1. Upadaha refers to cysts or swellings that occur in specific areas. The symptoms include minimal swelling in the gland region and a soft blueish swelling. Sushruta describes upadaha as curable through incision, application of soothing medicines, and drainage. 2. Pivani refers to circular inflammatory lesions on the conjunctiva that are red, hot, painful and associated with bleeding. Sushruta recommends excising pivani through a surgical incision in the upper and lateral parts under traction with a thread, followed by cauterization and application of soothing medicines. 3. Alaji is described as incurable, suggesting it may represent a malignant condition unlike the benign

1. संधिगत रोग

2.  संख्या – 9 सुश्रुत = वागभट=भा.व.=यो.र
 पववणी,पूयालस,अलजी,उपनाह,कृ मिग्रन्थि,4 स्त्राव(पपतस्त्राव,कफस्त्राव,रक्तस्त्राव,पूयस्त्राव)
 वागभट – जल स्त्राव
पूयालस
 स्त्िान –
 ननदान
 दोष – सननपात
 लक्षण -
 धिककत्सा – वेिन साध्य
 Acute dacryocystitis

3. पक्वः शोफः सन्थिजः संस्रवेद्यः साथरं पूयं पूनत पूयालसः सः
सुश्रुत
वागभट
लक्षण

5. धिककत्सा
पूयालसे शोणणतिोक्षणं ि हहतं तिैवाप्युपनाहनं ि |
कृ त्स्त्नो पवधिश्िेक्षणपाकघाती यिापविानं मभषजा प्रयोज्यः
• वेिन साध्य
• शोणणतिोक्षणं
• उपनाहनं
• पवधिश्िेक्षणपाकघाती
• अञ्जन • कासीसमसथिुप्रभवारवक
ै स्त्तु हहतं भवेदञ्जनिेव िार |
क्षौरान्थवतैरेमभरिोपयुञ्ज्यादथयत्तु ताम्रायसिूणवयुक्तैः

7. Dacryocystitis
• Definition – inflammation of lacrimal sac is called dacryosystitis.
• Types –Congenital
- Acquired -Acute dacryosystitis
-Chronic dacryosystitis
Acute dacryosystitis
Definition – acute suppurative inflammation of the lacrimal sac characterized by
presence of painful swelling in the sac region

8. Etiology –
• Causative organism – streptococcus haemolytic , staphylococcus, pneumococcus
• Acute develop in 2 ways
Acute exacerbation of
chronic dacryocystitis
Acute peridacryosititis due to involvement
from infected neighboring structures
(PNS infection, dental abscess, bone
infection)

9. Clinical features
Divided in to 3 stages- stage of cellulitis
- stage of lacrimal abscess
- stage of fistula formation
 Stage of cellulitis
- Characterized by painful swelling in lacrimal sac
- Associated with epiphora , fever and malaise
- Red ,hot, firm swelling
Stage of lacrimal abscess
Continues inflammation –occlusion canaliculi –sac filled
with pus – abscess formation

10. Stage of fistula formation
- Abscess untreated – fistula formation
External fistula
Below palpebral ligament
Internal fistula
Into nasal cavity

12. Complications
• Acute conjunctivitis
• Corneal abrasion
• Lid abscess
• Lacrimal bone – osteomyelitis
• Orbital cellulitis
• Rarely cavernous sinus thrombosis
Treatment
Stage of cellulitis
 Topical antibiotic
 Systemic anti-inflammatory
 Analgesic
 Hot fomentation

13. Stage of Abscess
 t/t of stage of cellulitis
 Pus point – drain with small incision
 DCT/DCR Sx – depend on condition
Stage of Fistula formation
 Fistulectomy along with DCT/DCR

14. CHRONIC DACRYOCYSTITIS
- More common than the acute
Etiology
- Multifactorial disease
- Due to stasis of vicious cycle mild infection for long duration
• Age – 40 to 60 yr age group
• Sex – common in female
• Heredity – due to facial configuration
• Socioeconomical status – lower
Predisposing factors

15. Cause of stasis of tear in lacrimal sac
• Anatomical cause – narrow bony canal , fold in NLD
• FB in sac
• Excessive lacrimation
• Obstruction of NLD by nasal polyp, DNS , Atrophic rhinitis etc.
 Causative organism – streptococci ,pneumococci ,staphylococci
 Source of infection – conjunctivitis, rhinitis , PNS infection

16. CLINICAL STAGES
Divided in to 4 stages
 Stage of chronic catarrhal dacryocystitis
 Stage of lacrimal mucocele
 Stage of chronic suppurative dacryocystitis
 Stage of chronic fibrotic sac

