ANCIENT METHODS OF EYE TREATMENT

1. Ocular Therapeutics (KRIYAKALPA)
in
Ayurveda
Dr Prasanta Kumar Sahoo
M.S (Ay) Shalakya, Netraroga. (NIA,Jaipur)
AMO, GAD, ADAVA
Tuesday, February 7, 2017

2. INTRODUCTION
KRIYA KALPA = KRIYA + KALPA
KRIYA/KARMA
कर्तव्यस्य क्रिया कर्त कर्त नान्यदपेक्षर्े |
प्रयत्नादद कर्त चेष्टिर्र्ुच्यर्े |
Act/ Action/ Medical treatment/ Practice (MW dictionary)
KALPA – KALPANA/ YOJANA
कल्प्यर्े व्यवस्था्यर्े प्रयोगा अनेनेतर् कल्पप ।
प्रयोग पद्धतर्तनर्ातण पद्धर्ीतर् कल्पप एवेतर् कल्पपना ॥
Practicable / Idea/ Art of preparing medicine (MW dictionary)
KRIYAKALPA:
The unique branch of medicine which deals with specialized
topical ocular procedures/ methods of preparation for the
management of different diseases of eye and Adnexa.
Tuesday, February 7, 2017

3. WHY KRIYA KALPA?
Blood aqueous barrier
Blood retinal barrier
Less doses required for optimum therapeutic effect
Like skin, structures of Eye are exposed to outer
environment. Thus - to clean/remove surface pathogens
topical therapies are essential.
For diseases of lid and lacrimal apparatus …
No biodegradation of drugs.
Non surgical and cost effective.
Can be used as preventive as well as curative.
Tuesday, February 7, 2017

4. WHAT ARE THESE?
TYPES
These are specifically designed according to the
stage, severity and site of the diseases.
Sushruta the father of Indian Ophthalmology
mentioned five Kriyakalpas.
Tarpana
Putapaka
Seka
Aschotana
Anjana AND
Two more procedures added by Sharangadhara
and Vagbhata. i.e. Pindi and Vidalaka.

5. ASCHYOTANA
(आश्च्योतन)
Instillation of the medicated solution into the conjunctival sac
when the eye is completely open and patient is in supine
position.
Indicated as first line of treatment in all ocular inflammatory
conditions where
Raga(congestion),Daha (burning pain), Ashrusrava
(excessive lacrimation), Sopha (inflammaiton) and Toda
(pricking pain) are present.
Methods : Decoctions prepared with leaves, bark etc. The
decoction should be neither concentrated nor diluted and it
should not be too hot or too cold.
Dose : 1-2 (Ghrita manda) / 7-8 /10/ 12 drops.
Duration: 3 to 5 days
Holding time/ धारण काल: 100 वाक र्ात्रा (= 2.5 minutes)
Tuesday, February 7, 2017

6. SEKA (सेक/ पररसेक)
Pouring of thin stream of medicated
solution into the closed eyes for a
stipulated period.
Indicated in acute and severe affections of
the eye.
Doses/ Procedure time: L/S/R-
200/400/600 वाक र्ात्रा (7/ 10/ 12 minutes)
Duration – 3- 5 days.
Tuesday, February 7, 2017

7. Drugs / Formulations used in
Ashyotana / Seka
Bacterial / Viral conjuctivitis: Triphala
+ Lodhra+Yastimadu+ Musta
decoctions.
 Allergic conjuctivitis- Haridra /
Daruharidra/ Yastimadhu/ Sirisha
 VKC- Shigru Patra swarasa/juice.
 Dry eye- Milk+ Haridra+ Daruharidra+
saidhava lavana.
 Ocular injuries- Human milk.
Tuesday, February 7, 2017

8. Cont..
Corneal opacities (Sukra roga)- Amla+Nimba +
Kapitha Patra+ Yastimadhu+ Lodhra+
Khadira+Tila decoction (Y.R)
Cataract- Triphala decoction (Ch.D)
Pterygium- Karanja bija+Milk
Pothaki (Trachoma)- khadira+ shigru+ Adhaki
Tuesday, February 7, 2017

9. PINDI (पपन्डी) / Kavalika
In Pindi-mild sudation is applied over the eye by
luke warm paste made out of different plant parts.
Indications:Conjuctivitis, Glaucoma, Inflammatory
conditions of eye
Drugs used
Eranda patra , moola, etc.
Amla / mahanimba
Shigru
Triphala
Tuesday, February 7, 2017

