Ayurvedic Treatment Options For Corneal Ulcer And Opacity

By Dr Raghuram Y.S. MD (Ay) & Dr Manasa, B.A.M.S
Corneal ulcers and opacities are common disorders of the eye which when not treated promptly will lead to destruction of vision and blindness.

Comparisons to modern science

There are four corneal disorders explained in Ayurveda under the category of krishnagata rogas. Among them a condition named Savrana Shukra has been closely compared to corneal ulcers due to resemblance in explanation of both these conditions. Another condition named Avrana Shukra has been closely compared to corneal opacities. While both these diseases are said to be caused by vitiated blood, Savrana Shukra is said to be an incurable condition and Avrana Shukra is a curable condition.
Read – Savrana Shukra, Avrana Shukla Eye Disorder – Symptoms, Treatment

Though Savrana Shukra has been said to be incurable, treatment has been mentioned for its earlier stages. Even in the prognosis of Savrana Shukra, the disease present in the first layer is said to be curable. The disease present in the second and third layers is incurable. The treatments of savrana and avrana shukra have been explained together. Few formulations are common remedies for both conditions.

I shall be using the terms corneal ulcer for savrana shukra and corneal opacity for avrana shukra for better understanding.
Read – Computer Vision Syndrome: Causes, Ayurvedic Remedies, Tips

Treatment strategies

Treatment principles in treating corneal ulcers and opacities
Lekhana Karma – i.e. scraping treatment is the best option in treating both savrana and avrana shukras i.e. corneal ulcer and opacity.

Though savrana shukra i.e. corneal ulcer is said to be incurable and surgical processes are contraindicated in avrana shukra i.e. corneal opacity, the scraping is considered by Ayurveda seers. Probably the contraindication may be due to the delicate nature of the eye. Indication of treatment is a clue that a wise physician can conduct scraping in both conditions in the initial stages; before the disease progresses to a stage of incurability and also that an expert surgeon can try these treatments.
Read – Watery Eyes: Causes, Ayurvedic Treatment, Remedies

Santarpana and Apatarpana treatment – In corneal ulcer, nourishing treatments and in corneal opacities, depleting treatments should be done.

Snigdha & Ruksha Chikitsa / Upakrama – Master Vagbhata opines that unctuous or drying therapies shall be done in treating shukra disorders after having considered the predominant dosha involvement in the causation of the disease.

Anjanas – Some useful collyriums are also mentioned by master Sushruta in the treatment of Shukra.
Read – Anjana – Collyrium Types, Method, Uses, Side Effects, Contra Indications

Vagbhata – treatment

Master Vagbhata’s principles and line of treatment of corneal ulcers and opacities (A.Hr.U.Ch 11)

Snigdha-Ruksha krama – The strength of the doshas in these diseases should be considered. After this, the unctuous and drying therapies should be done as and when needed, according to the doshas involved.

One or more of the below mentioned should be skillfully combined in treating these conditions –

Shita dravya lepa – Pastes of coolant herbs should be applied over the head and face.
Shita dravya seka – Decoctions of coolant herbs should be poured over the head.
Jalauka & Siravedha – Bloodletting in the eyes should be done using leech application and venesection procedure.
Read – Leech Therapy Procedure, Benefits, Side Effects, Treatment

In Corneal ulcers:
Nilotpaladi Ghrita – The ghee prepared with blue variety of lotus (Nymphaea stellata), raisins, liquorice, Pueraria tuberosa, sugar and goat’s milk should be used in the eyes, for instillation.
Lekhyanjana – After conducting the above said measures, when the redness of the eyes, tearing and pain are relieved, collyriums which are scraping in nature should be applied to the afflicted eyes.
Elevating shukra to the surface – Oral consumption of medicated fats, errhines and use of Rasanjana collyrium, pooling of medicated ghee and juices around the eyes, the shukra should be brought to the surface i.e. it should be healed.
Shadanga Guggulu – In Yogaratnakara treatise, the author has advised oral consumption of Shadanga Guggulu in treating corneal ulcers.
Read – Eye Diseases Causes, Pathogenesis, Symptoms, Treatment, Herbs

Treatment strategies in corneal opacities
Master Vagbhata has advised the use of many types of Lekhananjanas i.e. scraping collyriums in the treatment of corneal opacities.
Read – Netra Tarpana Treatment For Eye Care Benefits, How To Do?

Sushruta reference

Treatment and formulations for corneal ulcers and opacities as explained by master Sushruta
Lekhana Anjana – The collyrium prepared by mixing the ash of metals, powder of all types of salt, purified minerals, gems and horns of animals, cow, shell of the egg, garlic, trikatu, seeds of Pongamia pinnata and cardamom should be used in the eyes of the patients suffering from corneal ulcer and opacity.

