षण
बहलं बहलर ्ांसेाः सवणमचीयते स्े (वा)
धचककर्तसा
• लेखन क्म
• प्रनतसारण

48. It is the inflammation of conjunctiva with formation of very large sized
papillae.
Etiology.
It is a localised allergic response to a physically rough or deposited surface
(contact lens, prosthesis, left out nylon sutures).
Probably it is a sensitivity reaction to components of the plastic leached out by
the action of tears.
Symptoms.
• Itching,
• stringy discharge and
• reduced wearing time of contact lens or prosthetic shell.
GIANT PAPILLARY CONJUNCTIVITIS (GPC)

49. Signs.
• Papillary hypertrophy (1 mm in diameter) of the
upper tarsal conjunctiva,
Treatment
1. The offending cause should be removed. After
discontinuation of contact lens or artificial eye
or removal of nylon sutures, the papillae
resolve over a period of one month.
2. Disodium cromoglycate
relieve the symptoms and enhance the rate of
resolution.
3. Steroids are not of much use in this condition

50.  स्त्थान –
 ननदान
 संप्राक्प्त
 दोष –वपत
 लक्षण -
• ्ृदल्पवेदनं ताम्रं यद्वर्त्म स््ेव च |
अकस्त््ा्च भवेद्रलतं क्ललष्टवर्त्म तदाटदशेत
 धचककर्तसा – लेखन साध्य
 angioneurotic edema
क्ललष्टवर्त्म
 स्त्थान –
 ननदान
 संप्राक्प्त
 दोष –त्ररदोष
 लक्षण –
• क्ललष्टं पुनाः वपत्तानयुतं ववदहे्छोणणतं यदा |
तदा क्ललन्नर्तव्ापन्न्ु्यते वर्त्मकदम्ाः
 धचककर्तसा – लेखन साध्य
 acute bacterial conjuctivitis
वर्त्मकदम्ाः श्याव वर्त्म

51.  स्त्थान –
 ननदान
 संप्राक्प्त
 दोष –
 लक्षण –
• यद्वर्त्म बाह्यतोऽन्तश्च श्यावं शूनं सवेदन् |
दाहकण्डूपररललेटद श्याववर्त्ेनत तन््त् । ।
 धचककर्तसा – लेखन साध्य
 Periorbital ecchymosis
श्याववर्त्े

52. ANGIONEUROTIC EDEMA
• It is rapid swelling of dermis ,subcutaneous and mucosa of lid due to vascular/blood
leakage
• Small vessels are dilated and leak clear fluids into the skin in response to histamine
• Similar to urticaria
• Leakage of blood into deeper layer of skin generalized swelling on skin
cause
• Heredity
• Idiopathic
• Allergy –food ,drug, pollution
Clinical feature
• Mild pain
• Itching
• Swelling on lid

53. Treatment
• Systemic -Anti – histamines
• Topical - Steroids eye drop

54.  Acute mucopurulent conjunctivitis is the most common type of acute
bacterial conjunctivitis.
 It is characterised by marked conjunctival hyperaemia and mucopurulent
discharge from the eye.
 Common causative bacteria
Staphylococcus aureus, Pneumococcus ,Streptococcus.
ACUTE MUCOPURULENT/BACTERIALCONJUNCTIVITIS
Clinical picture
Symptoms
• Discomfort and foreign body sensation
• Mild photophobia
• Mucopurulent discharge from the eyes.
• Sticking together of lid margins with discharge during sleep.
• Sometimes patient may complain of coloured halos due to prismatic effect
of mucus present on cornea.

55. Signs
• Conjunctival congestion -marked in circumcorneal zone.
• Chemosis i.e., swelling of conjunctiva.
• Petechial haemorrhages are seen when the causative organism is pneumococcus.
• Flakes of mucopus are seen in the fornices, canthi and lid margins.
• Cilia are usually matted together with yellow crusts.

56.  Irrigation of conjunctival sac with sterile warm saline once or twice a day will help
by removing the dele
 Dark goggles - to prevent photophobia.
 No bandage should -Exposure to air keeps the temperature of conjunctival cul-de-
sac low which inhibits the bacterial growth
 No steroids should be applied, otherwise infection will flare up and bacterial corneal
ulcer maydevelop.
 Anti-inflammatory and analgesic drugs (e.g. ibuprofen and paracetamol) may be
given orally for 2-3 days
Treatment
 Topical antibiotics -Ideally, the antibiotic should be selected after culture and
sensitivity tests but in practice, it is difficult.
 broad specturm antibiotics. chloramphenicol (1%), gentamycin (0.3%) eye drops
3-4 hourly in day and ointment used at night
 If the patient does not respond to these antibiotics, then the newer antibiotic
drops such as ciprofloxacin (0.3%), ofloxacin (0.3%) use.

