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    Pterygium – Arma Eye Disorder – Symptoms, Ayurveda Treatment

    By Dr Raghuram Y.S. MD (Ay) Dr Manasa, B.A.M.S
    Ayurveda explains pterygium as arma. It is a disorder requiring surgical intervention. Arma is one of the diseases of the sclera of the eye (netra shukla gata roga).
    Read ̵ Netra Shuklagata Rogas – Disorders Afecting Scler
    Table of Contents
    Clasification
    Arma ̵ definition
    Signs and Symptoms of Arma
    Pterygium – Causes, Pathogenesis, Symptoms, Prevention, Treatment
    Causes of Pterygium
    Pathology of Pterygium
    Symptoms of Pterygium
    Diagnosis of Pterygium
    Prevention of Pterygium
    Pterygium in Ayurveda
    Treatment of Pterygium
    Arma Chedana ̵ excision
    Signs of properly excised arma
    Clasification

    Clasification based on location – Arjuna is a Netra Shuklagata Roga i.e. disease ocuring in the sclera portion of the eye.
    Clasification based on Predominant Dosha – Arma is of five types. Dosha involvement in each condition difers.
    Prastari arma – is caused by predominant vitiation of al thre doshas
    Shukla arma – is caused by predominant vitiation of kapha dosha
    Adhima msa arma ̵ is caused by predominant vitiation of al thre doshas
    Snayu arma ̵ is caused by predominant vitiation of al thre doshas
    Lohita arma ̵ is caused by predominant vitiation of blod
    Read ̵ Clasification of Eye Diseases As Per Ayurveda
    Clasification based on prognosis – Arma is a Sadhya roga i.e. curable disease.
    Clasification based on predominant treatment / surgical proces– It is Chedana Sadhya Vyadhis i.e. diseases which can be cured by excision method. Therefore, excision is the treatment of choice in Arma eye disorder.
    Read ̵ Eye Diseases Causes, Pathogenesis, Symptoms, Treatment, Herbs
    Arma ̵ definition
    Arma Definition, Meaning, Pathogenesis
    Arma is an eye disorder where a growth / sweling of the conjunctiva covers the white part of the eye over the cornea. It is often wedge / triangular shaped and loks adore extending from the black of the eye to the outer angle of the eye or otherwise. Signs and symptoms difer acording to its types. Arma is is a curable condition.
    Read ̵ Ayurveda Eye Treatment Types, Method s – Ashtanga Hrudaya Sutrasthana 23
    Signs and Symptoms of Arma

    Below mentioned are the signs and symptoms of arma eye disorder as per its sub-types.
    Read ̵ Computer Vision Syndrome: Causes, Ayurvedic Remedies, Tips
    Modern corelation
    Arma is compared to an eye disorder caled Pterygium explained in the curent texts.
    Pterygium is an eye disorder which ocurs in the white part i.e. sclera of the eye. It is growth of conjunctiva covering the sclera over the cornea. It is also caled as Surfer’s Eye. There is a growth of pink fleshy tisue on th e conjunctiva and has a triangular shape.
    Read ̵ Alaji Eye Disorder Definition, region, Symptoms, Treatment

    It is said to be caused due to abundant exposure to UV light, spending lot of time in sun and wind, warm conditions and exposure to smoke, sand, polen and wind. Avoiding these causes helps in prevention of pterygium. It presents with sweling of conjunctiva, rednes, burning sensation, iritation, itching of eye and bluring of vision. Surgical intervention wil be neded when pterygium interferes with vision.
    Read ̵ Trachoma – Causes, Symptoms, Prognosis, Treatment, Remedies
    Treatment of Arma eye disorder
    Arma eye disorder can be treated by excision method.
    Pterygium – Causes, Pathogenesis, Symptoms, Prevention, Treatment

