E-ISSN:2456-3110

Review Article

Adhimantha

Journal of Ayurveda and Integrated Medical Sciences

2022 Volume 7 Number 6 July
Publisherwww.maharshicharaka.in

A comprehensive understanding of Adhimantha w.s.r. to Glaucoma

Megha.1*, Hamsaveni V.2
DOI:

1* Megha, Post Graduate Scholar, Department of PG Studies in Shalakya Tantra, Sri Kalabyraveshwara Swamy Ayurvedic Medical College Hospital and Research Centre, Bengaluru, Karnataka, India.

2 V Hamsaveni, Professor, Department of PG Studies in Shalakya Tantra, Sri Kalabyraveshwara Swamy Ayurvedic Medical College Hospital and Research Centre, Bengaluru, Karnataka, India.

Adhimantha is considered as Sarvagata Netraroga which is a dreadful disease and possess symptoms of Glaucoma as per modern science. Where there is excessive churning type of pain in the eyes along with the involvement of the particular dosha. The estimated prevalence of glaucoma cases in India is reported to be 11.9 million. The prevalence of glaucoma in India is not the same at every place varying prevalence among different populations and subgroups having rate of being 2.3-4.7%. Glaucoma is a group of eye conditions that damage the optic nerve. This damage is caused due to raised intra ocular pressure this is the leading cause for blindness globally. In present scenario concept of Adhimantha and its management according to Ayurveda and modern science gain much important. Hence this article describes Ayurveda and modern perspectives of Adhimantha along with its treatment modalities.

Keywords: Ayurveda, Adhimantha, Glaucoma, Netraroga

Corresponding Author How to Cite this Article To Browse
Megha, Post Graduate Scholar, Department of PG Studies in Shalakya Tantra, Sri Kalabyraveshwara Swamy Ayurvedic Medical College Hospital and Research Centre, Bengaluru, Karnataka, India.
Email: 		Megha, V Hamsaveni, A comprehensive understanding of Adhimantha w.s.r. to Glaucoma. J Ayu Int Med Sci. 2022;7(6):127-140.
Available From
https://jaims.in/jaims/article/view/1887

Manuscript Received Review Round 1 Review Round 2 Review Round 3 Accepted
2022-05-30 2022-05-31 2022-06-07 2022-06-14 2022-06-21
Conflict of Interest Funding Ethical Approval Plagiarism X-checker Note
Nil Nil Yes 18%

© 2022by Megha, V Hamsaveniand Published by Maharshi Charaka Ayurveda Organization. This is an Open Access article licensed under a Creative Commons Attribution 4.0 International License https://creativecommons.org/licenses/by/4.0/ unported [CC BY 4.0].

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Introduction

Eye is an important sense organ when compared to all other senses i.e., “Sarvendriyanam Nayanam Pradanam.”[1]

Ayurveda emphasis on protection of the Indriyas for better perception of Indriyarthas hence we should not neglect the diseases of eyes. Acharya Sushruta while describing 76 types of eye diseases in Uttaratantra has mentioned a separate chapter for Sarvagata Akshirogas where Adhimantha has been mentioned under it.[2]

Severe pain in the eyes is the primary symptom of it, Clinical features of this disease vary depending on Dosha involvement. It is very difficult for management if Adhimantha is not treated at a proper time it will leads to loss of vision. According to Acharya Sushruta, Vataja, Pittaja, Kaphaja and Rakthaja Adhimantha are said to be Vyadhana Sadhya Vyadhi whereas Hatadhimantha is said to be Asadhya.[3]

Understanding the Samprapti of Adhimantha

jaims_1887_02.JPG


According to the Ayurvedic classics Adhimantha occurs due to the negligence or improper treatment of Abhishyanda.[4]

Chikitsa of this Vyadi includes Snehana, Raktamokshana, Virechana, Basti, Nasya and Seka, Aschyotanadi Kriyakalpa procedures.

