E-ISSN:2456-3110

Review Article

Red Eye

Journal of Ayurveda and Integrated Medical Sciences

2024 Volume 9 Number 7 JULY
Publisherwww.maharshicharaka.in

Differential Diagnosis of Red Eye: An Integrative Approach from Ayurvedic and Modern Perspective

Kangoo A1*, Shipra2, Dev S3
DOI:10.21760/jaims.9.7.37

1* Abhishek Kangoo, Post Graduate Scholar, Dept of Shalakya Tantra, Rajiv Gandhi Government Post Graduation Ayurvedic College and Hospital Paprola Distt, Kangra, Himachal Pradesh, India.

2 Shipra, Professor, Dept of Shalakya Tantra, Rajiv Gandhi Government Post Graduation Ayurvedic College and Hospital Paprola Distt, Kangra, Himachal Pradesh, India.

3 Suk Dev, Professor, Dept of Shalakya Tantra, Rajiv Gandhi Government Post Graduation Ayurvedic College and Hospital Paprola Distt, Kangra, Himachal Pradesh, India.

Red eye is a prevalent clinical presentation in ophthalmology, encompassing a broad spectrum of underlying aetiologies. This abstract delineates the differential diagnosis of red eye based on distinct clinical features. This article explores the Ayurvedic perspective on bloodshot eyes, highlighting the intricate relationship between ocular health and the balance of Doshas (Vata, Pitta, Kapha) and Rakta (blood). Drawing from classical texts such as the Sushruta Samhita, various conditions associated with red eyes are examined, including Shukalgata, Krishangata, and Sarvagata Rogas. The differential diagnoses encompass conditions like Prastari Arma, Lohita Arma, and Rakta Abhishyanda and Adhimanta among others, detailing their unique presentations and implications. Furthermore, the modern understanding of red eye conditions is summarized, showcasing parallels with Ayurvedic diagnoses. By integrating both perspectives, this article emphasizes the need for a holistic approach in treating ocular ailments, where Ayurvedic principles can complement contemporary medical practices. This synthesis not only enriches the understanding of red eye etiology but also guides therapeutic strategies in clinical practice.

Keywords: Red eye, Shukalgata, Krishangata, Sarvagata Roga, Netra Roga

Corresponding Author How to Cite this Article To Browse
Abhishek Kangoo, Post Graduate Scholar, Dept of Shalakya Tantra, Rajiv Gandhi Government Post Graduation Ayurvedic College and Hospital Paprola Distt, Kangra, Himachal Pradesh, India.
Email: 		Kangoo A, Shipra, Dev S, Differential Diagnosis of Red Eye: An Integrative Approach from Ayurvedic and Modern Perspective. J Ayu Int Med Sci. 2024;9(7):243-247.
Available From
https://jaims.in/jaims/article/view/3376

Manuscript Received Review Round 1 Review Round 2 Review Round 3 Accepted
2024-05-16 2024-05-16 2024-06-06 2024-06-16 2024-06-26
Conflict of Interest Funding Ethical Approval Plagiarism X-checker Note
None Nil Yes 12.34

© 2024by Kangoo A, Shipra, Dev Sand 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

Bloodshot eyes, characterized by redness and irritation, are a common concern that can arise from various underlying conditions. In Ayurveda, ocular health is closely linked to the balance of the three Doshas - Vata, Pitta, and Kapha - and the state of Rakta (blood). This ancient system of medicine provides a comprehensive framework for understanding the etiology of red eye conditions, offering unique insights into their prevention and treatment. Ayurvedic texts, particularly the Sushruta Samhita, detail a range of disorders associated with red eyes, categorized into specific Rogas based on their characteristics and underlying imbalances. Each condition reflects not only the physical manifestations but also the broader implications of Dosha disturbances and blood dyscrasias. In contrast, modern medicine categorizes red eye conditions through a clinical lens, addressing factors such as inflammation, infection, and trauma. This article aims to bridge the gap between these two perspectives, exploring the Ayurvedic classifications of red eye conditions alongside their modern equivalents. By doing so, it seeks to foster a holistic understanding of ocular health, promoting integrated approaches to diagnosis and treatment that consider both traditional wisdom and contemporary medical insights.