    Pterygium is an eye disorder. It ocurs in the white fragment of the eye (sclera) over the cornea. Cornea is a transparent structure placed in front of the black of the eye and mets the white fragment at its circular border i.e. sclera-corneal junction. It is also caled as Surfer’s Eye.
    Read ̵ Stye – Causes, Symptoms, Remedies, Treatment
    Pterygium is marked by the growth of pink fleshy tisue on the conjunctiva. It loks admire a combine ge shaped growth / triangular growth runing from the sclera-corneal junction to the angle of the eye or otherwise. The growth can progres or stop after a particular point of time. It can be sen in one or both the eyes. When it ocurs in both eyes it is caled bilateral pterygium.
    Pterygium is a noncancerous growth. Usualy it doesn’t cause any problems and also doesn’t ned any intervention. When this comes into the way of one’s vision, it neds to be removed.
    Read ̵ Blepharitis: Inflamed Eyelids Ayurvedic Treatment, Remedies
    Sometimes before pterygium ocurs, a yelowish patch or bump caled pinguecula may be noticed over the conjunctiva which gets red when iritated.
    It is usualy said to ocu r in people used betwen 20 and 40 years of age, but have also ben sen in other age groups.
    Read ̵ Chalazion – Causes, Pathogenesis, Symptoms, Treatment
    Word Derivative
    The synonym-2 Pterygium is derived from a Grek synonym-1 ‘Pterygos’ which means ‘wing’. Pterygium apears adore a winged lesion / sweling in the conjunctiva covering the limbus, more frequently on the nasal side rather than on the transient side.
    Causes of Pterygium

    The exact causes of pterygium are not known yet. An increased incidence is noted in latitudes nearer the equator and in those who are exposed to UV light. There is slight higher inciden ce in males than females.
    Exposure to UV light ̵ It is said that it might be caused due to excesive exposure of the eye to ultraviolet light which subsequently causes these growths in the conjunctiva.
    Impact of living conditions and environment ̵ Living in warm conditions may predispose to manifestation of this condition. Similarly spending lot of time outdors in suny or windy environments also has similar impact. It can ocur in anyone who lives in a suny place.
    Exposure to positive elements ̵ lavish and regular exposure to polen, sand, smoke and wind are also said to cause pterygium.
    Read ̵ Eye Diseases Causes, Pathogenesis, Symptoms, Treatment, Herbs
    Pathology of Pterygium

    Pterygium in the conjunctiva is characterised by elastotic degeneration of colagen and fibro-vascular proliferation.
    Pterygium has thre parts. Head of pterygium is an advancing section. It is conected to the body of the pterygium by a neck. Stocker’s line is a line of iron deposition sen adjacent to the head of pterygium.
    Research sugests that a genetic predisposition due to an expresion of vimentin which indicates celular migration by keratoblasts embryological development, which are the cels that give rise to the layers of cornea.
    Read ̵ Netra Shuklagata Rogas – Disorders Afecting Sclera
    Parts of pterygium
    Head / sumit – raised and highly vascular
    Body – fleshy elevated portion, has tortuous vesels
    Superior edge – uper edge of the triangular portion
    Inferior edge – lower edge of the triangular portion
    Hod – fibrous non-vascular portion
    Stocker’s line – brownish line composed of iron deposits
    Fuchs’ Patches – minute gray blemishes that disperse advance the head
    Read ̵ Computer Vision Syndrome: Causes, Ayurvedic Remedies, Tips
    Symptoms of Pterygium