Signs and symptoms of this disease is compared more with closure angle glaucoma in modern science. Glaucoma is a progressive optic neuropathy with loss of retinal neurons and nerve fibre layer, resulting in blindness if left untreated. High IOP is the strongest known risk factor for glaucoma.[5]

Having various clinical features like Photophobia, Blurred vision, Severe pain, Headache, Nausea and treatment measures include various procedures like Goniotomy, Trabeculectomy etc.

Samprapti Ghataka of Adhimantha


  • Dosha : Pitta pradhana Tridosha
  • Dooshya : Rasa, Rakta, Mamsa
  • Agni : Jataragni and Dhatwagni
  • Ama : Jataragni and Dhatwagni mandhya janya
  • Strotas : Rasavaha, Raktavaha, Mamsavaha
  • Srotodusti Prakara : Sanga, Vimargagamana, Atipravrutti
  • Udbhava Sthana : Amashaya
  • Sanchara Sthana : Rasayani
  • Vyaktha Sthana : Sarvagata Netra
  • Rogamarga : Madhyama

Tyes of Adhimantha[6]

1. Vataja

2. Pittaja

3. Kaphaja

4. Raktaja

Understanding Purvarupa of Adhimantha[7]


  • Vatapradhana - Toda (pain)
  • Pittapradhana - Usha (hot)
  • Kaphapradhana - Guru (heaviness)
  • Raktapradhana - Raga (redness)



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Understanding lakshanas of Adhimantha

Vataja Adhimantha[8,9]


SN Lakshanas Susrutha Vagbhata
1.          Netramutpatyate + +
2.          Aranyeva manthana + +
3.          Sangharsha + +
4.          Todanirbeda + +
5.          Mamsasamrabdha + +
6.          Aavilam + +
7.          Kunchanasphota + +
8.          Aadhmana + +
9.          Vepatu + +
10.       Shiraso ardha vyatha + +
11.       Karnanada - +
12.       Bhrama - +

Pittaja Adhimantha[10,11]


SN Lakshanas Susrutha Vagbhata
1.          Raktarajichitam + +
2.          Sravi + +
3.          Vanhineva dahyate + +
4.          Yakritpindopamam + +
5.          Ksharenaktam eva kshatam + +
6.          Prapakvocchuna vartmanta + +
7.          Saswedam + +
8.          Peetadarshanam + +
9.          Moorcha + +
10.       Shirodaha + +
11.       Jwaladangara kirnabham - +

Kaphaja Adhimantha[12,13]

SN Lakshanas Susrutha Vagbhata
1.          Sophavannatisamrabdha + -
2.          Srava + -
3.          Shaitya + -
4.          Gourava + -
5.          Paichillya + -
6.          Dooshika + -
7.          Harshana + -
8.          Roopam Pashyati Dukkhena + -
9.          Paamshupooranam Eva Avilam + -
10.       Naasadmana + +
11.       Shirodhukha + -
12.       Natam Krishnam - +
13.       Unnatam Shuklamandalam - +
14.       Paamshupoorna Akshi - +
15.       Praseka  -  +


Rakthaja Adhimantha[14,15]

SN Lakshanas Susrutha Vagbhata
1.          Bandhujeevaprathikasham + -
2.          Taamyathi + -
3.          Sparshanakshamam + -
4.          Raktastravam + -
5.          Nisthodam + -
6.          Pashat Agninibha Disha + -
7.          Raktamagnaaristavaccha Krishabhaga + -
8.          Asruk Nimagna - +
9.          Aristaabham Krishna - +
10.       Agnyabha Darshanam - +

Chikitsa

Purvarupa stage of Sarvakshigata Rogas is managed by: [16]

  • Shirovireka
  • Kavala
  • Dhoomapana
  • Upavasa

Vataja Adhimantha Chikitsa[17,18]

Snehapana

  • Purana Ghrita,
  • Sahacharadi Ghrita

Swedana

  • Rasna, Shatavari, Dashamoola, Bala, Kola, Kulatta and Yava cooked in Ajaksheera - Bashpa Swedana
  • Rice cooked in Ksheera, Vesavara, Salvana - Upanaha

Siramoksha

If pain persists even after Snehana and Swedana, Siramokshana is done in Spanasika, Lalata and Apanga pradesha.