57. PERIORBITAL ECCYMOSIS
DEFINITION
 escape of blood into the tissue from ruptured blood vessels and caused
discoloration
 Bilateral eccymosis refer to a collection of blood into both eyelid
 Raccoon eyes - also known in the United Kingdom and Ireland as panda
eyes
Etiological factors
• Blunt truma or boxer injury
• Neuroblastoma
• Skull fracture
• Orbital tumors
• Perforating injury
• Post sx

58. Symptoms
• blue or purple discoloration of the upper
and lower eyelid
• Itching mild
• pain
Treatment
• Most of the time, patches of ecchymosis
will go away without treatment.
• cold compress
• anti-inflammatory drugs - ibuprofen.
• Determining the underlying cause of
ecchymosis is essential for developing a
treatment plan.

59.  स्त्थान –
 ननदान
 संप्राक्प्त
 दोष –
 लक्षण –
• अरुजं बाह्यताः शून्न्ताः क्ललन्नं स्रवर्तयवप
कण्डूननस्त्तोदभूनयष्ठं क्ललन्नवर्त्म तदु्यते
 धचककर्तसा – औषि साध्य
 अंजन – योगांजान
 Simple Allergic conjuctivitis
क्ललन्नवर्त्म

60.  स्त्थान –
 ननदान
 संप्राक्प्त
 दोष –
 लक्षण –
• यस्त्य िौतानन िौतानन सम्बध्यन्ते पुनाः पुनाः |
वर्त्ामन्यपररपलवानन ववद्यादक्ललन्नवर्त्म तत |
 धचककर्तसा – लेखन साध्य
 अंजन –
• स्ुद्रफ
े नं लवणोत्तान्ं च शङ्खोऽथ ्ुद्गो ्ररचं च शुलल्
चूणामञ्जनं जाड्य्थावप कण्डू्क्ललन्नवर्त्ामन्युपहक्न्त शीघ्र्
 Chronic bactrial conjuctivitis
अक्ललन्नवर्त्म

61. It is the inflammation of conjunctiva due to allergic or hypersensitivity reactions which
may be immediate (humoral) or delayed (cellular).
The conjunctiva is ten times more sensitive than the skin to allergens.
Types
1. Simple allergic conjunctivitis -Hay fever conjunctivitis
• Seasonal allergic conjunctivitis (SAC)
• Perennial allergic conjunctivitis (PAC)
2. Vernal keratoconjunctivitis (VKC)
3. Atopic keratoconjunctivitis (AKC)
4. Giant papillary conjunctivitis (GPC)
5. Phlyctenular keratoconjunctivitis (PKC)
6. Contact dermoconjunctivitis (CDC)
ALLERGIC CONJUNCTIVITIS

62.  It is a mild, non-specific allergic conjunctivitis characterized by itching,
hyperaemia and mild papillary response.
SIMPLE ALLERGIC CONJUNCTIVITIS
Etiology
It is seen in following forms:
1. Hay fever conjunctivitis.
• It is commonly associated with hay fever (allergic rhinitis).
2. Seasonal allergic conjunctivitis (SAC)
• seasonal allergens such as grass pollens. It is of very common occurrence.
3. Perennial allergic conjunctivitis (PAC)
• perennial allergens such as house dust and mite. It is not so common

63. leading to exudation
PATHOLOGY
Vascular response
Sudden and extreme
vasodilation
increased permeability
of vessels
Increased connective tissue
formation
Cellular response
Conjunctival infiltration
and exudation
discharge of eosinophils,
plasma cells
Producing histamine and
histamine-like substances
Conjunctival response
Boggy swelling of
conjunctiva
mild papillary hyperplasia

64. Clinical picture
Symptoms
• intense itching
• Burning sensation in the eyes associated with watery discharge
• mild photophobia
Signs.
• Hyperaemia and chemosis conjunctiva
• mild papillary reaction.
• Oedema of lids.
Diagnosis
• typical symptoms and signs
• normal conjunctival flora
• Presence of abundant eosinophils in the discharge

