Topic- "Arma" ;"pterygium"

1. A COMPILATION OF
DEPARTMENT OF SHALAKYA TANTRA
DAYANAND AYURVEDIC COLLEGE, JALANDHAR

2. CONTENTS
Sau@lagat raoga1
2
Pterygium3
Ama-

3. Sau@lagat raoga

4. DlhNa ko Anausaar va%ma-gat raogaaoM ko baad Sau@lamaNDla ko raogaaoM ko vaNa-na ka karNa hO ik
SarIr rcanaa kI dRiYT sao va%ma-maNDla ko pScaat Sau@lamaNDla ka sqaana hO.
Aacaaya- sauEaut matanausaar Sau@lagat raoga 11 maanao hOM.
Aacaaya- sauEaut matanausaar Sau@lagat raoga 13 maanao hOM.
va%ma-maNDla ko baad Sau@lamaNDla ko raogaaoM ka vyaa#yaana hO.

5. sauEautmatanausaar Sau@lagat raoga
p`stairSau@laxatjaaiQamaaMsasnaayvama-saM&a KlaupHca raogaa .
syau Saui@tka caajau-naipYTkaO ca jaalaM isaraNaaM ipDkaSca qaa syau ..
raogaa balaasaga`iqatona saaQa-maokadSaaxNaao Klau Sau@laBaagao.
(sa. ]. 4/ 3-4)
Sau@lamaNDla maoM 11 raoga hOM.
 p`stair Ama-
 Sau@laama-
 xatjaama-
 AiQamaaMsajaama-
 snaayau Ama-
 Saui@tka
 Ajau-na
 ipYTk
 isarajaala
 isaraipDka
 balaasaga`iqat

6. vaagBaTmatanausaar Sau@lagat raoga
Sau@lamaNDla maoM 13 raoga hOM.
 p`stair Ama-
 Sau@laama-
 xatjaama-
 AiQamaaMsajaama-
 snaayau Ama-
 Saui@t
 Ajau-na
 ipYTk
 isarajaala
 isaraipDka
 balaasaga`iqat
 isarao%pat
 isarajaala

7. Ama-

8. p`stair Ama-
P`astair ga`iqatimahama- Sau@laBaagao ivastINa- tnau $iQarp`BaM sanaIlama.
(sa. ]. 4/ 5)
• nao~ ko Sau@laBaaga maoM p`sarNaSaIla, ivastRt, tnau , r@taBa , naIlaaBa p`Baa yau@t ga`iqat rcanaa p`stair Ama- hO.
• daoYa- i~daoYaja , saaQya
• icaik%saa- Codna kma- ; tIxNa , laoKna AHjana
maRWaSauvaRwqa$D,maaMsa p`stair Syaavalaaoihtma.. p`staya-ma- malaO: saasaO`:.
(A. ). ]. 10/ 17)
• Aacaaya- vaagBaT matanausaar r@tyau@t i~daoYa ko karNa maRdu , SaIGa` baZnao vaalaI , Syaava vaNa- kI p`sarNaSaIla , vaodnaariht
maaMsa kI rcanaa p`stair Ama- khlaatI hO.
• icaik%saa - naUtna AaOYaQa saaQya AaOr puratna Sas~ saaQya
• yaaogar%naakr evaM Baavap`kaSa nao sauEaut ko mat kao hI maanaa hO.

9. Sau@laama-
Sau@laa#yaM maRdu kqyaint Sau@laBaagao saSvaotM samaimah vaw-to icaroNa.
(sa. ]. 4/ 5)
• Sau@lamaNDla maoM Svaot vaNa- kI , maRdu , samaana $p vaalaI , QaIro QaIro baZnao vaalaI rcanaa Sau@laama- hO.
• daoYa- kfja , saaQya
• icaik%saa- Codna
kfacCu@lao samaM SvaotM icarvaRwyaiQamaaMsakma.
(A. ). ]. 10/ 12)
• Aacaaya- vaagBaT nao Sau@laama- ka vaNa-na krto hue kha ik kf daoYa ko karNa Sau@laBaaga maoM sama$p kI , dor sao baZnao vaalaI
rcanaa Sau@laama- hO.yah Sas~saaQya raoga hO ikntu naUtna Avasqaa maoM AaOYaQasaaQya haota hO.
• Aacaaya- Baavap`kaSa yaaogar%naakr nao Aacaaya- sauEaut ko matanausaar hI laxaNaaoM ka vaNa-na ikyaa hO.