The Perspective of Ayurveda

From the perspective of Ayurveda, bloodshot eyes can be attributed to various factors. Predominantly red eye is found in Ayurvedic Literature (Sushruta Samhita) in the following Diseases/Conditions:

jaims_3376_00.JPG
Figure 1: Causes of Red eye in Ayurveda

The differential diagnosis of red eye involves various conditions with distinct features:

Shukalgata Rogas causing red eye

1. Prastari Arma: in the white part of the eye, if there is a spreading structure resembling a thin red line or a lump and in some cases a blue-coloured lump, it is called "Prastari-Arma."[1]
2. Lohita Arma: In the white part of the eye, an overgrowth of red tissue resembling a red lotus is called "Lohitarma."[2]
3. Arjuna: If a single spot on the white part of the eye shines like rabbit's blood, it is called "Arjuna."[3]
4. Shirajaala: If large, thick veins spread across the conjunctiva of the eye, forming a red, net-like pattern, it is called " [4]
5. Shira Pidika: If small nodules surrounded by veins appear near the iris, in the sclera of the eye, they are called "Sirajnapidika”.[5]

Krishangata Rogas causing red eye

1. Svarna Shukra: If there is an ulcer located deep in the black part (iris) of the eye, barely visible or difficult to see, resembling a puncture wound made by a needle, from which warm tears flow and causes intense pain, it is called 'Svarna Shukra'.[6]

2. Ajkajata: If a structure resembling goat droppings, red in colour, painful, and associated with sticky red discharge, emerges by tearing through the black ring (iris) of the eye, it is called 'Ajakajat'.[7]

Sarvagata Rogas causing red eye:

1. Rakta Abhishyanda: The symptoms of Rakta Abhishyanda (conjunctivitis) are, discharge of copper-coloured tears, redness of the eyes, presence of red lines around the eyes, manifestation of other symptoms of aggravated Pitta (such as burning sensation, etc.)[8]

2. Pitta Adhimantha: The eye is suffused with red lines, there is discharge from the eye with a burning sensation and eyeball appears deep copper-coloured like a lump. A burning sensation is similar to that caused by an alkaline substance applied to a wound.

The edge of the eye appears swollen and inflamed. The patient sweats, and everything appears yellow to the patient. Sometimes, fainting occurs. There is a burning sensation in the head.[9]


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3. Rakta Adimantha: The symptoms of Rakta Adhimantha (inflammation due to blood) are: the patient's eyes are as red as the Japa flower (hibiscus), the patient experiences anxiety, the eyes are painful to touch and there is discharge of blood or blood-coloured fluid from the eyes.

The patient feels a pricking pain similar to a needle. The patient perceives all directions as burning with fire. The black part of the eye appears submerged in blood, resembling a lump of flesh. The eyes appear bright (as if burning), and there is redness around them.[10]

4. Shopha Yukta Akshipaka: Itching in the eyes, accumulation of discharge (mucus) in the eye and watering. The eye appears like a ripe fig fruit. Pricking pain is similar to a needle. Burning sensation in the eye. Coppery discoloration of the eye, swelling of the eye, frequent discharge of hot and cold, and sticky fluid. Irritation or restlessness in the eye with heaviness.[11]

5. Amladhyushita: When Pitta is aggravated by the consumption of sour substances or irritating liquids, it makes the eyes red and blue and causes swelling in eye. This condition is called 'Amladhyushita'.[12]

6. Shiro-Utpata: When a person's eye develops copper-colored lines, with or without pain, and these lines make the entire eye appear red over time, the condition is known as 'Sirotpata'.[13]

Nayan Abhighata: Due to causes such as injury from a stick or sharp instrument, people often suffer from eye injuries. These injuries lead to symptoms such as swelling (Sarambha), redness (raga), and severe pain in eye.

In such conditions, a wise physician should administer treatments such as nasal drops (Nasya), topical applications (Alepa), eye washes (Parishechana), and soothing eye treatments (Tarpana). Additionally, treatments mentioned for conditions like Rakta Abhishyanda (conjunctivitis) and Pitta Abhishyanda should be employed.

These treatments should be unctuous (Snigdha), sweet (Madhura), and cooling (Shitala), which bring comfort to the eyes. Similarly, for eyes injured by excessive sweating, fire contact, smoke exposure, fear, grief, or pain, the same type of treatment should be applied.[14]

Modern Perspective

Red eyes are known by various names, including bloodshot eyes, scleral injection, and conjunctival injection. The primary cause of eye redness is usually the swelling or dilation of blood vessels. As a result, the surface of the eye appears red or bloodshot

Table 1: Causes of Red eye according to modern concept.