65. Treatment
 Elimination of allergens
 Local palliative measures - immediate relief include
 Vasoconstrictors like adrenaline, ephedrine, and naphazoline.
 Sodium cromoglycate
 Steroid eye drops - avoided. However, these may be prescribed for
short duration in severe and non-responsive patients.
 Systemic antihistaminic drugs

66. ‘Chronic becterial conjunctivitis’ also known as ‘simple chronic conjunctivitis’is
characterized by mild catarrhal inflammation of the conjunctiva.
Etiology
Predisposing factors
• Chronic exposure to dust, smoke, and chemical irritants.
• Local cause of irritation such as trichiasis, foreign body and seborrhoeic scales.
• Eye strain due to refractive errors, phorias or convergence insufficiency.
• Abuse of alcohol, insomnia and metabolic disorders
CHRONIC BACTERIAL CONJUNCTIVITIS
Causative organisms
• Staphylococcus aureus
• Klebsiella pneumoniae,
• Escherichia coli
• Moraxella lacunata

67. Clinical picture
Symptoms
• Burning and grittiness in the eyes, especially in the evening.
• Mild chronic redness in the eyes.
• Feeling of heat and dryness on the lid margins.
• Difficulty in keeping the eyes open.
• Mild mucoid discharge
• Off and on lacrimation.
Signs.
• Congestion of posterior conjunctival vessels
• Mild papillary hypertrophy
• Surface of the conjunctiva looks sticky.
• Lid margins may be congested

68. • Predisposing factors when associated should be treated and
eliminated.
• Topical antibiotics - chloramphenicol or gentamycin should be
instilled 3-4 times a day for about 2 weeks to eliminate the
mild chronic infection.
• Astringent eye drops such as zinc-boric acid drops provide
symptomatic relief.
Treatment

69. वातहतवर्त्म
 स्त्थान –
 ननदान
 संप्राक्प्त
 दोष –
 लक्षण -
वव्ुलत संधि ननश्चेष्टं वर्त्म यस्त्य न ्ील्यते
एतद वातहतं वविात सरुजं यटद वा अरुजं
 धचककर्तसा –
 Lagophtalmos

70.  स्त्थान –
 ननदान
 संप्राक्प्त
 दोष –
 लक्षण -
 धचककर्तसा – साध्य
 Lagophtalmos
वर्त्ामवबंद

71. कण्डू्ताऽल्पतोदेन वर्त्मशोफ
े न यो नराः |
न स्ं छादयेदक्षक्ष भवेद्बन्िाः स वर्त्मनाः
लक्षण
वाग्भट - वणमन नह ं ककया
धचककर्तसा – लेखन

72. Lagophthalmos is characterised by inability to voluntarily close the eyelids.
LAGOPHTHALMOS
Etiology.
• Paralysis of orbicularis oculi muscle
• cicatricial contraction of the lids
• symblepharon
• severe ectropion
• proptosis
• over-resection of the levator muscle for ptosis
• Physiologically some people sleep with their eyes open(nocturnal lagophthalmos)

73. Clinical picture.
It is characterised by incomplete closure of the palpebral aperture associated with
features of the causative disease.
Complications
1. Conjunctival xerosis
• Corneal xerosis
• Exposure keratitis.
Treatment.
• To prevent exposure keratitis artificial tear drops instilled
• Antibiotic eye ointment during sleep
• Soft bandage contact lens may be used to prevent exposure
keratitis.
 Tarsorrhaphy if needed

74. नन्ेष
 स्त्थान –
 ननदान
 संप्राक्प्त
 दोष –
 लक्षण –
नन्ेवषणीाः मसरा वायुाः प्रववष्टो वर्त्मसंश्रयााः
चालयर्तयनत वर्त्मनन नन्ेषाः स गदो ्ताः
 धचककर्तसा –
 Blepharospasm

75. Blepharospasm
It refers to the involuntary, sustained and forceful closure of
the eyelids.
Etiology.
Blepharospasm occurs in two forms:
1. Spontaneous blepharospasm.
It is a rare idiopathic condition involving patients between 45
and 65 years of age.
2. Reflex blepharospasm.
 It usually occurs due to reflex sensory stimulation through
branches of fifth nerve-: phlyctenular keratitis, interstitial
keratitis, corneal foreign body, corneal ulcers and
iridocyclitis.
 It is also seen in excessive stimulation of retina by dazzling
light,
 Stimulation of facial nerve due to central causes