Snehavirechana: Tilwaka Ghrita followed by intake of Tilwaka Kashaya.

Basti

  • Sneha Basti in Vata Prakopa.
  • Niruha Basti in Malavruta Vata.

Sneha Nasya

  • Rasna, Abhiru, Dashamoola, Bala, Kola, Kulathha and Yava along with Taila.
  • Taila processed with Shalaparni, Ksheera and Madhura Gana Dravyas.

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Dhoomapana: Snehika Dhoomapana

Seka: Eranda Patra​, Moola and Twak or Kantakari Moola processed in Aja Ksheera in Sukoshna form

Ashchotana: Hribera, Tagara, Manjista along with Aja Ksheera

Tarpana: Kashmarya, Maduka, Kusta, Bhrihati, Talisapatra, Jatamamsi, Sariva, Prapoundarika, Darbhamoola and Kasheru along with Paya.

Putapaka

  • Snaihika Putapaka​
  • Putapaka Swarasa obtained from Yakrit of Chaga added with Pippali, Saindava, Madhu and Ghrita.

Anjana

  • Snehanjana with Sarpi kept in copper vessel and added with Saindava.
  • Maduka, Haridra, Haritaki and Devadaru triturated in Aja Ksheera.

Ahara: Gramya, Anupa, Audaka Mamsarasa, Snigdha Dravyas, Phalarasa, Ksheera.

Pittaja Adhimantha Chikitsa[19,20]

Snehapana: Ghrita mixed with Sharkara or Tikthaka ghrita

Raktamokshana: Snehana is followed by Raktamokshana by Siravyadha

Snehavirechana: Kwatha of Triphala, Kashmarya, Sharkara with Trivrit ​

Nasya

  • Sariva, Kashmari, Sharkara with Ikshurasa.
  • Nasya with Ksheerasarpi (ghee made out of milk)

Seka and Lepa

  • Chandana, Kumuda, Sariva and Jatamamsi processed with Ksheera.
  • Vrukshanadi Ghrita

Anjana

  • Shuddha Swarna rubbed in Sthanya Dugdha.
  • Rasakriya made out of Palasha or Shallaki added with Sharkara and Madhu.
  • Palasha Pushpa Swarasa mixed with Kshaudra and Sharkara.
  • Rasakriya prepared out of Yastimadhu mixed with Sharkara and

Aschothana

  • Kwatha of Prapoundarika, Amalaka, Brihati, kantakari, Dashamoola, Shatavari, Talisa patra, Manjista, Utpala mixed with Sitha and Sthanya
  • Chandanadi Qwatha with Kshaudra
  • Madhuka, Lodhra with Ghrita for Aschothana
  • Kwatha of Maduka and Daruharidra added with Sharkara

Kaphaja Adhimantha Chikitsa[21-23]

Apatarpana

  • For 3 days followed by intake of Tikta Ghrita.
  • After Snehapana Raktamokshana is done by Siravyadhana.

Snehapana: Ghrita processed with Trikatu and Yavakshara

Swedana: Swedana is done with Tagara, Kapitta, Nirgundi, Bilwa and Arka

Raktamokshana: Done by Siravyadha

Nasya: Avapeedana Nasya with Kaphahara Dravyas.

Doomapana: Yava, Madanaphala, Burjapatra, Shamipatra​ along with Ghrita.

Pariseka: The course powder of Nimba, Patola, Jatipatra, Lodhra, Brihati, Kantakari, Shunti taken in a cloth soaked in Kshoudra and Sidhu.

