Excision and Scraping – Chedana And Lekhana Karma In Eye Disorders

By Dr Raghuram Y.S. MD (Ay) & Dr Manasa, B.A.M.S
Chedana is an excision method of surgical intervention should be adopted in the below mentioned three eye disorders namely –

Arshovartma
Shushkarsha
Vartmarbuda

They are said to be Chedana Sadhya Vyadhis i.e. disorders treatable through excision method. All these conditions can be clubbed under ‘tumors and warts of the eyelids’. They need to be handled through surgical methods.
Read – Sushruta’s 8 Types Of Surgical Procedures – Astavidha Shastra Karma

Table of Contents

Arshovartma

Arshovartma is an eyelid disorder. In this condition, many small and rough lumps are formed on the eyelids. These lumps resemble the shape and size of musk melon. There will be mild pain associated with these lumps. Due to their resemblance with the shape of hemorrhoid mass (arsha), they are called arshovartma. This condition can be closely correlated with the ‘papillary form of trachoma’.
Read – Arshovartma, Shushkarsha Eye Disorders – Symptoms, Treatment

Shushkarsha – Shushkarsha is an eyelid disorder. Long sprout like masses appear in the eyelids in this condition. The masses are rough, hard and troublesome in nature. Elongated sprouts also appear like dried pile masses and hence called shushkarsha. This condition can be closely correlated with ‘Chronic Form of Papillary Trachoma’.

Vartmarbuda – Vartmarbuda is an eyelid disorder. In this condition, an irregular lump is formed on the interior of the eyelid. It is devoid of pain. The eyelid appears red due to the association of pitta and blood. The lump hangs free from the edge of the eyelid. Vartmarbuda can be closely correlated with tumors of the eyelids. Angiomas and benign cysts of lids can also be considered.
Read – Utsangini, Vartma Sharkara Eye Disorders – Symptoms, Treatment

Excision method

Excision method in treatment of Arshovartma, Shushkarsha and Vartmarbuda Eye Disorders

Purvakarma – Pre-operative measures

Systemic and local examination of the patient should be thoroughly done.
to check if the patient is eligible to undergo surgical treatment.
The essential equipments needed for surgery should be kept ready, including the needles, forceps and round edged knife.
Medicines needed for post-operative care should also be kept ready.
The procedure should be explained to the patient and counselled.
Read – Blepharitis: Inflamed Eyelids Ayurvedic Treatment, Remedies

Pradhana Shastra Karma – Operation – the main surgical procedure for excision of arshovartma, shushkarsha and vartmarbuda

Swedana – Mild sudation should be administered to the eyes before excising the lumps present in the above mentioned disorders.
Bhedana and Chedana – After sudation, the physician should evert the afflicted eyelid with the help of his thumb and index finger, so that the lump is exposed. Now he should pierce the root of the lump with the tip of the needle and elevate it upwards. After the lump has been elevated, it should be incised first and then with the help of Mandalagra shastra i.e. round edged knife should be excised completely.
Read – 4 Types Of Swedana As Per Sushruta And Vagbhata

Paschat Karma – Post-operative care

Pratisarana – After excision of the lumps in the mentioned disorders, the wound should be rubbed with the powder prepared using rock salt, long pepper and green vitriol.
Dahana karma – Following rubbing of the wound with medicated powder (mentioned above), the bleeding will be checked. Once the bleeding stops, the wound should be burnt with the help of hot rods (shalaka).
Avalekhana / lekhana – Even after burning (cauterization) of the wound, if there are remnants of the disease, they should be scraped by rubbing with alkali.
Ubhayah Shodhana – The doshas causing and exacerbating these disorders too need to be taken care of. By administering strong emesis and strong purgation, the doshas should be expelled from both routes.
Abhishyanda kriya vidhi – Measures and line of treatment for abhishyanda i.e. conjunctivitis should be adopted as per dosha in treating these conditions.
Pathya ahara vihara – For one month following surgery, the patient should follow stringent diet and lifestyle changes so as to enable quick healing.
Read – Krimigranthi, Jantugranthi Definition, Location, Symptoms, Treatment

Shloka

Lekhana – scraping

Lekhana Karma – Scraping treatment in Eye Disorders
Lekhana means scraping or scarification therapy. This can be achieved using medicines, blunt surgical instruments, blunt minor surgical instruments or sharp surgical instruments.

Certain eye disorders can be treated by administering scraping method of treatment. Such diseases are called ‘lekhana sadhya vyadhis’ (diseases curable by scraping therapy).

Lekhana Sadhya Vyadhis – Diseases curable by scraping therapy
Below mentioned 9 eye disorders are curable by scraping method.

Utsangini
Bahalavartma
Kardamavartma
Shyavavartma
Baddhavartma
Klishtavartma
Pothaki
Kumbheekini / Kumbhika pidika
Vartmasharkata

All these disorders are ‘eyelid disorders’.
Read – Vartmakardama, Shyavavartma Eye Disorders – Symptoms, Treatment

Lekhana Karma Procedure

Purvakarma – Pre-operative measures

Examination of the patient – Thorough examination of the patient should be done.
The eligibility of the patient to undergo scraping therapy should be accessed.
The equipments needed for scraping should be kept ready beforehand.
The procedure should be explained to the patient and counseled.
Read – Procedure of surgical operation: Ashtanga Hrudaya Sutrasthana 29

Shodhana / Cleansing treatments – The patient should be given with body purifying treatments to expel the doshas. They should be administered with oleation, emesis and purgation therapies.