17.  Stage of chronic catarrhal dacryocystitis
• Mild infection of sac associated with NLD blockage
• Symptoms – watering of eye is only symptoms
• Regurgitation – clear fluid / mucoid flake
Stage of lacrimal mucocele
• Chronic stagnation – distension of lacrimal sac
• Symptoms – constant epiphora with swelling below the inner cantus
• Regurgitation test – gelatinous mucoid flake
 Encysted mucocele – due to chronic infection –both canaliculi blocked – large swelling
seen at the inner canthus with negative regurgitation

19. Stage of chronic suppurative dacryocystitis
• Pyogenic infection – mucoid discharge become purulent
• Mucocele converted into pyocele
• Symptoms – epiphora associated with recurrent conjunctivitis
and swelling below inner canthus
• Regurgitation – purulent discharge
Stage of chronic fibrotic sac
• Repeated infection – thickening of mucosa – fibrotic sac
• Symptoms – epiphora with discharge

20. Treatment
• Conservative treatment – repeated syringing in early case
• Balloon catheter dilation – useful in partial NLD blockage
• DCR
• DCT – when DCR is contraindicated

21. सम्प्राप्ति
स्राव
 4 स्राव
 स्त्िान –
 संधि
 ननदान
 दोष –
 सम्प्प्रान्प्त
 लक्षण -
 धिककत्सा – असाध्य
 Chronic dacryocystitis
गत्वा सथिीनश्रुिागेण दोषाः क
ु युवः स्रावान् रुन्ववहीनान् कनीनात्
तान् वै स्रावान् नेरनाडीििैक
े तस्त्या मलङ्गं कीतवनयष्ये ितुिाव

22. लक्षण
• पूयास्राव - पाकः सथिौ संस्रवेद्यश्ि पूयं पूयास्रावो नैकरूपः प्रहदष्टः |
• श्लेष्िास्राव - श्वेतं साथरं पपन्छिलं संस्रवेद्यः श्लेष्िास्रावो नीरुजः स प्रहदष्टः|
• रक्तास्राव - रक्तास्रावः शोणणतोत्िः सरक्तिुष्णं नाल्पं संस्रवेथनानतसाथरि् |
• पपत्तास्राव - पीताभासं नीलिुष्णं जलाभं पपत्तास्रावः संस्रवेत् सन्थििध्यात् |
 धिककत्सा – असाध्य

23. Watering eye

24. Watering of eye
INTRODUCTION
 It is characterised by overflow of tear from conjunctival sac.
 Occurs due to excess secretion of tears (Hyper lacrimation)
 or result from obstruction to the outflow of tear path (Epiphora).

25. • Hyper lacrimation-
• Primary Hyper lacrimation direct stimulation ( lacrimal tumour , cyst)
Drug effect of gland
• Reflex Hyper lacrimation Stimulation of sensory branch 5th nerve
Lid- Stye, Hordeolum, Meibomitis, Trichiasis, Concretion.
Conjunctiva- Conjunctivitis.
Cornea- Corneal abrasion, Ulcers, Keratitis.
Sclera- Scleritis, Episcleritis.
Uveal tissue- Iritis, Cyclitis, Iridocyclitis, Acute glaucoma.
• Central lacrimation- Occur in emotional condition.

26. Cause of Epiphora-
1. Physiological cause- Lacrimal pump failure due to lower lid laxity or
weakness of orbicularis muscle.
2. Mechanical cause
-Punctal cause- -Erosion of lower punctal - lid laxity
- Punctal obstruction
-Canaliculi cause- - Canaliculitis (most common)
- Congenital & Acquired
EPIPHORA
-Lacrimal Sac- Dacryocystitis, Traumatic stricture, FB.
-Nasolacrimal duct- -Congenital- Non canalization, Partial canalization.
- Acquired- Traumatic strictures and Inflammatory
stricture.

27. 1. Slit lamp diffuse examination- Rule out the cause of Reflex,
Hyper lacrimation of cornea, conjunctiva, lid, sclera, uveal
tissue.
2. Regurgitation Test- Mucopurulent secretion-Indicates chronic
Dacryocystitis
Clinical evaluation of watering eye-
3. Fluorescein dye disappearance test
• normally- no dye in sac
• obstruction – retention of dye
4. Lacrimal syringing test
• normally- saline came in to throat/nose
• obstruction –no fluid passes
5. Jone dye 1/2
6. dacryocystography

28. उपनाह
 स्त्िान –
 संधि
 ननदान
 दोष –
 लक्षण -
 धिककत्सा – साध्य
 Lacrimal cyst / mucocele