10. laaoihtama-
yanmaaMsaM p`cayamaupOit Sau@laBaagao pdmaaBaM tdupidSaint laaoihtama-.
(sa. ]. 4/ 5)
• Sau@lamaNDla maoM laala kmala kI AaaBaa vaalao maaMsa ka saMcaya laaoihtama- haota hO.
• daaoYa- r@t , saaQya
• icaik%saa- Codna kma-
• [sakao Aacaaya- sauEaut nao xatja Ama- BaI kha hO.
SaaoiNatama- samaM SlaxNaM pdmaaBamaiQamaaMsakma.
(A. ). ]. 10/ 16)
• AYTaMga)dyama maoM [sakao SaaoiNatama- kha gayaa hO.[sakao Aacaaya- nao Sas~saaQya kha hO prntu naUtna Avasqaa maoM [sakao
AaOYaQasaaQya maanaa hO.
• Baavap`kaSa maoM Aacaaya- sauEaut matanausaar hI laxaNa batayao hOM.

11. AiQamaaMsaja Ama-
ivastINa-M maRdu bahlaM yakR%p`kaSaM SyaavaM vaa tdiQamaaMsajaama- ivaVat.
(sa. ]. 4/ 6)
• nao~ ko Svaot Baaga maoM yakRt ko samaana vaNa- ka , maulaayama , maaoTa , ivastINa- AaOr Syaava vaNa- kI rcanaa kao AiQamaaMsajaama-
khto hOM.
• daoYa- i~daoYaja , saaQya
• icaik%saa- Codna kma-
SauYkasaRkipNDvacCyaavaM yanmaaMsaM bahlaM pRqau.
(A. ). ]. 10/ 18)
• AYTaMga)dyama maoM AiQamaaMsaja Ama- kao saUKo hue r@tipND ko samaana , sqaUla , pRqau maaMsa kI rcanaa kao AiQmaaMsaja Ama- kha
hO.
• [sakao Sas~saaQya vyaaiQa maanaa hO prntu naUtna Avasqaa maoM [sao AaOYaQasaaQya maanaa hO.

12. snaayau Ama-
Sau@lao yai%piSatmaupOit vaRiwmaott snaayvamao-%yaiBa piztM KrM p`paNDu.
(sa. ]. 4/ 6)
• nao~ ko Sau@la Baaga ko maaMsa maoM KurdrI tqaa paNDu vaNa- kI ]%pnna vaRiw kao snaayvama- khto hOM.
• daoYa- i~daoYaja , saaQya
• icaik%saa- Codna kma-
snaavaama- snaavasainnaBama.
(A. ). ]. 10/ 18)
• AYTaMga)dyama maoM Sau@lamaNDla maoM snaayauvat idKa[- donao vaalaI rcanaa kao snaavaama- kha gayaa hO.
• [sakao Sas~saaQya maanaa gayaa hO prntu naUtna Avasqaa kao AaOYaQasaaQya maanaa gayaa hO.
• raogar%naakr AaOr Baavap`kaSa nao Sau@laBaaga maoM kizna va Acala , caaODa , maaMsabahula, saUKa , s~avariht maaMsavaRiw hao tao ]sao
snaayvama- khto hOM.

13. Ama- kI icaik%saa
• Codna maoM Sas~ kma-
cama-aBaM bahlaM ya~u snaayaumaaMsaGanaavaRtma.
CoVmaova tdma- syaat kRYNamaNDlaM ca yat.
(sa. ]. 15/ 18)
cama- kI trh idKnao vaalaa , sqaUla , snaayau va maaMsa sao AacCaidt Ama- va kRYNamaNDla tk
phuMcanao vaalaa Ama- Codna yaaogya hO.
• pUva-kma-
isnagQaM Bau@t@tao (nnamaupivaYTsya ya%nat:.
saMraoYayao~u nayanaM iBaYak caUNaO-stu laavaNaO:..
(sa. ]. 5/ 3)
raogaI kao isnagQa Anna ka saovana krayaoM.t%pScaat raogaI kao ya%napUva-k ibaza kr Ama- kao
iSaiqala krnao ko ilae mahIna saOMQava lavaNa kao nao~ maoM lagaakr nao~ kao xaubQa kroM.