76. Clinical features.
• Persistent epiphora may occur due to spasmodic closure of the canaliculi
• Oedema of the lids
• Spastic entropion (in elderly people)
• Spastic ectropion (in children and young adults) may develop in long-
standing cases.
Treatment.
In essential blepharospasm
 Botulinum toxin, injected subcutaneously over the orbicularis muscle, blocks the
neuromuscular junction and relieves the spasm.
 Facial denervation - in severe cases.
In reflex blepharospasm,
 causative disease should be treated to prevent recurrences.
 Associated complications should also be treated.

77. पक्ष््कोपाः
 स्त्थान –
 ननदान
 संप्राक्प्त
 दोष –
 लक्षण –
दोषााः पक्ष््ाशयगतास्त्तीक्ष्णाग्राणण खराणण च |
ननवमतमयक्न्त पक्ष््ाणण तैघुमष्टं चाक्षक्ष दूयते ||
उद्िृतैरुद्िृतैाः शाक्न्ताः पक्ष््मभश्चोपजायते |
वातातपानलद्वेषी पक्ष््कोपाः स उ्यते ||
 धचककर्तसा – चतुववमि धचककर्तसा
 Trichiasis

78. • स्ननग्धदेहनयोिविष्टनय नरनय,
• भ्रुवोरिस्त्तात परर्ु्य भागौ पक्ष््ाधश्रतं चैक्
तोऽवकृ न्तेत
• कनीनकापाङ्गस्ं स्न्ताद्
• उर्तकृ र्तय शस्त्रेण यवप्र्ाणं
• बालेन सीव्येद
• सवपम्मिु लेप
• व्रणे यत
शस्त्र क्म

79.  It refers to inward misdirection of cilia (which rub against the eyeball) with normal
position of the lid margin.
 The inward turning of lashes along with the lid margin (seen in entropion) is called
pseudotrichiasis.
Etiology.
 Cicatrising trachoma,
 ulcerative blepharitis,
 healed membranous conjunctivitis,
 hordeolum externum,
 Mechanical injuries, burns, and operative scar on the lid margin.
TRICHIASIS

80. Symptoms
 foreign body sensation
 Photophobia
 Patient may feel troublesome irritation,
 Pain and lacrimation.
Signs
 Examination reveals one or more misdirected cilia touching the cornea.
Reflex blepharospasm
 photophobia occur when cornea is abraded.
 Conjunctiva may be congested.
 Signs of causative disease.

81. Treatment.
Epilation (mechanical removal with forceps):
• It is a temporary method, as recurrence occurs within 3-4 weeks.
Electrolysis:
• It is a method of destroying the lash follicle by electric current. In this technique,
infiltration anaesthesia is given to the lid and a current of 2 mA is passed for 10
seconds through a fine needle inserted into the lash root.
Cryoepilation:
• It is also an effective method of treating trichiasis. After infiltration anaesthesia,
the cryoprobe (–20 °C) is applied for 20-25 seconds to the external lid margin.
Its main disadvantage is depigmentation of the skin.
Surgical correction:
• When many cilia are misdirected operative treatment similar to cicatricial
entropion should be employed

82.  स्त्थान –
 ननदान
 संप्राक्प्त
 दोष –
 लक्षण -
एवामरुबीजप्रनत्ााः वपडका ्न्दवेदनााः |
सूक्ष््ााः खराश्च वर्त्मस्त्थास्त्तदशोवर्त्म कीर्तयमते
 धचककर्तसा – छेदन साध्य
 lid papilloma
अशो वर्त्म

83. शुष्कअशम
 स्त्थान –
 ननदान
 संप्राक्प्त
 दोष –
 लक्षण -
द घोऽङ्क
ु राः खराः स्त्तब्िो दारुणो वर्त्मसम्भवाः |
व्याधिरेष स्ाख्याताः शुष्काशम इनत सक्ञ्ज्ञताः |
 धचककर्तसा – छेदन साध्य
 lid papilloma

84.  स्त्थान –
 ननदान
 संप्राक्प्त
 दोष –
 लक्षण -
वर्त्ामन्तरस्त्थं ववष्ं ग्रक्न्थभूत्वेदन् |
ववज्ञेय्बुमदं पुंसां सरलत्वलक्म्बत्
 धचककर्तसा – छेदन साध्य
 Benign tumors of lid
वर्त्मअबुमद