Adnexa/lidsConjunctivaSclera and CorneaOther Conditions
Blepharitis
Floppy eyelid syndrome
Trichiasis,
Distichiasis
Meibomitis, stye,
Canaliculitis
Dacryocystitis
Lagophthalmos
Acne rosacea
Entropion or ectropion
Sub-tarsal foreign body		Hyperaemia
Conjunctivitis
Ophthalmia neonatorum
Subconjunctival haemorrhage
Pinguicula
Superior limbic keratoconjunctivitis
Giant papillary conjunctivitis
Conjunctival FB
Symblepharon etc		Sclera:
Episcleritis
Scleritis
Cornea
Infections or inflammatory keratitis
Contact lens-related problems
Corneal FB
Recurrent corneal erosion
Pterygium
Neurotrophic keratopathy
Medicamentosa
Ultraviolet or chemical burn		Trauma
Postoperative
Dry eye syndrome
Endophthalmitis
Anterior uveitis/ iritis
Pharmacologic (prostaglandin analogues)
Angle-closure Glaucoma
Carotid-cavernous fistula (corkscrew conjunctival vessels)
Cluster headache
Orbital cellulitis vs pre-septal cellulitis

Table 2: Red eye classification according to Discharge and Pain

With DischargeWithout Discharge
More common:
Conjunctivitis, ophthalmia neonatorum, blepharitis
Less common:    Ac. allergic reaction, dacryocystitis, canaliculitis.		PainMinimal or No Pain
Typically, mild to moderate:    Dry-eye syndrome, blepharitis, pingueculitis, inflamed pterygium,
FB (corneal or conjunctival),
corneal disorders (superficial punctate keratitis etc.), episcleritis, etc.
Typically moderate to severe:
Corneal disorders (abrasion, erosion, infiltrate/ulcer), anterior uveitis, scleritis, acute angle closure glaucoma		More common:
Sub-conjunctival haemorrhage injected pterygium/pingueculum, blepharitis, dry-eye syndrome. Contact lens complications
Less common:
Conj. tumour

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Table 3: Differential diagnosis according to diseases

ConjunctivaPupilCorneaAnt. chamberIOP
1.Subconjunctival HaemorrhageBright redNormalNormalNormalNormal
2.ConjunctivitisInjected vessels, fornices, DischargeNormalNormalNormalNormal
3.IritisInjected around CorneaSmall, fixed, irregularNormal
KP’s		Turgid, deepNormal
4.Acute GlaucomaEntire eye redFixed, dilated, ovalHazyShallowHigh

Red eye due to trauma

  • Subconjunctival haemorrhage.
  • Corneal trauma - abrasion/laceration/edema
  • Scleral rupture/laceration.
  • Vitreous haemorrhage.
  • Retinal tear/detachment.

Discussion

In Ayurveda, the health of the eyes is closely related to the balance of the Doshas (Vata, Pitta, Kapha) and the state of Rakta (blood). Any imbalance can lead to various ocular conditions.

1. Vata Imbalance: Associated with dryness, strain, and nerve-related issues in the eyes. Conditions like acute angle closure glaucoma and corneal ulcer may have Vata involvement due to the severe pain they cause.

2. Pitta Imbalance: Primarily linked to inflammation and redness. Conditions like conjunctivitis, scleritis, and iridocyclitis often involve Pitta due to the heat and inflammation they exhibit.

3. Kapha Imbalance: Can lead to congestion and fluid accumulation, although less frequently a primary cause in severe conditions, it may contribute to the watery discharge seen in viral conjunctivitis.

4. Rakta Dushti: Involvement of the blood, leading to conditions where there is significant inflammation, redness, and possible bleeding, such as scleritis and sub conjunctival haemorrhage.