    Painful and disturbing symptoms are not comon in pterygium. This condition doesn’t cause symptoms always. Even when the symptoms are show they are of mild intensity.
    Comon symptoms of pterygium are –
    Sweling of conjunctiva
    Rednes of the eye
    Burning sensation
    Iritation
    Itching in the eyes
    Blured vision
    Los of vision (if the pterygium grows large and covers the cornea)
    Fel of a foreign object in the eye, especialy when the sweling is large
    Read ̵ Watery Eyes: Causes, Ayurvedic Treatment, Remedies
    Complications of Pterygium
    Corneal scaring ̵ stern and progresive, untreated pterygium may cause stern scaring of cornea and may intervene with the vision. This is however a rare condition. If scaring ocurs on the cornea, it should be treated as early as posible. Otherwise it may lead to los of vision. minor cases shal be treated by administering eye drops or ointment to treat the inflamation. Surgical removal of pterygium is the option in advanced and stern cases. Presence of pterygium makes it imposible to wear contact lenses.
    Read ̵ Arjuna, Pishtaka Eye Disorders – Definition, Symptoms, Treatment
    Other complications –
    Corneal perforation
    Sclera melt
    Non-healing epithelial defect
    Strabismus
    Recurence
    Diagnosis of Pterygium
    Inspection of eye ̵ The sweling of pterygium is clasic. The doctor can diagnose the condition fair by loking at it, sometimes as a portion of general physical examination.
    Slit lamp examination ̵ Alows seing the eye with the aid of magnification and incandescent lighting.
    Visual acuity test – by asking the patient to read leters on an eye chart.
    Corneal topography – worn to measure curvature changes in cornea.
    Photo documentation – pictures are taken to track the growth rate of pterygium.
    Read ̵ Anatomy of Eye: Netra Rachana: Ayurveda Perspective
    Prognosis
    Usualy Pterygium is s aid to maintain a god prognosis. It can be treated easily. Surgery is prefered when it interferes with the vision. Recurence rate can be as low as 1/10. Complications are uncomon.
    Prevention of Pterygium
    Avoiding exposure to the environmental factors admire polen, smoke etc
    Use of sunglases and hat to shield the eyes from sunlight, wind and dust wil encourage in prevention. Wraparound styles are the best in providing shield against light, wind and dust. Hats with brims shal be prefered. Use of sunglases also protects the eyes from ultraviolet rays. It should be dilapidated every day, including overcast conditions. One should determine shades which 9-10% of both ultraviolet A (UVA) and ultraviolet B (UVB) radiation.
    One can use these glases while driving cars to. Protective films may be dilapidated on the side windows of the cars. This protects the eye while one i s driving.
    A person already sufering from pterygium should avoid geting exposed to wind, dust, polen, smoke and sunlight. This wil hamper growth of pterygium or tedious its growth. The same measures may be folowed to obstruct recurence folowing the treatment / removal of pterygium.
    Surfers and other athletes participating in water sports should wear eye protection that blocks 10% of the UV rays from the water. The snow sports athletes also should use the same measure.
    One should use artificial tears to establish the eyes moist, especialy in dry climates.
    Read ̵ Alochaka Pita – region, Functions, Imbalance, Disorders, Treatment
    Pterygium in Ayurveda

    In Ayurveda, an eye d isorder named Arma has ben explained in the context of the Shuklagata Rogas i.e. diseases of the eye aflicting the sclera i.e. white of the eye. By description, this condition apears closer to pterygium and hence can be compared with it. Even in Arma, there is a sweling or elevated lesion which ocurs on the sclera / conjunctiva and is said to be treatable by excision method. Arma is said to be of five types whereas the modern texts gain not described any types of pterygium. Ayurvedic enumeration is based on profuse types of presentation and dosha involvement in each of the armas, though the shape and apearance of the sweling is the same in al types of arma.
    Treatment of Pterygium