This should be applied after administering all the measures starting with bloodletting and ending with pooling of herbal juices around the eyes as explained in the treatment lineup of conjunctivitis.
Read – Excision and Scraping – Chedana And Lekhana Karma In Eye Disorders

Treatment summary

Step-wise treatment approach, to sum up
Internal cleansing – Internal cleansing of the body and expulsion of doshas can be achieved by administration of bloodletting, head purging errhines and purgation.
External cleansing – Before scraping therapy, application of medicinal pastes, sprinkling of medicated fluids, errhines, medicated smoking, eye drops, massage, saturating treatments like pooling of medicated ghee around eyes and pooling of medicated juices around the eyes should be done. External purging / expulsion of doshas occur by doing these therapies.
Read – Nasya Karma Procedure, Types, Benefits, Contra Indications

All these measures are beneficial in the treatment of conjunctivitis. Conjunctivitis is the chief cause for the manifestation of shukra disorders. Therefore, in order to eliminate the root cause, i.e. treating conjunctivitis, the external and internal cleansing is mentioned. Following this, scraping collyriums should be applied to the eyes.
Lekhana – After having done external and internal cleansing, scraping therapies should be done.
Shirishabijadi churna gharshana – Corneal ulcer immaterial of being superficial or deeply located, if it is rough in appearance, the ulcer should be rubbed with the powder of the below mentioned ingredients –

Alternatively, the ulcer may be rubbed only with rock salt powder.
Read – Saindhava Lavana Rock Salt Benefits, Ayurveda Usage, Side Effects

Sushruta’s Anjanas – collyriums

Principles of treating corneal ulcers as explained in Yogaratnakara treatise
In corneal ulcers the below mentioned are highly recommended –

  • Shadanga Guggulu for oral consumption
  • Bloodletting through leech application in the eyes
  • Bloodletting following consumption of ghee processed and prepared with rock salt and Operculina turpethum

Other collyriums explained in Yogaratnakara treatise

  • Yashtyahva Aschotana
  • Lamajjakadhyanjana
  • Trivrit Anjana
  • Chandanadi Varti
  • Mahanilavarti

Special formulations / collyrium for corneal opacities

  • Dantanjana
  • Suvarnamakshikanjana
  • Jatyadi jala prakshalana
  • Karanjabijadi varti
  • Vaidehi varti
  • Chandrodaya varti
  • Karpuranjana

Medicines for internal consumption (for both corneal ulcers and opacities)
Lohadi Guggulu – should be consumed with honey and ghee.
Patoladi Ghrita should be consumed orally.

Nasya therapy

Nasya – Nasal medication in treatment of corneal ulcers and opacities
Krushnadhya taila – Oil prepared with the below mentioned ingredients should be used for nasal medication or for instillation into the afflicted eyes in the treatment of corneal disorders.

  • Long pepper
  • Embelia ribes
  • Licorice
  • Rock salt
  • Paste of ginger
  • Goat’s milk

Importance of Collyriums

By Dr Raghuram Y.S. MD (Ay) & Dr Manasa, B.A.M.S
Use of collyrium (anjana) is an important strategy of Ayurveda system to treat eye disorders and in promotion of eye health. It has also been included in the schedule of dinacharya i.e. diurnal activities.

Many collyriums have been explained in Ayurvedic treatises which are said to be highly effective in curing savrana shukra i.e. corneal ulcers and avrana shukra i.e. corneal opacities.
Read – Anjana – Collyrium Types, Method, Uses, Side Effects, Contra Indications

Effective collyriums used in treatment of corneal ulcers and opacities
Lekhana Anjana
– The collyrium prepared by mixing the below mentioned ingredients should be used i.e. applied in the eyes of the patients suffering from corneal ulcer and opacity –

  • ash of metals like gold, brass, bronze, lead, silver, black iron etc,
  • soft and fine powder of all types of salt
  • soft and fine powder of purified minerals like realgar, red ochre etc,
  • soft and fine powder of gems like cat’s eye, emerald etc and
  • soft and fine powder of horns of cow, bullock etc
  • herbs of avasadaka group of herbs
  • shell of the egg
  • garlic
  • trikatu (long pepper, black pepper and ginger)(read)
  • seeds of Pongamia pinnata
  • cardamom

Collyrium prepared by mixing all the above mentioned ingredients is called lekhananjana i.e. collyrium used in scraping therapy.
Read – Lekhaneeya Gana Herbs: Weight Reducing Benefits, Review, Medicines

This should be applied to the eyes after administering all the measures starting with bloodletting and ending with pooling of herbal juices around the eyes as explained in the treatment lineup of conjunctivitis. The same shall be skillfully administered in the treatment of avrana shukra i.e. corneal opacities too by a wise physician.

Measures to be taken before administering scraping collyriums
This means to tell that the below mentioned treatments shall be done in a chronological way to treat corneal ulcers and opacities.

