Netra Roga — Ayurvedic Ophthalmology Overview

Anatomical Framework

Sushruta divides the eye into **5 mandala** (zones):

1. **Pakshma mandala** — eyelashes + lid margins
2. **Vartma mandala** — eyelids
3. **Shweta mandala** — sclera + conjunctiva
4. **Krishna mandala** — cornea + iris
5. **Drishti mandala** — lens + vitreous + retina

And **6 sandhi** (joint regions where 2 zones meet) at the corners.

This makes a systematic disease enumeration possible: each disease is named by which mandala/sandhi it involves.

The 76 Netra Roga (selected)

Sandhigata (junctional) — 9 diseases - Puyalasa (purulent discharge from canthi) - Upanahaha (chronic inflammation) - Parvanika (chronic granulomas)

Vartmagata (eyelid) — 21 diseases - Stibdha-vartma (rigid lid) - Sirajala (extensive vascularity) - Anjana namika (stye / hordeolum) - Vartmavabandha (entropion/ectropion equivalent) - Lagana (chalazion)

Shuklagata (sclera/conjunctiva) — 11 diseases - Snayu arma (pterygium) - Sira pidaka (conjunctival haemorrhage) - Avalambika (subconjunctival mass)

Krishnagata (cornea/iris) — 5 diseases - Sirotapata (vascular invasion of cornea) - Akshipakatyaya (uveitis)

Sarvagata (all-zone) — 17 diseases - Adhimantha (acute angle closure glaucoma — though specific subtype debated) - Adhi-nimesha (frequent blinking) - Hatadhimantha (long-standing glaucoma) - Vata-paryaya (random pain)

Drishtigata (lens/vitreous/retina) — 12 diseases - **Timira** — early cataract (graded 1-3 by severity) - **Linganasha** — full cataract requiring surgery - Some retinal disorders

Bahya roga (external) — 1 disease

Diagnostic Approach

1. **Lakshana parikshana** — symptom assessment
2. **Mandalik parikshana** — which zone is involved
3. **Doshic assessment** — vataja (sharp pain, dry, irregular), pittaja (burning, redness, photophobia), kaphaja (mucus, swelling, blurry vision), raktaja (haemorrhage, pain)
4. **Sadhya-asadhya determination** — early timira sadhya, linganasha kricchsadhya, retinal detachment generally asadhya in classical text

Treatment Modalities

1. Ashchyotana (eye drops) Liquid kashaya dripped into eye. Indications: dryness, allergic conjunctivitis, infective conjunctivitis early stage.

Common formulations: - **Triphala kashaya ashchyotana** — daily for digital eye strain - **Yashtimadhu kashaya** — pittaja netra roga - **Madhuyashti ksheera** — chronic mild conjunctivitis

2. Bidalaka (paste application on closed lid) External application. Indications: lid swelling, stye, mild conjunctivitis.

Common formulations: - **Triphala churnam + ghrita lepa** — eye lid swelling - **Lodhra churnam + madhu** — chronic blepharitis

3. Anjana (collyrium) Direct application into conjunctival sac. Types: - **Lekhana anjana** (scraping) — for kapha-pradhana with discharge - **Ropana anjana** (healing) — chronic ulceration - **Prasadana anjana** (clarifying) — vision strengthening

**Souviranjana** (mild collyrium) — daily use protective **Rasanjana** (medicated) — weekly therapeutic

4. Tarpana (eye nourishment) The hallmark Ayurveda eye procedure. Method: 1. Ring of dough placed around eye 2. Medicated ghrita warmed and poured into ring 3. Patient lies supine, eye open, ghrita covers eye 5-30 min 4. Drain, gentle cleansing

Indications: - **Dry eye syndrome** - **Computer vision syndrome / digital eye strain** - **Early cataract** (timira) - **Post-LASIK dryness** (modern use) - **Glaucoma management** (controlled studies)

Common formulations: - **Triphala ghrita** — first-line - **Jeevantyadi ghrita** — chronic dry eye - **Patoladi ghrita** — pittaja conditions

**Modern evidence**: Several RCTs published 2015-2024 show statistically significant improvement in dry eye Schirmer test + symptom scores after 7-21 day tarpana protocols. Effects last 3-6 months.

5. Putapaka (eye fumigation with hot poultice) Indications: chronic external eye disease, post-operative recovery.

6. Seka (continuous pouring of cold/warm liquid) Indications: acute inflammation, foreign body sensation.

Sushruta's Cataract Surgery

The most famous Shalakya procedure. The classical **couching** technique:

1. Patient seated facing east, morning light
2. Anaesthesia: pranayama + light alcohol (classical — modern: topical anaesthetic)
3. Patient lid stretched + eye fixed
4. **Yava-vrana shastra** — small curved needle
5. Needle inserted from sclera (1 yava distance from limbus), advanced gently
6. Lens displaced inferiorly into vitreous (couching)
7. Eye lavaged with breast milk kashaya
8. Bandaging for 7 days
9. Recovery + visual rehabilitation

**Outcome**: vision improvement was real but the technique had long-term complications (glaucoma, lens-induced uveitis). Modern phacoemulsification has replaced it. But Sushruta's technique was practised in India for ~2000 years and was an established cure when European medicine had no answer for cataract.

Daily Eye Care (preventive)

Ayurveda recommends daily: - **Cold water splashing** to face + eyes (morning) - **Triphala-water eye wash** weekly - **Daily anjana** (mild — souviranjana) - **Avoid prolonged screen exposure** without 20-20-20 rule - **Padabhyanga** (foot massage) at night — classical claim of indirect eye health

Self-test

• Name the 5 mandala of the eye.
• Differentiate timira and linganasha.
• List the 6 main treatment modalities.
• Describe the tarpana procedure.
• Name 3 modern conditions where tarpana has evidence-supported use.