85.  स्त्थान –
 ननदान
 संप्राक्प्त
 दोष –
 लक्षण -
नछन्नाक्श्छन्ना ववविमन्ते वर्त्मस्त्था ्ृदवोऽङ्क
ु रााः |
दाहकण्डूरुजोपेतास्त्तेऽशमाः शोणणतसम्भवााः
 धचककर्तसा – असाध्य
 Malignant tumors of lid
शोणणताशम

86. Almost all types of tumours arising from the skin, connective tissue,
glandular tissue, blood vessels, nerves and muscles can involve the lids.
Classification
1. Benign tumours. simple papilloma, naevus, angioma, haemangioma,
neurofibroma and sebaceous adenoma.
2. Pre-cancerous conditions. These are solar keratosis, carcinoma-in-situ
and xeroderma pigmentosa.
3. Malignant tumours.
squamous cell carcinoma, basal cell carcinoma, malignant
melanoma
TUMOURS OF THE LIDS

87. Papillomas
 These are the most common benign tumours arising
from the surface epithelium.
 These occur in two forms:
 squamous papillomas
 seborrhoeic keratosis
BENIGN TUMOURS
Squamous papillomas
 occur in adults, as very slow growing or stationary,
raspberry-like growths or as a pedunculated lesion,
 usually involving the lid margin.
 treatment - simple excision.
Seborrhoeic keratosis
middle-aged and older persons.

88.  These are creamy-yellow plaque-like lesions which
frequently involve the skin of upper and lower lids
near the inner canthus
 Xanthelasma occurs more commonly in middle-aged
women.
 Xanthelasma represents lipid deposits in histiocytes
in the dermis of the lid.
 These may be associated with diabetes mellitus or
high cholesterol levels.
Xanthelasma
Treatment:
 Excision may be advised for cosmetic reasons; but recurrences are common.

89. Basal-cell carcinoma
• It is the commonest malignant tumour of the lids (90%) usually seen in
elderly people.
• It is locally malignant and involves most commonly lower lid (50%)
followed by medial canthus (25%), upper lid (10-15%) and outer canthus
(5-10%).
MALIGNANT TUMOURS
Clinical features -present in four forms:
 Non ulcerative nodular form
 Sclerosing morphea type
 Pigmented basal cell ca
 Noduloulcerative basal cell carcinoma
• most common presentation. It starts as a small nodule which undergoes central
ulceration with pearly rolled margins. The tumour grows by burrowing and
destroying the tissues locally like a rodent and hence the name.

90. Treatment
 Surgery.
 Local surgical excision of the tumour along with a 3 mm surrounding area
of normal skin with primary repair is the treatment of choice.
 Radiotherapy and cryotherapy

91. • It forms the second commonest malignant tumour of the lid.
• Its incidence (5%) is much less than the basal cell carcinoma.
• It commonly arises from the lid margin (mucocutaneous junction) in
elderly patients. Affects upper and lower lids equally.
Clinial features.
It may present in two forms:
An ulcerated growth with elevated and indurated margins
is the common presentation .
The second form, fungating or polypoid verrucous lesion without
ulceration, is a rare presentation.
Metastasis. It metastatises in preauricular and submandibular lymph
nodes.
Squamous cell carcinoma
Treatment on the lines of basal cell carcinoma.

92. क
ु क
ू णक
 स्त्थान –वागभट ने वर्त्मगत रोगों ्े वणमन ककया
 सुश्रुत ने 76 नेर रोगों क
े अलावा वणमन ककया है
 ननदान – सुश्रुत – दुष्ट स्त्तन्यजन्य
- वागभट – दांतोंभेदजन्य
 दोष – कफ वात वपत रलत
 संप्राक्प्त- स्त्तन्यप्रकोपकफ्ारुतवपत्तानरलतैबामलाक्षक्षवर्त्मभव एव क
ु क
ू णकोऽन्याः
 लक्षण –
्ृद्गानत नेर्नतकण्डु्थाक्षक्षक
ू टं नासाललाट्वप तेन मशशुाः स ननर्तय्
सूयमप्रभां न सहते स्रवनत प्रबद्िं,