Internal cleansing – should be done first by administration of

External cleansing – should be done by the below mentioned measures –

Lekhananjana – scraping collyriums should be administered after internal and external cleansing. These treatments would eliminate the doshas. They are also best remedies for conjunctivitis which is a chief cause for the manifestation of corneal ulcers. When collyrium is done after internal and external purifying treatments as said above, the scraping will be very effective.

Other Collyrium (anjanas) mentioned by Sushruta
Tamradi Churnanjana
– The ulcer is rubbed with the smooth powder of the below mentioned ingredients or applied as collyrium.

Shankadhyanjana – Collyrium prepared with –

  • Conch shell
  • Seed of jujube
  • Seeds of Strychnos potatorum
  • Raisins
  • Licorice
  • Chalcopyrite

Kshaudradyanjana
Ingredients –

Ksharanjana – Collyrium which has been explained in the treatment of conjunctivitis caused by vitiated kapha also heals corneal ulcers and opacities.

Shankadhyanjana – The collyrium prepared with the below mentioned ingredients heals corneal ulcer, alleviates morbid vata and nourishes the eyes.

Mudgadhyanjana – Green gram should be fried and their husk removed. In the powder of green gram, powder of conch shell, sugar and honey are mixed and collyrium prepared. This is useful in corneal ulcers and opacities.

Other two useful collyriums –

Vamshadhyanjana – Tender bamboo sticks, Semecarpus anacardium, toddy palm, coconut and bones of camel are burnt in the fire of sesame sticks so as to obtain their ash. This ash is mixed in 6 or 8 times water and its decoction prepared such that ¼ of the liquid remains. This liquid is sieved many times (strained through sterile cloth). The bones of camel (its powder or ash) is given 7 titrations with the above said liquid and dried in sunlight. Later this powder is ground into smooth powder and used for collyrium. While applying into the eyes, this powder is mixed with required quantity of honey. The collyrium is applied with clean finger or collyrium rod. After applying the collyrium and rubbing it over the ulcer, the eye is washed with Triphala decoction. This wards of the cloudiness of the cornea and brings normal color to the cornea.
Read – Excision and Scraping – Chedana And Lekhana Karma In Eye Disorders

Other collyriums explained in Yogaratnakara treatise
Yashtyahva Aschotana
– The decoction of the below mentioned herbs should be mixed with breast milk and used as eye drops to cure corneal ulcers.

  • Licorice
  • Extract of Berberis aristata
  • Lotus
  • Lac
  • Water lily
  • Vetiver grass
  • Valeriana wallichii

Lamajjakadhyanjana – The decoction prepared from the below mentioned ingredients, when gets solidified and sticks to the vessel, it should be removed from the contact of fire and stored in an iron or stone vessel. The resultant product should be used as a collyrium to treat corneal ulcers.

Trivrit Anjana – Decoction of roots of Operculina turpethum mixed with honey should be used as collyrium to treat corneal ulcers.

Chandanadi Varti – The wick prepared with the below mentioned herbs should be used as collyrium in a patient suffering from corneal ulcer.

Mahanilavarti
Ingredients – Taken in equal proportions.

The above said ingredients should be rubbed on copper plate.
The paste is applied on the copper plate in a thick layer.
Barley, leaves of Indian gooseberry and ghee should be burnt together. The soot of the same should also be taken on the same copper plate on which the paste is applied. All the above said are mixed with honey and stored.

This should be used as collyrium in corneal ulcer. After applying collyrium, the eye should be rinsed with the decoction of turmeric, licorice, Hemidesmus indicus and Symplocos racemosa.

Special formulations

Dantanjana – The collyrium prepared with the powder of the below mentioned ingredients should be used to cure corneal opacities.

  • Teeth of cow
  • Teeth of donkey
  • Teeth of camel
  • Conch
  • Cuttlefish

Suvarnamakshikanjana – Chalcopyrite should be ground in honey and applied in the eyes of the patient suffering from corneal opacities.

Jatyadi jala prakshalana – Leaves of jasmine and licorice should be fried in ghee and mixed in cold water. This water should be used to wash the eyes of the patient suffering from corneal opacities.

Karanjabijadi varti – Wick prepared by rubbing seeds of Pongamia pinnata in the juice of Butea monosperma many times is used as collyrium.
Read – Karanja – Pongamia pinnata: Uses, Side Effects, Research

Vaidehi varti – Wick prepared from aqueous extract of Berberis aristata, Parmelia perlata, saffron, realgar, conch, white pepper and sugar should be used as collyrium.

Chandrodaya varti – wick mentioned in the context of treatment of timira i.e. darkness in front of the eyes should be used as collyrium in treating corneal opacities.

Karpuranjana – Good quality camphor powder ground in the latex of Banyan tree is beneficial.
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