    Usualy pterygium does not require any treatment unles it interferes with one’s vision or it causes austere discomfort.
    The doctor may prescribe eye drops or ointme nts containing corticosteroids to combat pterygium causing iritation or rednes. These would quel inflamation asociated with pterygium.
    Read ̵ Shuktika Eye Disorder – Definition, Symptoms, Treatment
    Surgery
    Surgery is indicated in obstinate, spreading and growing pterygium, especialy if it doesn’t respond to eye drops and ointments. Surgery wil be an option when the pterygium encroaches over the cornea causing los of vision or a condition caled as astigmatism which causes bluring vision. Surgery is also an option to waive pterygium for cosmetic reasons.
    Excision along with adjunctive therapies such as radiotherapy, mitomycin and 5FU is the preferable surgical intervention in pterygium. Conjunctival flap / graft is said to be the gold standard of care and is said to be asociated with les recurence and minimal complications.
    Read ̵ Sushruta’s 8 Types Of Surgical Procedures – Astavidha Shastra Karma
    Conjunctival auto-grafting and amniotic membrane transplantation are other efective methods.
    In some cases, pterygium can recur folowing surgical removal. Surgery may cause drynes and iritation of eyes. In such cases, the doctor can prescribe medications to provide relief from symptoms and also to quel the risk of re-growth of pterygium.
    Post operative care with intensive topical steroids may be neded. Folow up should be regularly done, at least for one year after surgery, especialy if recurence is sen. Most recurences are sen in the first year folowing surgery.
    Read ̵ Methods Of Surgical Training Elaborated In Ayurveda
    Excision in Pterygium – Ayurveda perspective
    Pterygium is compared to a condition caled Arma explained in Ayurveda texts. estem pterygium, arma to is said to be curable by excision method. Even in the absence of recent day sophistications, Ayurveda surgeons had conducted surgeries on delicate parts of the body like eyes.
    Arma Chedana ̵ excision
    Method of Chedana / excision in treating Arma eye disorder
    The method of excising the arma is similar for al the five types of armas. The method is as described below.

    Preoperative measures
    Snigdha Ahara – Before conducting the operation on arma, the patient should be fed with faty fod. There is also an opinion that snigdha ahara means medicated fats (ghe) should be given for oral consumption on the previous night and on the day of excision, the patient is made to eat fod, before surgery.
    Experts also opine that the body of the patient shal be cleansed by administering purifying treatments i.e. emesis and purgation and also nasal purge before conducting excision on arma. After purification, the patient shal be fed with faty fod, folowed by excision of arma. subsequent unctuous fod, the patient should be made to sit comfortably on a comfortable seating.
    Read ̵ Unctuousnes Quality – Snigdha Meaning, Action On Doshas, Therapeutic Uses
    Lavana Churna Anjana / Avachurnana – Later, the physician should aply finely ground salt powder into the eye in the form of colyrium to cause iritation of arma. This wil also losen the sweling of arma and prepare it to get excised. Alternatively, the salt powder can be sprinkled into the eye. The efects of sprinkling / dusting are same as aplication.
    Read ̵ Saindhava Lavana Rock Salt Benefits, Ayurveda Usage, Side Efects
    Operative procedure
    Swedana – Sudation should be given to the lump of arma which has ben softened and made l ose (bulged) by administering salt powder. (read here)
    Parighatana – After sudation, the arma should be mobilized by touching or rubing it repeatedly.
    Chedana – Excision of Arma
    The arma is losened up by administration of salt powder, sudation and by mobilizing it. Due to these procedures, folds / wrinkles apear on the sweling of arma.
    Exactly at the space where wrinkles are formed on the arma, the badisha yantra i.e. hok should be aplied.
    The patient is instructed to se towards outer canthus / outer angle of the eye. The physician conducting excision should sit exactly in front of the patient. The physician should now catch the swolen arma with muchundi i.e. forceps and elevate it. Alternatively, a nedle i n which a thread is inserted is pierced beneath the arma and the sweling is lifted up.
    Read ̵ Shastra – Surgical Instruments Of Ayurveda: Astang Hriday Sutrasthana 26
    Importance of handling the sweling gently ̵ The physician should not hasten in elevating the sweling; in fact he should enact it gently and slowly. If he huries the procedure, he may rupture the sweling in a premature way and create complications.
    Read ̵ Types Of Sweling – Ayurveda Diagnosis Charak Samhita Sutrasthan-18
    Importance of positioning the eye before excision ̵ The physician should place both the eyelids open and positioned properly so that it is convenient to conduct the surgery. Or else there is always a hazard of damaging or cuting the eyelids in the proces. When the eyelids are not held properly in location, it becomes efortful) to operate on the arma. The sweling which has losened and separated from the eyebal should be held using thre hoks and elevated properly.
    Excision of sweling using scalpel ̵ folowing this, the physician should cut / excise the arma using Mandalagra shastra i.e. round headed scalpel. When the arma gets detached and separated from the white and black of the eye and elsewhere on the eyebal, it should be gradualy puled towards the iner canthus / angle of the eye and excised entirely while protecting the angle of the eye from geting damaged.
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    Importance of sub-total excision ̵ While excising arma, the physician should be careful and alow one fourth of the fleshy portion of it to remain on the eyebal, i.e. it should not be excised in totality. By doing so, he wil not cause any hurt to the eye or vision or create any new complications. Acidentaly if the physician not taking caution excises the iner canthus along with the sweling of arma, it causes bleding and foundation of sinus tract in the eye. I f les proportion of arma is excised, the remnants of arma wil grow back into ful size.
    Post-operative care
    Pratisarana – aplication of medicated powders over the excised wound of arma
    After complete excision of arma, powder of alkali of barley, ginger, black peper, long peper and salt should be aplied on the wound formed after excision. After aplying the above said powder, the wise physician should give sudation to the eye, should establish a coton swab or cloth over it and tie a bandage.
    Read ̵ Kshara: Properties, Types, Preparation Method As per Sushruta