29. लक्षण
ग्रन्थिनावल्पो दृन्ष्टसथिावपाकः कण्डूप्रायो नीरुजस्त्तूपनाहः
वागभट

30. धिककत्सा
मभत्त्वोपनाहं कफजं पपप्पलीििुसैथिवैः
लेखयेथिण्डलाग्रेण सिथतात् प्रछियेदपप
• भेदन
• पपप्पली ििु सैथिव प्रनतसारण
• लेखन -िण्डलाग्र द्वारा
• प्रछिन

31. पववणी
 स्त्िान –
 संधि
 ननदान
 दोष –
 लक्षण -
 धिककत्सा – िेदन साध्य
 Benign conjuctival tumors

32. लक्षण
ताम्रा तथवी दाहशूलोपपथना रक्ताज्ञेया पववणी वृत्तशोफा |
जाता सथिौ कृ ष्णशुक्लेऽलजी स्त्यात्तन्स्त्िथनेव ख्यापपता पूववमलङ्गैः (सु उ)

33.  धिककत्सा – िेदन साध्य
सथिौ संस्त्वेद्य शस्त्रेण पववणीकां पविक्षणः
उत्तरे ि त्ररभागे ि बडडशेनावलन्म्प्बताि् ||
निथद्यात्ततोऽिविग्रे, स्त्यादश्रुनाडी ह्यतोऽथयिा |
प्रनतसारणिरापप सैथिवक्षौरमिष्यते ||
लेखनीयानन िूणावनन व्याधिशेषस्त्य भेषजि् |
• सथिौ संस्त्वेद्
• पकड़े -उत्तरे ि त्ररभागे –बडडश यंर से अवलन्म्प्बत
• िेदन किव – अिव अग्रे
• प्रनतसारण – सैथिव + क्षौर
• व्याधिशेष - लेखनीय िूणव

34. अलजी
 स्त्िान –
 संधि
 ननदान
 दोष –
 लक्षण -
 धिककत्सा – असाध्य
 Malignant conjuctival tumors

35. लक्षण
जाता सथिौ कृ ष्णशुक्लेऽलजी स्त्यात्तन्स्त्िथनेव ख्यापपता पूववमलङ्गैः (सु उ)
(वागभट)

36. Non-pigmented tumours
I. Congenital: dermoid and lipodermoid
II. Benign: granuloma, papilloma, fibroma .
III. Premalignant: intraepithelial epithelioma
(Bowen's disease).
IV. Malignant: epithelioma or squamous cell
carcinoma, basal cell carcinoma.
TUMOURS OF THE CONJUNCTIVA
Pigmented tumours
I. Benign: naevi or congenital moles.
II. Precancerous : superficial melanoma
lentigo maligna
(Hutchinson’s freckle).
III. Malignant: malignant melanoma
Classification

37. BENIGN TUMOUR
NAEVUS/CONGENITAL MOLES
• Common pigmented lesions
• grey, brown or black, flat or slightly raised nodules
on the bulbar conjunctiva, mostly near the limbus
• Usally appear during early childhood and may
increase in size at puberty or during pregnancy.
• Malignant change is very rare and when occurs is
indicated by sudden increase in size.
 Excision is usually indicated for cosmetic reasons
and rarely for medical reasons.

38. • extensive polypoid, cauliflower-like growth of granulation
tissue.
• Simple granulomas are common following squint surgery,
as foreign body granuloma and inadequately scraped
chalazion.
Treatment consists of complete surgical removal.
Simple granuloma
• It is benign polypoid tumour usually occurring at inner
canthus, fornices or limbus.
• It may resemble the cocks comb type of conjunctival
tubercular lesion.
 It has a tendency to undergo malignant change and hence
needs complete excision.
Papilloma

39. • Usually occurs at the transitional zones i.e. at limbus and the lid
margin.
• The tumour invades the stroma deeply and may be fixed to
underlying tissues.
Treatment.
 Early cases treated by complete local excision combined
 In advanced and recurrent cases radical excision including
enucleation Or postoperative radiotherapy.
Fibroma
 It is a rare soft or hard polypoid growth usually occurring in lower fornix
Squamous cell carcinoma (epithelioma)

40. • It may invade the conjunctiva from the lids or from the plica
semilunaris or caruncle.
• it responds very favourably to radiotherapy,
the complete surgical excision
Basal cell carcinoma
• It may present as pigmented mass near limbus or on any other part of
the conjunctiva.
• It spreads over the surface of the globe and rarely penetrates it.
• Distant metastasis occurs elsewhere in the body, commonly in liver.
Treatment. Once suspected, enucleation or exenteration is the treatment
of choice, depending upon the extent of growth.
Malignant melanoma