Bidalaka: Kusta, Tagara, Murungi, Vyosha, Ela, Daruharidra.

Tarpana and Putapaka

  • Yakrit of Aja, Agaru, Priyangu, Lashuna, Nalada, Shigru and Devadaru boiled in Paya, after it cools churned and obtained Navaneeta; it is cooked with same drugs and medicate Ghrita is prepared.
  • Kusta, Tagaru, Daruharidra, Eladi Gana Dravyas added with Madhu and Ghrita.

Aschyothana[24]

  • Shigrupallava Swarasa to reduce pain, foreign body sensation and Shopha.
  • Koshna Aschyotana with Nagara, Triphala, Nimba, Vasa, Lodhra Kwatha.



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Anjana

  • Haritaki, Haridra, Madhuyasti
  • Trikatu, Triphala, Vidanga and Haridra with water
  • Anjana prepared by flowers of Jati, Shobanjana, Karanja with water

Kavalagraha: Teekshna Dravyas

Aahara: which does not vitiates Kapha

Raktadimantha Chikitsa

Should be managed as Pittaja Adhimantha.[25,26]

Snehana: Snehapana with Kaumbha Ghrita (100yrs old) or Mamsarasa added with Ghrita and then Raktamokshana is done,​ followed by Virechana and Shirovirechana.[24]

Swedana: In the conditions of severe pain in the eyes - Mrudu Sweda, Jalaukavacharana is done.

Raktamokshana

Done by means of Siravyada or Jalaukavacharana.

Nasya

  • Ghrita manda,Sharkara, Maduka, Nilautpala and Sthanya.
  • In the conditions of severe pain in the eyes - Mrudu sweda, Jalaukavacharana is done.

Dhoomapana: Snehika Dhoomapana is done.

Seka[27]

  • Prapoundarika, Yastimadhu, Daruharidra, Lodhra, Rakthachandana, Erandamoola and Ambu.
  • Triphala, Yasti, Lodhra, Musta and Sharkara with

Pralepa

Shatadouta Ghrita mixed with Nilotpala, Usheera, Daruharidra, Kaliyaka, Maduka, Mustha, Lodhra, Padmaka applied around eyes.

Aschothana

  • Kasheruka, Madhuka Choorna mixed with Jala
  • Stree Sthanya Ascyottana
  • Yastyadi Qwatha
  • Mixture of Musta and Yastimadu Choorna wrapped in cloth and kept in vessel containing rain water


Anjana

  • Krishnasarpi Ethyadi Anjana.
  • Saindava, Kataka, Rasanjana and Kasisa are triturated with Madhu

Prognosis of Adhimantha[28]

All the 4 types of Adhimantha are said to be Sadhya if treated in time, if ignored or patient does not follow proper Pathyapthya, leads to loss of vision.


Types Sushruta Astanga Hrudaya
Vataja Adhimantha Loss of vision in 6 days Loss of vision in 5 days
Pittaja Adhimantha Loss of vision immediately Loss of vision immediately
Kaphaja Adhimantha Loss of vision in 7 days Loss of vision immediately
Raktaja Adhimantha Loss of vision in 5 days Loss of vision in 3 days

Hatadimantha: is a complication of Vataja Adhimantha, when Vataja Adhimantha is neglected, it leads to:[29]

  • Shrinking of eyes
  • There will be severe intolerable pain
  • It is not curable (Asadhya)

According to Vagbhata[30]

  • Painful eye as a result of improper treatment of Vatadhimantha
  • Anekaroopa Jayate Vedana (different types of pain)
  • Vrano Drustau (different varities of ulcers are formed on Dristi.
  • Drustihani (leads to Dristinasha)

Pathyapathya[31]