10. BIDALAKA (बिडालक)
In Bidalaka–paste of different drugs is applied over the
closed eyelids leaving the eye lashes.
Indications: it is indicated in mild inflammatory conditions of
the eye.
तरूण नेत्र रोग (prodormal conditions)
अश्रुस्राव (Hyperlacrimation)
वेदना (Pain)
तोद (Pricking sensation)
कन्डु (Itching)
शोथ (edema)
Mostly in the diseases of eye lids and lacrimal
apparatus- stye, blepharitis, lid abscess, trichiasis.
Drugs used are- Manjistha, Chandana, Sariva.
Like mukha lepa – Saindhavadi lepa – Saindhava lavana,
Rasanjana, yastimadhu and daruharidra.
Tuesday, February 7, 2017

11. TARPANA (तपपण)
Concentric boundary is formed around the orbit and
medicated ghee (clarified butter) and oils are filled for a
stipulated period.
Drug used: Ghee /medicated ghee.
Indications: It is indicated in a variety of ocular
disorders such as
Jihyata (squinting)
Tamyata (symptomatic visual disturbances)
Rookshata (dryness)
Adhimantha (Glaucoma)
Average time prescribed is 20 minutes
Quantity required 20ml for each eye
For 3/ 5/ 7 days can be advised.
Tuesday, February 7, 2017

12. Cont..
Jivantyadi Ghrita- ARMD, Optic atrophy and
degenarative disorders of retina.
Patoladighritha- Uveitis
Doorvadyaghrita- DR( NPDR)
Mahatriphalaghritha- Senile cataract, Refractive
disorders, RP
Triphalaghritha- Refractive disorders,
Tikthakaghritha- corneal opacity
Tuesday, February 7, 2017

13. TARPANA (तपपण)
Tuesday, February 7, 2017

14. PUTAPAKA (पुटपाक)
Topical application of extracts prepared out of plant drugs,
animal flesh, mineral drugs and fats, byn heating their
mixture (paste) in a closed chamber.
This extract is retained over the eyes as in Tarpana.
Compliance, disposal and tissue contact time are also same
as in Tarpana.
Pippalyadi Putapaka- Retinitis pigmentosa (RP)-
(Sleshmavidagdha dristi)
Krushnadi Putapaka- Lekhana (Scraping properties)-
Corneal opacity.
Tuesday, February 7, 2017

15. Tuesday, February 7, 2017

16. ANJANA (अन्जन)
(Application of Collyrium
Topical application of the drug in the form of powder/paste/
thick liquid into the conjuctival fornices with an applicator.
Anjana means which spreads or propagates‘Anakti anena
anjanam’.
According to its form Anjana is of 3 types i.e. Gutika,
Rasakriya and Churna.
Even though anjanas are meant for eye diseases it has wide
applications in systemic diseases too.
Tuesday, February 7, 2017

17. Indications: Anjana is indicated when clinical features of doshas have
become manifested and localised in the eye and acute inflammatory
signs are subsided by the application of seka and aschotana.
Contra-indications: In acute inflammatory conditions.
Drug used: Compound drugs prepared of metals, minerals and herbs.
Generally antimony ,lead and tin compounds are frequently prescribed.
Dose: Harenu matra
Post Anjana Karma- Pratyanjana
Naktandhya (Night blindness)- maricha+ dahi anjan, pippalyadi
anjan.
Chandrodaya varti anjan- Arma (Pterygium)
Guduchi rasakriya anjan- vascular disorders of retina , optic nerve
diseases etc. Chandraprava varti anjana- degenerative conditions of
conjuctiva- pingeicula etc.Tuesday, February 7, 2017

18. Selection of Kriyakalpa (Stage)
Status Therapy
Inflammatory
conditions
(Amma avastha)
Seka
Aschyotana
Pindi
Bidalaka
Non inflammatory
conditions
(Nirama Avastha)
Tarpana
Putapaka
Anjana
Tuesday, February 7, 2017

19. Cont..
SEGMENT THERAPY
ANTERIOR ASCHYOTANA
SEKA
TARPANA
PUTAPAKA
ANJANA
POSTERIOR TARPANA
PUTAPAKA
ANJANA
NASYA
Tuesday, February 7, 2017