14. • p`Qaana kma-
Tt: saMraoiYatM tUNa-M sauisvannaM pirGaidRtma.
Ama- ya~ valaIjaatM t~OtllagayaidBaYak..
ApagaM p`oxamaaNasya vaiDSaona samaaiht:.
maucauNDyaa||daya maoQaavaI saUcaIsaU~oNavaapuna:..
na caao%qaapyata ixap`M kaya-ma%yaunnatM tu tt.
Sas~abaaQaBayaaccaasya va%ma-naI ga`hyaoddRZ,ma..
Tt: p`iSaiqalaIBaUtM i~iBarova ivalaimbatma.
]illa#anmaNDlaaga`oNa tIxNaona pirSaaoQayaot..
ivamau@tM sava-tScaaip kRYNaacCu@laacca maNDlaat.
naI%vaa knaInakaopantM iCnQaannaait knaInakma.
knaInakvaQaadsa`M naaDI vaaDPyaupjaayato..
hInacCodat punavaR-iwM SaIQa`maovaaiQagacCit.
(sa. ]. 15/ 18)
Ama- p`doSa ka svaodna kr calaayamaana kroM.ijasa sqaana pr Ama- maoM vaila pD,o ]sa pr vaiDSa yaM~ lagaakr }pr ]zayaoM.
raogaI kao ApaMga kI Aaor Aqavaa saUica maoM Qaagaa Dala kr Ama- ko naIcao lao jaakr QaIro sao ]zayaoM.

15. p`maadvaSa SaIGa`ta krnao sao Ama- ko TUTnao ka Baya rhta hO.va%maao-M kao }pr va naIcao sao dRZta sao pkDoM.nao~gaaolak sao iSaiqala hue Ama- kao
tIna vaiDSaaoM sao pkDkr }Mcaa ]za kr tIxNa maNDlaaga` Sas~ sao kaT doM.
kRYNamaNDla va Sau@lamaNDla sao Ama- mau@t hao jaanao pr ]sao knaInak saiQaM kI Aaor lao jaato hue knaIinaka kao bacaato hue kaT doM.Ama-
kao kaTto hue ]saka catuqaa-MSa nao~ maoM lagaa rhnao doM.ijasasao ik r@t kI sa`uit na hao nao~naaDI na hao.yaid Ama- ka hIna Codna hao tao yao
raoga puna: hao sakta hO.
• samyak iCnna Ama- ko laxaNa
ivaSauwvaNa-mai@laYTM ik`yaasvaixa gat@lamama.iCnnao|ma-iNa Bavaot samyagyaqaasvamanaupd`vama .. (sa. ]. 15/ 19)
yaid Ama- Codna ko pScaat nao~ ka vaNa- p`akRt hao nao~ kI inamaoYaaonmaoYa ik`yaaeoM saucaa$ $p sao hao rhI haoM nao~ pUNa-t: @laoSa riht hao va
hIna tqaa Ait Cod ko ]pd`va sao riht hao.yah samyak iCnna Ama- ko laxaNa hoM.

16. PTERYGIUM

17. The word Pterygium is derived from the Latin word,
“Pterygos”
which means a wing .
Pterygium is a common ocular surface lesion characterized by a wing
shaped fibrovascular fold of bulbar conjunctiva which encroaches upon the
cornea.
Also known as ‘SURFER’s EYE’.

18. ETIOLOGY
The etiology of pterygium is still unknown. But there
are various theories that are proposed that contributes
to the development of pterygium which includes:-
• Point mutations of proto-oncogenes K-ras.
Alterations in the expression of tumor suppressor
genes as p53/p63
• UV radiations--- exposure to these rays results into
induction of mediators for growth of pterygium.
It is called ‘TWO HIT’ Mechanism.
The first hit is the process of tumor suppressor gene
deactivation.
The second hit is the environmental factors that
includes viral infection or the exposure of UV
radiations.

19. PATHOLOGY
 Pathologically pterygium is a degenerative and hyperplastic condition
of conjunctiva.
 The subconjunctival tissue undergoes elastic degeneration and
proliferates as vascularized granulation tissue under the epithelium,
which ultimately encroaches the cornea.
 The corneal epithelium, Bowman's layer and superficial stroma are
destroyed.