93.  हरेद् रुधिर्ाशु – रलत ्ोक्षण
 ववननमलमखे्च –
 प्रनतसारण - क्षौद्रायुतैश्च कटुमभाः
 व्न वविान
• क्षीरप – ्ाता दुग्ि + अपा्ागम बीज +सेंिव +्िू
• क्षीरान्नाद – वचा चूणम से
• अन्नाद – ्दनफल से
 गुटटकांजन प्रयोग
धचककर्तसा

94. Ophthalmia neonatorum is the name given to bilateral inflammation of
the conjunctiva occurring in an infant, less than 30 days old.
It is a preventable disease usually occurring as a result of carelessness at
the time of birth.
As a matter of fact any discharge or even watering from the eyes in the
first week of life should arouse suspicion of ophthalmia neonatorum,as
tears are not formed till then.
OPHTHALMIA NEONATORUM
Etiology
Source and mode of infection
Infection may occur in three ways: before birth, during birth or after birth.
Before birth –
• very rare through infected liquor amnii in mothers with ruptured membrances

95. During birth.
• It is the most common mode of infection from the infected
birth canal especially when the child is born with face
presentation
After birth.
• Infection may occur during first bath of newborn or from soiled
clothes or fingers with infected lochia

96. Causative agents
Chemical conjunctivitis - It is caused by silver nitrate or
antibiotics used for prophylaxis.
Gonococcal infection
Other bacterial infections
• Staphylococcus aureus, Streptococcus haemolyticus, and
Streptococcus pneumoniae.
Neonatal inclusion conjunctivitis
• serotypes D to K of Chlamydia trachomatis is the commonest
cause of ophthalmia neonatorum in developed countries.
Herpes simplex ophthalmia neonatorum is a rare condition

97. Clinical features
Incubation period
It varies depending on the type of the causative agent as shown below:
Causative agent Incubation period
1. Chemical 4-6 hours
2. Gonococcal 2-4 days
3. Other bacterial 4-5 days
4. Neonatal inclusionconjunctivitis 5-14 days
5. Herpes simplex 5-7 days

98. Symptoms and signs
 Pain and tenderness in the eyeball.
 Conjunctival discharge.
• It is purulent in gonococcal ophthalmia neonatorum and mucoid or
mucopurulent in other bacterial
 Lids are usually swollen.
 Conjunctiva may show hyperaemia and chemosis.
 Corneal involvement, though rare, may occur in the form of superficial punctate
keratitis especially in herpes simplex ophthalmia neonatorum.

99. Treatment
Prophylactic treatment is always better than curative.
Prophylaxis
Antenatal measures - care of mother and treatment of genital infections when
suspected.
Natal measures are of utmost importance, as mostly infection occurs during child
birth. Deliveries should be conducted under hygienic conditions taking all aseptic
measures. The newborn baby's closed lids should be thoroughly cleansed and dried.
Postnatal measures include : Use of either 1 percent tetracycline ointment or 0.5
percent erythromycin ointment or 1 percent silver nitrate solution (Crede's method)
into the eyes of the babies immediately after birth.
 Single injection of ceftriaxone 50 mg/kg IM or IV (not to exceed 125 mg) should be
given to infants born to mothers with untreated gonococcal infection

100. Curative treatment.
culture sensitivity swabs should be taken before starting the
treatment.
Chemical ophthalmia neonatorum is a self-limiting
condition, and does not require any treatment.
Gonococcal ophthalmia neonatorum
Topical therapy :
• Saline lavage hourly till the discharge is eliminated.
• Bacitracin eye ointment 4 times/day.
• If cornea is involved then atropine sulphate ointment
should be applied
Systemic therapy.
• Ceftriaxone 75-100 mg/kg/day IV or IM, QID.
• Cefotaxime 100-150 mg/kg/day IV or IM, 12 hourly.
• Ciprofloxacin 10-20 mg/kg/day or Norfloxacin10 mg/kg/day.
• If the gonococcal isolate is proved to be susceptible to penicillin G
50,000 units to full term

101. Other bacterial ophthalmia neonatorum
• be treated by broad spectrum antibiotic drops and ointments for 2 weeks.
Neonatal inclusion conjunctivitis
• responds well to topical tetracycline 1 per cent or erythromycin 0.5 per cent
eye ointment QID for 3 weeks
Herpes simplex conjunctivitis
• usually a selflimiting disease.
• topical antiviral drugs