Category Pathya Apathya
Ahara Mudga, Yava Kaumba Sarpi Raktavarna Shaali Dhanya Kulattayusha Peya, Vilepi Suranakanda Patola, Karavellaka Punarnava Kakamachi Shaaka Draksha Madhu Triphala, Chandana Naari Paya Maduka Pushpi Taamboola Matsya, Dadhi Amla, Lavana, Vidahi Tikshna, Katu Gurvannapana  
Vihara Langana   Ashru Maithuna Vegadharana Sukshma Darshana Danta Vigarshana Nisha Bhojana Prajalpana Atapa Sevana
Manasika Guru Vandana (Padapooja)   Krodha Shokha
Procedure   Aschyotana Anjana Swedana Virechana Pratisarana Prapurana Nasya Raktamokshana Lepa Vamana  



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Shamanaushadhi

Orally Locally
Bhrihat Vasakadi Kashaya Darvyadi Rasakriya
Patoladi Kashaya Bruhatyadi Varti
Vasanimbadi Kashaya Haridranjana
Guduchitriphaladi Qwatha Lodhradi Aschyotana
Bhrihat Kusumananda Avalehya Durvadi Lepa
Shadanga Guggulu Kathakadya Anjana, drops
Kaishora Guggulu Spatika drops

Glaucoma: Glaucoma is a progressive optic neuropathy caused by a group of ocular conditions which lead to damage of the optic nerve with loss of visual function. It is a symptomatic condition of the eye where IOP is more than normal Level.[32]

IOP: Intra ocular pressure - refers to the pressure exerted by intra ocular fluids on the coats of eye ball. Normal IOP - 10 to 21mm of Hg.

Ocular hypertension: Constantly raised intra ocular pressure (>21mm of Hg) without any associated glaucomatous damage.

Normal tension or low-tension glaucoma: Glaucomatous changes even with low IOP (< 21 mm of Hg) or normal IOP.

Classification[30]

1. Congenital Glaucoma

2. Primary Glaucoma

a. Primary open angle Glaucoma

b. Primary angle closure Glaucoma

3. Secondary Glaucoma

Congenital or infantile glaucoma

It is defined as glaucoma appearing between birth and the age of 3-4years.There is raised intraocular tension present since birth. when glaucoma is present at puberty known as Juvenile glaucoma.

Etiology: It is transmitted as an autosomal recessive trait.

Types:

1. Congenital glaucoma - It manifests at birth

2. Infantile glaucoma - It presents between 1-3 years

3. Juvenile glaucoma - It presents around puberty


Signs

  • Iris is not completely separated from cornea
  • Persistence of embryonic mesodermal tissue at the angle
  • Absence of canal of Schlemm

Symptoms

  • Lacrimation
  • Photophobia
  • Defective vision
  • Enlargement of whole eye ball

Treatment: The treatment of congenital or infantile glaucoma is always surgical.

Primary Glaucoma

a. Primary Open Angle Glaucoma: Also known as slowly progressive condition of adult onset.

Characterised by:

  • Slowly progressive raised IOP (> 21 mm hg)
  • Open angle of anterior chamber
  • Characteristic optic disc cupping
  • Specific visual field defects

Predisposing factors:

  • Heredity
  • Age: Between 50-70yrs
  • Myopics
  • Diabetics have higher incidence
  • Smoking
  • High blood pressure

Pathogenesis: There is increase in IOP due to decrease in aqueous outflow due to increased resistance to the flow by:

  • Thickening and sclerosis of trabecular meshwork
  • Deposition of material in trabecular meshwork
  • Collapse of schlemm’s canal

Clinical features

  • Insidious onset and remains asymptomatic until significant loss of visual field
  • Loss of contrast sensitivity
  • Gradual loss of peripheral vision (Tunnel vision)
  • Mild headache and eye ache

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  • Scotoma (defect in visual field) noticed by observant patients
  • Difficulty in reading and close work
  • Frequent changes in presbyopic glasses
  • Delayed dark adaptation (late stages)
  • Significant loss of vision and blindness if untreated