    He should mediate the dosha, season, strength of the patient and time of administration of medicines while doing the bandaging. After considering these factors he should wisely aply fats as and when neded and as beneficial to the condition over the wound and treat it on the line of management of ulcers and wounds.
    Example, in involvement of vata or kapha, he should aply oil and in involvement of pita, he should aply ghe. After thre days, he should remove the bandage. After that he should warm his hands by rubing them. With his warm hands, the physician should aply heat to the aflicted eye. Later he should administer cleansing and healing treatments.
    Read ̵ Oil, Ghe And Honey – Best Remedies To Balance Doshas
    Management of hurt asociated with excision of arma
    Aschotana, eye drops – If there is hurt in the eye caused due to excision of arma, the physician should administer eye drops using milk prepared with paste and decoction of Pongamia pinata, Gosebery and liquorice after having adjunct honey to the compound. This should be done twice daily. Pralepa, anointment – Along with the above said eye drops; paste of liquorice, stamens of lotus flower and Bermuda gras ground in milk and joined with ghe is aplied over the aflicted eye.
    Read ̵ Ayurveda Eye Treatment Types, Methods – Ashtanga Hrudaya Sutrasthana 23
    Use of Lekhananjana
    If some section of arma which had to be excised out has ben left out, it neds to be destroyed by aplication of scraping colyrium. This colyrium scraps of the residue section.
    Read ̵ Anjana – Colyrium Types, Method, Uses, Side Efects, Contra Indications
    Shukra Chikitsa
    Arma which is smal, has white colour resembling the colour of curds or blue or red in colour and is thin should be treated on lines of treating shukra disease i.e. inflamation of cornea (black of the eye) / keratitis.
    Management of Charma Arma (arma resembling skin)
    The arma which is plump / masive resembling skin (leather) and is enveloped by masive and abundant fleshy fibres and that which encroaches over the cornea should necesarily be excised.
    Signs of properly excised arma

    Below mentioned are the signs of properly excised arma –
    Vishudha varnam – eye gets its normal colour
    Aklishtam kriyasu akshi – eye gets efortlesly fervent in its activities / functions including closing, opening, seing etc
    Gata klamam – the tirednes of the eyes goes away
    Anupadravam – the eye wil not get aflicted by any complications
    Click to Consult Dr Raghuram Y.S. MD (Ayu) ̵ Email / Skype
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