Preparation – The patient who has undergone purifying therapies should be made to sleep supine on the bed placed in a room or cottage devoid of breeze and sunlight. Cordial and strong attendants / masseurs should hold the patient in position so that the physician can conduct the treatment in a comprehensive way.
Read – Vamana Virechana – Emesis and Purgation – Ashtanga Hridayam Sutrasthana 18

Pradhana Shastra Karma – Operation

Swedana – Before conducting the scraping treatment, sudation should be done on the afflicted eye(s). It should be done in the form of wet fomentation using a sterile cloth dipped in warm water. Fomentation on eyes should always be mild. Care should be taken to see that water is not hot.

Vartmam nirbhujya – After fomentation, the physician should carefully evert the afflicted eye of the patient by holding the lid with the help of his left thumb and index finger wrapped with sterile cloth or cotton pad. This will help him to hold the everted eyelid in its position. He should hold the eyelid firmly without shaking his hand. This would facilitate the scraping to be done perfectly.

Lekhana karma – After holding the eyelids firmly, the physician should scrap the afflicted eyelid with the help of a rough leaf or with a sharp instrument. Alternatively the part may be incised or excised with the help of a sharp instrument. When the bleeding stops the lids should be given fomentation once again.
Read – Ayurveda Eye Treatment Types, Methods – Ashtanga Hrudaya Sutrasthana 23

Pratisarana & Prakshalana – After second fomentation, the wound should be rubbed with the powder of the below mentioned herbs –

Manashila – Realgar
Rasanjana – extract of Berberis aristata
Kasisa – green vitriol
Trikatu – powder of long pepper, black pepper and ginger
Rock salt
Swarna makshika – chalcopyrite
Read – Rasanjan Uses, Remedies, Dose, Side Effects, Research

Following this, the eye should be washed thoroughly.

Vranopachara & Bandhana – Next, ghee should be applied over the wound. Later the wound should be treated in terms and lines of treating wounds. Following this, bandaging should be done.

Other points to take care of –

Bleeding should be taken care of while conducting scraping therapy. The blood should be constantly swabbed with a sterile swab.
Different methods of scraping shall be followed taking into consideration the doshas involved.
Example – In kapha-vata conditions, scraping should be done with the help of sharp instruments.
If the disease is fit to be incised, the scraping should be done through incision.
If the disease is fit to be excised, excision shall be done.
If the lesions of the eyelid are smooth and caused by joint vitiation of pitta and blood, scraping shall be done using rough leaves or rough sterile cloth.
Read – Kshara Agnikarma Vidhi – Cauterization- Astanga Hridaya Sutrasthana 30

Paschat Karma – Post-operative care
Vishrama – Total rest should be given to the afflicted eye(s) for a period of 3 days following the scraping therapy. The measures like sudation, errhines etc which might probably cause irritation in the eyes shall be done only after three days rest.

Indications for scraping

Conditions for doing Scraping therapy in different eye disorders

In Shyavavartma and Kardamavartma eyelid disorders general scraping method should be followed. This means to tell that scraping should be done in one take in these conditions. It should neither be done too deep nor too superficial.
In Bahalavartma, Vartmavabandha, Klishtavartma and Pothaki, initially scarification should be done using sharp instruments. This should be followed by scraping therapy done using vriddhi patra (scalpel) etc instruments.
In Kumbhika pidika, Vartmasharkara and Utsangini, the lumps should first be cut (excised) off using sharp instruments. Later scraping should be done gently.
If small, hard and coppery eruptions / lumps arise in the lids and when they get suppurated (mature), they should first be incised and later scraping therapy done.
Newly manifested lumps having less pain and irritation on the outer part of the eyelids should be treated with fomentation, anointment of medicinal pastes and cleansing measures.
Read – Lepa Kalpana: Ayurvedic Dosage Forms For External Application

Samyak Lekhana Lakshanas – Signs of proper scraping

There is no bleeding or any other type of discharge from the wound
Absence of itching and swelling
The part of the eyelid which has been scraped is similar to the surrounding eyelid, leveled and has ‘nail like’ appearance
Read – Diet And Ayurvedic medicines For Itching

Durlikhita Lakshanas – Signs of improper / deficit scraping

Redness of the eyes
Thick blood flows out of the wound made by the sharp instrument during scraping therapy
Swelling of the eyes
Discharges from eyes
Feeling of darkness in front of the eyes
There is no relief in the disease / symptoms
Eyelids become black / dark, heavy, stiff, itchy and dirty
If this condition is not treated properly it may lead to suppuration of the eyes

If these symptoms are found, oleation therapy should be done and later scraping should be properly done once again.
Read – Watery Eyes: Causes, Ayurvedic Treatment, Remedies

Atilikhita Lakshanas – Signs of excessive scraping