Signs

1. Increase in IOP: above 21 mm of Hg and ranges between 35-40 mm hg in later stages.

2. Optic disc changes:

  • Cupping of optic disc
  • Thinning of neuroretinal rim
  • Nasal shifting of vessels
  • Glaucomatous optic atrophy

3.Visual field defects: Visible areas of reduced vision on perimetry

Clinical examination

a. Slit lamp examination

b. Perimetry

c. Ophthalmoscopic evaluation of fundus and optic disc

d. Gonioscopy

Tonometry

IOP

  • Not permanently raised
  • Exaggeration of normal diurnal variation. A variation over 5mm is suspicious and over 8mm of Hg is diagnostic of glaucoma
  • Later stages, IOP is permanently raised above 21mm of hg and ranges between 30 and 45mm of Hg

Ophthalmoscopic examination: Progressive changes in the optic disc are seen.

  • Vertically oval cup
  • Marked cupping
  • Thinning of neuroretinal rim
  • Nasal shifting of retinal vessels
  • Optic atrophy - optic disc appears white and excavated

Optic disc changes and visual field loss: Rim of optic nerve becomes thinner as disc caves in and becomes more cupped.

Treatment

1. Medical therapy

2. Laser Trabeculoplasty

3. Filtration surgery/Trabeculectomy

1. Medical therapy

  • Topical Beta blockers - reduces aqueous secretion by affecting the receptors on ciliary processes. Eg. Timolol Maleate
  • Prostaglandin analogues-increases the aqueous outflow. Eg. Latanoprost
  • Dorzolamide - Decreases aqueous secretion
  • Brimonidine - Decreases aqueous production and by increasing uveoscleral outflow.

2. Laser trabeculoplasty: It is safe, non-invasive and out-patient department procedure. An average drop of intraocular tension is about 8-10mmHg. Mainly indicated in open angle Glaucoma.

Mode of action

Laser beam causes a shrinkage of the collagen on the inner surface of the trabecular ring, there by opening the intraocular spaces, results in aqueous outflow.

3. Filtration surgery: A new channel is created through which aqueous humor flows from anterior chamber into sub conjunctival space. Indicated in uncontrolled IOP despite maximal medical therapy and trabeculoplasty.

Primary Angle Closure Glaucoma

Primary angle closure is characterised by apposition of peripheral iris against the trabecular meshwork resulting in obstruction of aqueous outflow by closure of an already narrow angle

Pre disposing factors:

  • Age - PACG seen most frequently in 6th and 7th decade
  • Hypermetropic eyes with shallow anterior chamber
  • Eyes where iris lens diaphragm is placed anteriorly



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Mechanism of raise in IOP

  • Mid Dilation of Pupil (physiological - dim illumination, pharmacological - using mydriatics and other drugs)
  • Causes increased amount of apposition between the iris and lens with a considerable pressure. This is called Relative Pupillary Block.
  • Aqueous collects in the posterior chamber pushing the peripheral flaccid iris. This is called iris bombe. This is called Appositional Angle Closure. This results in transient rise in IOP.
  • Long standing cases appositional closure is converted to Synechial Angle Closure by development of peripheral anterior synechiae. This results in continuously raised IOP.

Classification of PACG

1. Subacute PACG

2. Acute PACG

3. Chronic PACG

4. Absolute Glaucoma

1. Subacute primary angle closure glaucoma: Attack of transient rise of IOP (40-50mm Hg) lasting for few minutes to 1-2 hours.

Precipitating factors

  • Physiological mydriasis
  • Pharmacological mydriatics
  • Physiological shallowing of anterior chamber after lying prone

Clinical features

  • Unilateral transient blurring of vision
  • Coloured haloes around light
  • Headache, brow ache and eye ache on the affected side

On examination

  • Eye is not congested
  • Synechiae present
  • Elevated IOP

Treatment - Prophylactic Laser Iridotomy

2. Acute primary angle closure glaucoma: This is an acute attack of rise in IOP in patients with PAC due to sudden closure of the angle. It does not terminate on its own and can last for many days if not treated.

