Keratitis (Svrna Shukla or Shukra ) Written by Kumar Vinod

Keratitis

Inflammation of the cornea. Inflammation of the cornea (keratitis) is characterised by corneal oedema, cellular infiltration and ciliary congestion.

Classification 

It is difficult to classify and assign a group to each and every case of keratitis; as overlapping or concurrent findings tent to obscure the picture. However, the following simplified topographical and etiological classification provide a workable knowledge.

Topographical (morphological) classifications
(A) Ulcerative keratitis (Corneal ulcer)
Corneal ulcer can be further classified variously.

1. Depending on location

• Central corneal ulcer
• Peripheral corneal ulcer

2. Depending on Purulence

• Purulent corneal ulcer or suppurative corneal ulcer most bacterial and fungal corneal ulcers are suppurative)
• Non purulent corneal ulcer (most of viral, chlamydial and allergic corneal ulcers are non suppurative.)

3. Depending upon association of hypopyon

• Simple corneal ulcer (without hypopyon)
• Hypopyon corneal ulcer.

4. Depending upon depth of ulcer

• Superficial corneal ulcer.
• Deep corneal ulcer.
• Corneal ulcer with impending perforation.
• Perforated corneal ulcer

5. Depending upon slough formation

• Non sloughing corneal ulcer.
• Sloughing corneal ulcer.

(B). Non ulcerative Kertitis

1. Superificial keratitis

• Duffuse superficial keratitis.
• Superficial punctuate keratitis (SPK)

2. Deep Keratitis

a. Non suppurative

• Interstitial keratitis
• Disciform keratitis
• Keratitis profunda
• Sclerosing keratitis.

b. Suppurative Deep keratitis

• Central corneal abscess
• Posterior corneal abscess.

Etiological classification

1. Infective Keratitis

• Bacterial
• Viral
• Fungal
• Chalmydial
• Protozoal
• Spirochaetal

2. Allergic keratitis

• Phlyctenular keratitis
• Vernal Keratitis
• Atopic keratitis

3. Trophic keratitis

• Exposure keratitis.
• Neuroparalytic keratitis.
• keratomalacia.
• Atheromatous ulcer.

4. Keratitis associated with diseases of skin and mucous membrane

5. Keratitis associated with systemic collagen vascular membrane.

6. Traumatic keratitis, which may be due to mechanical trauma, chemical trauma, thermal burns, radiations.

7. Idiopathic keratitis e.g.

• Mooren’s Corneal ulcer
• Superior limbic keratoconjunctivitis.
• Superficial punctuate keratitis of thygeson.

The Keratitis described in modern Ophthalmology Accoding to Ayurvedic literature can be correlated with

Savrna, Shukla - Acharya Shuruta
Svrna Shukra - Acharya Vagbhata

Treatment According to vaghabhatta

1. According to Doshas, Triphla Shoud be used either in Ruksha (Dry) or in Snigdha (wet) form.
2. Use of Tikta Ghrit Orally
3. Perform Raktamoskhan (Blood letting) in supra clavicular area e.g., skull, temporal area.
4. Virechan, parishek, Aaschyotan, Tarpan should be performed.
5. Use of Ghrit Prepared with Trivrit Kwath three times a day orally
6. Perform Rakta Mokshan (Blood letting) with Sira or Jalauka.
7. Use of Chameli, Lakshna, Gura, Chandan the form of Varti.
8. For all type of Shukras, use of tamala Patra and Cow tooth, + Shankh, + Samudrafen + tamra Bhasma Vasti prepared with gomutra has been mentioned.

Svrana Shukla is Raktaj Vyadhi.
Acharya Sushruta has mentioned ithe use of Anjanas in its treatment and Aacharya vaghbhatta ahs mentioned the Raktamokshan.

Treatment According to Acharya Sushruta

First of all lekhan karma should be done followed by Santarpana.
For lakhan Karma Lekhan Churna as are

1. Shirish Beej, Marich, Pippli, Saindhav Mixture.
2. Only Saindhav can also be used.

For Anjana Karma
Different Anjans are

1. Sandhav - 1 part
   Marich - 2 part
   Manah Shila - 4 part
   Shankh - 8 part
   Tamra Bhasma- 16 part
2. Madhuksar Madhu
3. Mung + Shankh + Madhu+ Chini – All in equal parts.
4. Vibheetak Asthi Majja and Madhu
5. Shankh + Badan Asthi + Nirmaliphal; + Draksha + Yashtimadhu + Swarna Makshik – All equal parts.