Modern and Ayurvedic Co-relation

Key findings include:

  • Ayurvedic Diagnoses and Modern Equivalents:
AyurvedicModern
1.ArmaPterygium
2.ArjunaSub-Conjunctival haemorrhage
3.ShirajaalaScleritis and Episcleritis
4.Shira pidikaDeep Scleritis or Phlyctenular conjunctivitis
5.Svarna shukrCorneal Ulcer
6.AjkajataAdherent Leucoma /Ant. Staphyloma
7.Rakta AbhishyandaConjunctivitis (Bacterial and Viral)
8.Pitta and Rakta AhimanthaAcute Angle Closure Glaucoma
9.Shopha yukta AkshipakaEndophthalmitis/pan-ophthalmitis
10.AmladhyushitaChemosis
11.Shiro-utpataScleritis
12.Nayana AbhighataTrauma to eye
  • Conditions such as Lohita Arma and Rakta Abhishyanda show direct parallels to modern conjunctivitis and scleritis, highlighting the importance of recognizing traditional classifications in contemporary practice.
  • Holistic Treatment Approaches: Ayurvedic therapies emphasize the use of herbal remedies, dietary modifications, and lifestyle interventions that can mitigate symptoms and restore balance. This is particularly beneficial for patients seeking natural treatment options alongside conventional therapies.
  • Enhanced Understanding of Ocular Health: By examining the interplay between dosha imbalances and specific eye conditions, healthcare practitioners can develop more personalized treatment plans that address both the physical symptoms and the underlying imbalances in the patient’s constitution.

Conclusion

The integration of Ayurvedic insights with modern medical understanding of red eye conditions provides a comprehensive framework for diagnosis and treatment.

The identification of specific Ayurvedic terms correlating with modern conditions enhances the clinician's ability to approach ocular health from multiple angles.

In conclusion, this discussion reinforces the importance of a holistic approach in managing red eye conditions, advocating for the integration of Ayurvedic wisdom into modern medical practice to enhance patient care and outcomes.


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References

1. Acharya Sushruta, Sushruta Samhita, Dr Ambikadatta Shastri: Chaukhambha publications, Varanasi, Edition-Reprint: 2006; Uttar Tantra 4/5, pg. no.26

2. Acharya Sushruta, Sushruta Samhita, Dr Ambikadatta Shastri: Chaukhambha publications, Varanasi, Edition-Reprint: 2006; Uttar Tantra 4/5, pg. no.27

3. Acharya Sushruta, Sushruta Samhita, Dr Ambikadatta Shastri: Chaukhambha publications, Varanasi, Edition-Reprint: 2006; Uttar Tantra 4/7, pg. no.27

4. Acharya Sushruta, Sushruta Samhita, Dr Ambikadatta Shastri: Chaukhambha publications, Varanasi, Edition-Reprint: 2006; Uttar Tantra 4/8, pg. no.28

5. Acharya Sushruta, Sushruta Samhita, Dr Ambikadatta Shastri: Chaukhambha publications, Varanasi, Edition-Reprint: 2006; Uttar Tantra 4/7, pg. no.28

6. Acharya Sushruta, Sushruta Samhita, Dr Ambikadatta Shastri: Chaukhambha publications, Varanasi, Edition-Reprint: 2006; Uttar Tantra 5/4, pg. 29

7. Acharya Sushruta, Sushruta Samhita, Dr Ambikadatta Shastri: Chaukhambha publications, Varanasi, Edition-Reprint: 2006; Uttar Tantra5/10, pg. no.33

8. Acharya Sushruta, Sushruta Samhita, Dr Ambikadatta Shastri: Chaukhambha publications, Varanasi, Edition-Reprint: 2006; Uttar Tantra 6/9, pg. no.35

9. Acharya Sushruta, Sushruta Samhita, Dr Ambikadatta Shastri: Chaukhambha publications, Varanasi, Edition-Reprint: 2006; Uttar Tantra 6/15, pg. no.36

10. Acharya Sushruta, Sushruta Samhita, Dr Ambikadatta Shastri: Chaukhambha publications, Varanasi, Edition-Reprint: 2006; Uttar Tantra 6/18-19, pg. no.36

11. Acharya Sushruta, Sushruta Samhita, Dr Ambikadatta Shastri: Chaukhambha publications, Varanasi, Edition-Reprint: 2006; Uttar Tantra 6/21-22, pg. no.98

12. Acharya Sushruta, Sushruta Samhita, Dr Ambikadatta Shastri: Chaukhambha publications, Varanasi, Edition-Reprint: 2006; Uttar Tantra 6/28, pg. no. 39

13. Acharya Sushruta, Sushruta Samhita, Dr Ambikadatta Shastri: Chaukhambha publications, Varanasi, Edition-Reprint: 2006; Uttar Tantra 6/29, pg. no.40

14. Acharya Sushruta, Sushruta Samhita, Dr Ambikadatta Shastri: Chaukhambha publications, Varanasi, Edition-Reprint: 2006; Uttar Tantra 19/3-4, pg. no.104


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