Clinical features

  • Pain
  • Nausea, vomiting, prostrations are commonly seen with pain
  • progressive impairment of vision
  • Redness
  • Photophobia
  • Lacrimation

Signs

  • Lids appear edematous
  • Conjunctiva - chemosis, congestion seen
  • Cornea- oedematous and insensitive
  • Anterior chamber- shallow. Aqueous flare or cells may be seen
  • Iris may be discoloured
  • Pupil non-reactive semidilated, vertically oval and fixed
  • IOP is elevated (40-70mm of Hg)
  • Optic disc - Edematous and Hyperaemic

Treatment

a. Medical therapy

  • Systemic hyperosmotic agent - IV Mannitol
  • Iv Acetazolamide followed by orally 3 times
  • Analgesics and anti-emetics
  • Pilocarpine eyedrops
  • Topical Beta blockers
  • Corticosteroid eyedrops

b. Surgical treatment

  • Peripheral Iridotomy
  • Filtration surgery

3. Chronic primary angle closure glaucoma

It results from gradual synechial closure of the angle of anterior chamber.

Criteria:

  • Peripheral anterior synechiae are formed
  • IOP is constantly elevated
  • Optic disc shows glaucomatous damage
  • Visual field shows typical glaucomatous defects



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Clinical features

  • IOP is raised
  • Optic disc cupping
  • Visual field defects

Treatment

  • Laser Iridotomy
  • Filtration Surgery

4. Absolute primary angle closure glaucoma

PACG if untreated gradually passes into the final phase of absolute glaucoma.

Clinical features

  • Painful blind eye: the eye is painful, irritable and completely blind (no light perception)
  • Cornea - insensitive
  • Anterior chamber - shallow
  • Iris- atrophic
  • Pupil becomes fixed and dilated
  • Optic disc - glaucomatous optic atrophy
  • IOP is high
  • Eyeball stony hard

Treatment

  • Retrobulbar alcohol injection - It is given to relieve pain, destroys the ciliary ganglion.
  • Destruction of secretory ciliary epithelium by Cryotherapy.
  • Enucleation of eyeball - when pain is not relieved by conservative methods.

Complications

  • Corneal ulceration
  • Staphyloma formation
  • Atrophic bulbi - ciliary body degenerates, IOP falls and the eyeball Shrinks.

Secondary glaucoma

Increase in IOP is secondary to some Occular or Systemic disease.

Depending on the causative primary disease

a. Aphakic Glaucoma

b. Inflammatory Glaucoma

c. Steroid induced Glaucoma

A. Aphakic glaucoma: It occurs due to intumescent (swollen) cataractous lens or anterior dislocation of lens.

O/E

  • Lens - cataractous and swollen
  • Anterior chamber - deep and open angle in fellow eye

Management

  • Medical treatment to control IOP
  • Laser iridotomy
  • Cataract extraction

B. Inflammatory glaucoma

Glaucoma due to uveitis

Rise in IOP occurs due to inflammation of uveal tissue - when not treated over the period PAS develop and cause synechial angle closure.

O/E

  • Raised IOP
  • Iris bombe
  • Seclusio pupillae

Management

  • Medical treatment to lower IOP
  • Filtration surgery

C. Steroid induced glaucoma

It is a type of secondary open angle glaucoma which develops following topical or systemic steroid therapy.