41. किमिग्रन्थि
 स्त्िान –
 संधि
 ननदान
 दोष –
 लक्षण -
 धिककत्सा – भेदन साध्य
 Blephriritis

42. किमिग्रन्थिववत्िवनः पक्ष्िणश्ि कण्डूं क
ु युवः किियः सन्थिजाताः |
नानारूपा वत्िवशुक्लस्त्य सथिौ िरथतोऽथतनवयनं दूषयन्थत
लक्षण

43. सम्प्यन्क्स्त्वथने कृ मिग्रथिौ मभथने स्त्यात् प्रनतसारणि्
त्ररफलातुत्िकासीससैथिवैश्ि रसकिया
धिककत्सा
• स्त्वेदन सम्प्यक
• भेदन
• प्रनतसारण –त्ररफला तुत्ि कासीस सैथिव

44. It is a subacute or chronic inflammation of the lid margins.
 It is an extremely common disease which can be divided into following
clinical types:
1. Seborrhoeic or squamous blepharitis,
2. Staphylococcal or ulcerative blepharitis,
3. Mixed staphylococcal with seborrhoeic blepharitis,
4. Posterior blepharitis or meibomitis, and
5. Parasitic blepharitis.
BLEPHARITIS

45. Seborrhoeic or squamous blepharitis
• It is usually associated with seborrhoea of scalp (dandruff).
• Some constitutional and metabolic factors play a part in its etiology. In it,
glands of Zeis secrete abnormal excessive neutral lipids which are split
by Corynebacterium acne into irritating free fatty acids.
Etiology.
Symptoms.
• whitish deposition material at the
lid margin
• mild discomfort
• Irritation
• occasional watering
• falling of eyelashes

46. Signs.
• Accumulation of white dandruff-like scales are seen on the lid
margin
• On removing these scales underlying surface is found to be
hyperaemic (no ulcers)
• lashes fall out easily but are replaced quickly
• General measures - improvement of health and balanced diet.
• Local measures – removal of scales from the lid margin with the help of lukewarm
solution of 3 percent sodabicarb or baby shampoo
- application of combined antibiotic and steroid eye ointment
Treatment.

47. Ulcerative blepharitis
Etiology.
• It is a chronic staphylococcal infection of the lid margin.
• usually starts in childhood and may continue throughout life
• Chronic conjunctivitis and dacryocystitis may act as predisposing factors
Symptoms.
• chronic irritation
• itching
• mild lacrimation
• gluing of cilia
• photophobia
• symptoms are characteristically worse in the
morning

48. • Yellow crusts are seen at the root of cilia which glue
them together
• Small ulcers are seen on removing the crusts.
• In between the crusts, the anterior lid margin may
show dilated blood vessels (rosettes).
Signs
Treatment.
• Crusts should be removed after softening
• hot compresses with solution of 3 percent soda bicarb
• Antibiotic ointment - after removal of crusts, at least twice
daily
• Antibiotic eyedrops should be instilled 3-4 times in a day.
Avoid rubbing of the eyes
• Oral antibiotics

49. seen in longstanding cases
• Chronic conjunctivitis
• madarosis (absence of lashes)
• Trichiasis
• poliosis (greying of lashes),
• tylosis(thickening of lid margin)
• Recurrent styes is a very common
complication.
Complications

50.  it is a meibomian gland dysfunction
 more commonly in middle-aged persons with acne rosacea and
seborrhoeic dermatitis.
 It is characterized by white frothy (foam-like) secretion
 At the lid margin, openings of the meibomian glands become prominent
with thick secretions
Posterior blepharitis (Meibomitis)
Chronic meibomitis
Acute meibomitis
 mostly due to staphylococcal infection.

51. meibomitis

52. Treatment
 Expression of the glands by repeated vertical lid massage
 Rubbing of antibiotic-steroid ointment at the lid margin.
 Antibiotic eyedrops should be instilled 3-4 times.
 Systemic tetracyclines for 6-12 weeks remain the mainstay of
treatment of posterior blepharitis.
 Erythromycin may be used where tetracyclines are contraindicated.

53.  Chronic blepharitis associated with Demodex folliculorum infection
and Phthiriasis palpebram.
 Chronic blepharitis characterized by presence of nits at the lid margin
and at roots of eyelashes
 Treatment
 Mechanical removal of the nits with forceps
 Rubbing of antibiotic ointment on lid margins
 Delousing of the patient, other family members, clothing and bedding.
Parasitic blepharitis

54. Phthiriasis palpebram