20. Cont..
SURFACE
LESIONS/
ADNEXA
LENS
CILIARY BODY
IRIS
RETINA
OPTIC NERVE
VISUAL
PATHWAY
TARPANA
PUTAPAKA
SEKA
ASCHYOTANA
ANJANA
PINDI
BIDALAKA
SEKA
ASCHYOTANA
ANJANA
TARPANA
TARPANA
PUTAPAKA
ANJANA
NASYA
TARPANA
PUTAPAKA
ANJANA
NASYA
Tuesday, February 7, 2017

21. PHARMACOLOGICAL ACTION
KRIYAKALPA MODE OF ACTION &
DRUG DELEVERY
Advantage Disadvantage
Aschyotana Direct Diffusion Better compliance
Commonly use
Less tissue contact time
Seka Direct Diffusion Removes surface
pathogens
Drug excretion more
Less bioavailabity
Pindi Trans-cutaneous drug
absorption and pressure
effect e.g. in Glaucoma
Better compliance.
Tissue contact time more
Transient effect
Needs repeatation- long
term use.
Vidalaka Trans-cutaneous drug
absorption
Better compliance.
Tissue contact time more
Mostly limited to lids,
adnexa and anterior
segment eye diseases.
Tarpana Bothe precorneal and
corneal drug absorption
Both lipd and water soluble
drugs absorbed
Tissue contact time more
Effective both in ant. And
post. Segment.
After follow up little difficult.
Putapaka Drug ionisation, nano
particles. Better absorption,
bioavailability more
Tissue contact time more
Very effcetive in both ant.
And post. Eye diseases
Very concentrated,
Complications more
Anjana Solid drug delivery
Both conjuctival , scleral.
Tissue contact time more.
Prolong drug delivery
Effective both in ant. And
post. Segment.
Patient compliance less.
Tuesday, February 7, 2017

22. FACTORS RESPONSIBLE FOR
OCULAR DRUG DELIVERY
Routes of drug administration- in case of Kriyakalpa mainly
mocosal and cutaneous routes..
Solubility and bioavailability- lipid soluble/ water soluble/
aqeous suspensions( medicated ghee/oils), tissue contact
time
Physical state of the drug- colloids / crystalloids,
concentrated tonicity/ pH, molecular weight,
Absorption (Time and rate of absorption)
Absorbing surface- surface area
Vascularity of the surface
Compliance and excretion of the drugs.
Ionisation of the drug- non ionised drugs penetrate the lipid
cellular layers.
Microimulsions – oil+water- surfactantsTuesday, February 7, 2017

23. SUMMARY
WHY KRIYAKALAPA?
WHAT ARE THESE?
HOW THESE ARE DONE?
WHICH CONDITIONS
PHARMACOLOGY AND OCULAR DRUG DELIVERY
ANALOGY AND COMPARISION BETWEEN MODERN
AND AYURVEDA OCULAR DRUG DELIVERY SYSTEM.
FUTURE PROSPECTIVES
Tuesday, February 7, 2017

24. CONCLUSION
Ancient medical shcolars were aware of the mechanism of
blood aqueous barrier as well as ocular pharmacology
Putapaka is highly developed Nanoconcept which is been
used since thousands of years.
By Pindi and Bidalaka therapies, vasodilatation and drainage
of toxins from the site of lesion is possible.
In all the drug preparations of Kriyakalpa mostly herbal and
natural excipients are used like -
Honey- best natural preservative
Antioxidant – Triphala
Surfactant- Nirmali bija
Viscosity – honey, ghee etc
Tonicity – saindhavalavana etc.
ANIMAL STUDIES WITH CONTROL GROUPS ARE
REQUIRED TO STANDARDISE THE PROTOCOLS FOR
TREATMENT PURPOSES.
Tuesday, February 7, 2017

25. TAKE HOME MESSAGE
NON SURGICAL NON INVASIVE
COST EFFECTIVE
BOTH PREVENTIVE AND CURATIVE
EFFECTIVE IN BOTH ANT. AND POIST.
SEGMENT DISEASES
Tuesday, February 7, 2017

26. CONT..
चक्ष्युरक्षायाां सवपकालां मनुष्यॆयपत्नः कतपव्यो िजवतते याविद्छा
व्यथो लोकोऽयां तुल्यराबत्रिदवानाां पुांसामन्धानाां ववद्दमानेऽवप ववत्ते ॥
(A.H. U.13/97)
“All effort should be made by men to protect the
eyes, throughout the life; for the man who is blind
this world is useless, the day and night are the
same even though he may have wealth”.
(A.H.U.13/98)
Tuesday, February 7, 2017

27. Thank You
Tuesday, February 7, 2017