Causes: Decreased phagocytosis by endothelial lining of trabecular meshwork, inhibits prostaglandins which increases aqueous outflow. Hence rise in IOP

Management   

  • Regular monitoring of IOP
  • Discontinuation of steroids
  • Medical therapy with 0.5% with timolol maleate

Comparison of Adhimantha and Glaucoma

Ayurvedic Modern
Kaphaja Adhimantha POAG
Vataja Adhimantha PCAG
Pittaja Adhimantha PCAG
Raktaja Adhimantha PCAG
Hatadhimantha Absolute glaucoma

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Lakshanas which can be correlated to POAG


Lakshana Signs and symptoms Comparision
Adhmana Raised tension (IOP) POAG    
Upekshanat Akriyavanta No symptoms so no medication in early stage
Praseka Nausea
Natam Krishnamunnatam Shuklamandalam Chemosis
Shirodukha Headache
Rupam Pashyati Dukhena Visual field defect

Lakshanas which can be correlated to PCAG


Lakshana Signs and symptoms Comparision
Avilam Blurness of vision PCAG
Aadhmana Raised tension (IOP)
Raktaparyantam & Asruk Nimagnam Circum corneal and conjunctival congestion
Shiraso Ardham Vyathana Headache, Brow ache, eye ache
Yakrit Pindopamam Iris discolouration
Taamyati Progressive impairment of vision
Kunchana Shallow anterior chamber

Lakshanas which can be correlated to Absolute Glaucoma


Lakshana Signs and symptoms Comparision
Prasahyarujadi Severe pain Absolute glaucoma
Sadayati Atropic changes in eye
Jaayante vrana Corneal ulceration
Asadhya Enucleation of the eye

Adhimantha differential diagnosis


SN Features Adhimantha Akshipakathyaya Sirashukla
1.          Dosha Tridosha Tridosha Tridhosha
2.          Ruja Manthanavath Peeda Theevra Ruja Toda
3.          Varna Asruk Nimagna Samchadhyate Shweta Nibha Sirashuklam Krishna Mandala
4.          Lakshanas Vanhineva Avadahyate Raga, Daha, Shotha Yukta Sa Toda Daha Tamrabhihi, Animitta Ushna Sheeta Asrik Srava
5.          Sadhya-Asadhyata Vyadana Sadhya Asadhya Asadhya




Glaucoma differential diagnosis

SN Features Acute conjunctivitis Acute iridocyclitis Closure angle glaucoma
1. Onset Gradual Gradual Gradual
2. Pain Mild discomfort Moderate Severe
3. Discharge Mucopurulent Watery Watery
4. Coloured halos May be present Absent Present
5. Media Clear Hazy due to aqueous flares, exudates Hazy due to odematous cornea
6. Pupil Normal Small and irregular Large and oval

Discussion

Adhimantha has drawn attention of ancient physicians which is evident from the fact that its description, classification, symptomology, complication and management are available in literature.

Abhishyanda is one of the main cause for Adhimantha if it is not treated at a proper time.

Adhimantha is said to be Vyadhana Sadhya Vyadhi whereas Hataadhimantha is said to be Asadhya.

Glaucoma is a group of disorders characterized by progressive optic neuropathy resulting in a characteristic appearance of the optic disc and a specific pattern of irreversible visual field defects.

Glaucoma is one such condition which mainly affects quality of life of a human being. Various medicines and surgical procedures are mentioned in this condition, so it’s necessary to treat glaucoma at early stage and prevent the prognosis and complications.

Conclusion

The explanation of the disease along with its symptomology has brought out the fact that the disease Adhimantha has similarity with glaucoma in its clinical presentation. It is one of the clinically defined conditions of the eye where in at least two symptoms need to be looked for. The clinical presentation of the disease is based on the symptoms like blurring of vision, pain in the eyes, headache, raised intra-ocular pressure, optic disc cupping and visual field changes. Glaucoma is a devasting disease that affects millions of people worldwide and it is one of the second most leading cause of blindness, early diagnosis and treatment can prevent vision loss from the disease. Individuals with pre-disposing factors such as Heredity,


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Myopia, Diabetes should be evaluated periodically. The thorough understanding of Nidana, Samprapthi and Dosha involvement play a very important role in adopting appropriate treatment modalities.

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