Review of Shuskaakshipak with reference to dry eye syndrome. *Corresponding Author: Mob. : ;

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1 Review of Shuskaakshipak with reference to dry eye syndrome R. W. More* 1, Veena sharma 2, Arun S. Dudhamal 3 1. Asso. Professor and H.O.D. Dept. of Shalakya Tantra 2. Assistant Professor, Dept. of Shalakya Tantra 3. Asso. Prof. and H. O. D., Rognidan Dept. Ayurved mahavidyalaya, sion, mumbai *Corresponding Author: Mob. : ; ravimore67@gmail.com Abstracts: In today s era peoples are more depending upon the machines and computers in all sectors of life. These causes some sort of heat and radiations which certainly causes some ill effect on eyes.environmental changes, pollution, industrialization and work stress become major issues which play an important role in health of eyes. Life style changes play an important role in the management of dry eye. Ayurvedic management specially Anjan Tarpan and internally ghrutpan can play key role in the management of dry eye syndrome. Key words : dry eye shuskashipak Anjan Tarpan Introduction Revolutionary effect reflected in every field including the medical science which has changed the life style of the society. People are largely depending upon the machines. Computers are used in all sectors including the health sector.due to globalization the work stress has been increased accounting to the health problems.over use of X- ray,uv rays, infra rays along with wide range of Electromagnetic waves of monitors are unhealthy for eyes causing various disorders one of them is dry eye syndrome. Dry eye is symptom complex occurring as a sequel to deficiency or abnormality of tear film. This condition has no cure in modern science. many treatment modalities has been utilized in combination with mucolitics, topical retinoids and lubricant. We can correlate dry eye to Shuskakshipak. The symptom complex described in it are more similar to dry eye. In such a condition where the name of disease is not known ayurveda has given certain guidelines. As per Charaka physician have to consider the pathophysiology and predominance of tridoshas for the management of any disorder. [1][2]

2 In dry eye syndrome lipid layer of precorneal tear film get disturbed.break up time reduces causing dryness of the eye. Etiological factors as per Ayurveda: Sushruta has described the etiological factors common for all ocular disorders. Out of these particularly prasakta, sanrodan, kopa,shoka and Bashpagrahat. Which are responsible for vitiation of vata and pitta dosha. Usnabhitaptasya may aggravate pitta causing dryness. [3] Anatomically eye is composed of following panchabhautik elements.but Teja mahabhut is predominant different parts of the Netra are formed by different mahabhutas. [4] Material and Method: The panchabhautic composition of eyes as per ayurveda is as follows Aqueous tear deficiency [5] KCS keratoconjunctivitis Sjogren s syndrome- autoimmune disease occuring in women between 40 to 50 Primary sjogren s syndromecombinations of kcs and xerostomia. Paralytic hyposecretion Idiopathic hyposecretion Congenital Alacrima- a familial dysautonomia, a genetic condition with lac of overflow tears during emotional crying. Mucin deficiency It occurs when goblet cells are damaged Hypovitaminosis- A(xeropthalmia) Conjunctival scarring disease as trachoma, chemical burn, Radiation Part of Eye Mansa Rakta Krusnsbhaga Shwetabhaga Ashrubhaga Panch-Mahabhut Pruthvi Teja Vayu Jala Akasha Lipid deficiency It is rare in absence of meibomian glands, in chronic blepharitis,chronic meibomitis Impaired eye lid function Bell palsy or damage to facial nerve,pterygium,ectropion,symblepharon In the pathogenesis of dry eye Ativishuskata and Rukshata are caused by disturbance in the vayu, Jala And Akasha mahabhutas which may cause chronic inflammatory changes in the Shweta, Akashabhaga and Krusnabhaga means cornea and conjunctiva. Etiological factors as per modern science Drug induced Wide variety of common medication can cause dry eye by reducing tear secretion. Diuretics Betablockers Antihistamines