20. PARTS OF PTERYGIUM
It consists of 3 parts :-
 Head :- present on cornea (apical part ).
 Neck :- narrow part near limbus (limbal part).
 Body :- extending between limbus and canthus
(scleral part).
Stocker’s Line
A Stocker line is the brown iron line in the cornea
anterior to the head of the pterygium.

21. TYPES OF PTERYGIUM
Depending upon the progression it may be of 2 types:
 Progressive pterygium is thick, fleshy and
vascular with a few infiltrates in the cornea, in
front of the head of the pterygium (called cap of
pterygium).
 Regressive pterygium is thin, atrophic,
attenuated with very little vascularity. There is no
cap. Ultimately it becomes membranous but never
disappears.

22. SYMPTOMS & SIGNS
1. It is usually asymptomic.
2. There is cosmetic disfigurement.
3. Visual disturbances occur when it encro
aches the papillary area .
4. Occasionally diplopia due to limitation
of ocular movement .
5. Other symptoms includes:-
Discomfort
Foreign body sensation
Congestion
SYMPTOMS
 Triangular encroachment of
conjunctiva on the cornea .
 Numerous small opacities may
lie in front of apex of pterygium.
SIGNS

23. Clinical
Grading
Tan’s
Classification
GRADING OF PTERYGIUM

24. GRADING OF PTERYGIUM
Clinical Grading
 GRADE 1: extends 2mm on the cornea
 GRADE 2: involves upto 4 mm of the cornea it can be
primary or secondary.
 GRADE 3: encroaches more than 4mm of the cornea
&it can hamper visual axis.
Tan’s Classification
 T1 GRADE: clearly visible episcleral vessels under the
pterygium
 T2 GRADE: partially visibility of the episcleral vessels
under the pterygium.
 T3 GRADE: total obscured view of the episcleral
vessels under the pterygium.

25. CLINICAL GRADING

26. TAN’s CLASSIFICATION

27. DIFFERENTIAL DIAGNOSIS
CHARACTERS PTERYGIUM PSEUDOPTERYGIUM
AGE More common in older age
groups
Maybe seen in anygroup
SITE 3’oclock to 9’oclock meri
dians
Mayappear anywhereon the
cornea
LATERALITY bilateral Mostly unilateral
STAGES Progressive,reggresiveor stat
ionary
Always stationary
ETIOLOGY Degenerative process
Mayoccur due to exposure to s
unlight & dust
Inflammatory process
2’to chemicalburns,trauma.
LIMBAL RELATIONS Adhered to limbus Not adhered to limbus
ASSOCIATIONS Pinguecula ------

28. treatment
Early in the disease process, physicians often take a conservative approach,
limiting therapy to lubricating medications. Since UV radiation is believed
to be an important risk factor, the clinician should recommend that
patients with early-stage pterygia use proper protective eyewear. If the
lesion grows, surgical intervention becomes more compelling.

29. INDICATIONS
Surgical excision is the only satisfactory
treatment, which may be indicated for:
(1) Cosmetic reasons
(2) Continued progression threatening to
encroach onto the pupillary area (once
the pterygium has encroached pupillary
area, wait till it crosses on the other side)
(3) Diplopia due to interference in ocular
movements.
(4) Visual Impairment
Recurrence of the pterygium after surgical
excision is the main problem (30-50%).

30. PROCEDURE
 Transplantation of pterygium in the lower fornix
(McReynold's operation) is not performed now.
 Postoperative beta irradiations (not used now).
 Postoperative use of antimitotic drugs such as
mitomycin-C or thiotepa.
 Surgical excision with bare sclera.
 Surgical excision with free conjunctival graft taken
from the same eye or other eye is presently the
preferred technique.
 In recurrent recalcitrant pterygium, surgical excision
should be coupled with lamellar keratectomy and
lamellar keratoplasty.

31.  In simple excision the conjunctiva is sutured
back to cover the sclera.
 In bare sclera technique, some part of
conjunctiva is excised and its edges are sutured to
the underlying episcleral tissue leaving some bare
part of sclera near the limbus.
 Free conjunctival membrane graft may be
used to cover the bare sclera. This procedure is
more effective in reducing recurrence. Free
conjunctiva from the same or opposite eye may be
used as a graft.
 Limbal conjunctival autograft transplant-
ation (LLAT) to cover the defet after pterygium
excision is the latest and most effective technique
in the management of pterygium.

33. BOOKS
websites
• Textbook of Opthalmology
- A.K.Khurana
• https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3069871/
• https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5340105/