Introduction

Pyogenic Granuloma (PG) is the most common, acquired, benign vascular proliferation of skin and mucous membranes. Conjunctival Pyogenic Granulomas are common following trauma, burst chalazion or ill-fitting prosthesis.^[1] This lesion’s name is a double misnomer. First, “pyogenic” is defined as involving or relating to the production of pus; second, “granuloma” is defined as a mass of granulation tissue. This condition is not caused by an underlying bacterial infection and usually lacks giant cells. Pyogenic granulomas have also been referred to as lobular capillary hemangiomas.^[2] Most commonly these lesions are seen over the palpebral or bulbar conjunctiva.^[1] Classically Conjunctival Pyogenic Granuloma presents with Vascular, Bright red, lobular pedunculated masses. Due to intralesional fibrosis in some rare cases might present with a tan colour.^[3] Treatment options include excision, topical steroid therapy, intralesional Steroid injection and Topical beta-blocker therapy, Electrocautery, Radiosurgery, Cryosurgery, Sclerotherapy or laser treatment.^[4]

On the basis of similarity in the symptoms, Conjunctival Pyogenic Granuloma can be correlated to Vartma Arbudha. Acharya Sushrutha considered Vartmarbudha as Sannipataja Vartmaggata Roga with clinical features Vartma Antarastham (grown over the Inner aspect of eyelid i.e., Palpebral Conjunctiva), Vishama (Irregular in shape), Granthibhuta ( Cystic Growth), Avedana (Painless/ Non-Tender), Saraktam (Hyperemic), Avalambitam (Pedunculated).^[5] Acharya Vagbhata explained it as Mamsa Pindabha (Lobular), Shvyathu (Swelling), Grathita (Thickened), Aruja (Painless), Sasraihi Syat Doshaihi Vishama (Due to vitiation of all three dosha as well as Rakta), and Bahyataha Chala (Mobile).^[6] Treatment explained classically is Chedana Karma as explained in the Chedyarogapratishediya Adyaya by Acharya Sushrutha.^[7]

The treatment modality of Pyogenic Granuloma is Excision, Curettage and Cauterization which is an invasive technique, laser ablation, Cryotherapy, Sclerotherapy, and diathermy are considered to be very costly. Hence the following study was conducted to find the cheaper, non-invasive simple treatment modality for the treatment of Pyogenic Granuloma.

Diagnosis: Palpebral Conjunctival Pyogenic Granuloma (Vartmarbudha)

Therapeutic intervention

Vartma Arbudha is a Rakta and Pitta Pradhana Tridoshaja Vyadhi. Hence Jaloukavacharana, the best treatment modality for Pitta Dushita Raktaja Vyadhi, was considered the choice of treatment. Jaloukavacharana was done by applying the Jalouka over the affected palpebral conjunctiva near the Arbudha as seen in Fig. 2 and Fig. 3 to reduce the swelling and remove the Dushita Rakta from the site. Then the patient was advised Kanchanara Guggulu orally to reduce the swelling and Opthocare eye drops to reduce the conjunctival irritation and redness as shown in Table 2.

Figure 2:

Figure 3:

Table 2: Treatment Protocol

Follow-up and outcome

After one sitting of Jaloukavacharana therapy, due to the outflow of Dushita Rakta immediate reduction in the size of the Arbudha was observed (fig.4).

Due to the above-mentioned action, Kanchanara Guggulu helps in the reduction of the Arbudha. Kanchanara Guggulu contains chemical constituents such as Oleo-resins which have anti-inflammatory action, exhibiting cytotoxic and antiproliferative activity.

Opthacare eyedrops ingredients are Madhu, Amalaki, Haridra, Tulsi, Satapatri, Vibhitaki, Yavani and Karpoora which are all Chakshushya in Karma and have a soothing effect on the eye. This reduces the irritation, foreign body sensation, congestion and watering of the eye.

Timeline

Conclusion

Vartmarbudha which is Pitta and Rakta Pradhana Sannipataja Vyadhi where in Chedana procedure has been explained as the treatment modality. Jaloukavacharana, a non-invasive Parasurgical procedure explained in ayurveda mainly for Pitta Dushita Raktaja Vyadhis, was considered for the treatment of the disease effectively.

Jaloukavacharana and Kanchanara Guggulu reduced the size of the Arbudha in one sitting by removing the Dushita Rakta from the site. Within one week of the application of Jalouka, a notable reduction in the size of growth was noticed. There was complete relief from irritation, redness, discomfort and watering from the eye within 4-5 days of Jaloukavacharana, and administration of the Kanchanara Guggulu and Opthocare eyedrops.

Hence, instead of opting for a surgical approach to the treatment of the Pyogenic Granuloma of conjunctiva, Jaloukavacharana a non-invasive simple Para surgical procedure can be opted as the best treatment modality.