3 Sleepjng pills Diagnosis: Vagbhata has Reflected more similarity with dry eye. He states that Shuskakshipak caused by vitiation of Vata and Pitta. Sign and symptoms are as follows. [6][7] Gharsha Toda/bheda Rukshsa Daruna Kruchonmilan Vikunan/vishuskata itching/ F.B.sensetion irritation pricking sensation drying of eye parts Hardness discomfort of eye lid drying and deficient in moisture Confirmation of diagnosis depends upon sign and symptoms and dosha vitiation discussed in sushruta, vaghbhata and other contemporary Authors of Ayurveda. But tear film break up time-it is noted that after instilling a drop of fluorescein and examining in a cobalt blue light of slit lamp Normal value: Range from 15 to 35 seconds. Values less than 10 seconds imply an instable tear film. [8] 2) Schirmer 1 Test:- It measures total Tear secretion. It is performed with the help of a 5X35mm strip of whatman-41 filter paper which is folded 5mm from one end and kept in lower fornix at the junction of lateral 1/3 and medial 2/3 Patient is asked to look up and not to close eye after 5 minutes. Wetting of filter paper strip from the bent end is measured. 3) Rose Bengal test: very useful test for detecting even mild cases. Following are the three pattern of staining of Rose Bengal test. [8] Three staining pattern has been described. a) Severe cases with confluent staining of conjunctiva and cornea b) Moderate cases with extensive (staining) c) Pattern represents mild or early fine punctate-strains in the inter palpebral area 4) Tear osmolarity. [8] 5) Tear level Lactoferrine [8] 6) Conjunctival impression cytology. [8] 5) Tear function index (TFI) [8] 6)Tear stability analysis system (TSAS) [8] Criteria for diagnosis : 1 abnormally low schirmer test result 2 objective evidence of low salivary flow 3 biopsy proven lymphatic infiltration of labial salivary glands

4 4 dysfunction of immune system as manifested by serum auto antibodies aslike ANA,RF etc Management in modern science suggest the following principals [9] Lubricating supplements Gels and ointment Anti inflammatory agents Systemic immunosuppressant Surgical intervention which includes absorbable, non absorbable plugs Thermoplastic plugs hydrogel plugs other surgical options includes corneal or corneo scleral patching lateral Tarsorrhaphy and mucous membrane grafting conjunctival flap Management of dry eye by Ayurveda:- Treatment should be directed towards the vitiated Vata and Pitta dosha which include. (10) Ghritpan: cow ghee should be given internal at night for shaman purpose till symptoms get reduced Tarpan: it is local treatment in which melted cow ghee of body temperature or medicated with Shatavari or Yestimadh is used as per Tarpan procedure.. Parisheka: Stanya parisheka or with Haritaki or Daruharidra are found to be effective. Anjana: With Mahaushdhi Nasya: Should be supported with Anu Taila nasya Basti: Should be supported by Yoga Bastikrama for 8 days. Should be supported by Pitta shamak Kamdudha or Praval Panchambruta like kalpas for vitiation of pitta dosha Particularly Tarpan is indicated and found to be very effective in this condition. Discussion In dry eye lipid layer of the tear film is disturbed due to eatiological factors described in ayurved. which results in reduction of tear film break up time.it leads to irritation (daha) itching (kandu) many studies reveals that the tear film BUT reduces due to instability of lipid and higher evaporation rate. Ayurvedic management like ghrutpan and anjana maintain the moisture of the cornea and sclera and thereby preventing corneal scarring. Ghee is having chakshusya properties and when it is medicated with chakshusya dryavya the result are fortified.ayurvedic management has definite role in treating dry syndrome correlated as shuskshipaka. Conclusion Local treatment modalities like tarpan, Anjana with internal medication maintain the moisture of eyes which lubricates the patalas of eyes. Tarpan and Anjana stimulates the secretion of lacrimal as well as maebomian and other glands which maintain the pre corneal tear film. Radiation effect on eyes is reversed or prevented by Tarpan like krikalpas. Ayurvedic management in dry eye syndrome is effective safe economical

5 without sde effects and complications.it can be used as alternative to artificial tear drops. Reference 1. Pt. Shastri Kashinath & Chaturvedi Gorkhanath Charak samhita Sutrsthan 18/44 Bharti Academy Varanashi Edition 2005(Repriented) 2. Pt.Shastri Kashinath & Chaturvedi Gorakhnath charak Samhita Sutrasthan 9/24Bharti Academy Varanashi Edition 2005 (Repriented) 3. Kaviraj Dr.Shastri Ambikadatta Sushruta Samhita Uttar tantra Repriented Edition 2009 Chapter 1/27 4. Kaviraj Dr.Shastri Ambikadatta Sushruta Samhita Uttara Tantra Repriented edition 2009 chapter 1/26 5. Dr. A. K. Khurana, Ophthalmology 6. Kaviraj Dr.Shastri Ambikadatta Sushruta Samhita Uttara Tantra Repriented edition 2009 chapter 26/7 7. Dr. Tripathi Bramhanand Asthang Hrudayamuttar Tanta 16/29 Chaukhambha Sanskrit Pratisthan Varanashi Repriented Edition Brooks Mfda Class rapid Test For Dry Disease Medscape Med (Serial online) View Article Dec Kaviraj Dr.Shastri Ambikadatta Sushruta Samhita Uttar tantra Repriented Edition 2009 Chapter 18/ Shinota and Tandon Parsons disease of eye 19 th ISBN: Butter worth - Heineman june 2002 Cite this article: R. W. More, Veena sharma, Arun S. Dudhamal Review of Shuskaakshipak with reference to dry eye syndrome -2014; 3(2): 1-15