Akshipakatyaya, Ajakajata Eye Disorder – Definition, Symptoms, Treatment

By Dr Raghuram Y.S. MD (Ay) & Dr Manasa, B.A.M.S
Akshipakatyaya is one of the diseases of the cornea i.e Netra Krishna Gata Roga.
Read – Eye Diseases Causes, Pathogenesis, Symptoms, Treatment, Herbs

Classification

Based on the location – Akshipakatyaya is a Netra Krishnagata Roga i.e. disease occurring in the cornea.
Based on Predominant Dosha – Akshipakatyaya is a Tridoshaja Netra Roga i.e. it is caused by simultaneous vitiation of all three doshas.
Based on prognosis – incurable disease.
Classification based on predominant treatment – Since it is an incurable disease, neither medicines nor surgical procedures will be effective in this condition.
Read – Classification of Eye Diseases As Per Ayurveda

Akshipakatyaya, definition, meaning, pathogenesis and prognosis
In this condition the entire cornea gets covered by doshas which are whitish i.e. whiteness occurs in the black of the eye / white layer covers the entire cornea. It is caused as an effect of conjunctivitis and is associated with severe pain in the eye.
Read – Anatomy of Eye: Netra Rachana: Ayurveda Perspective

Signs and Symptoms of Akshipakatyaya

• Sanchadyate shweta nibhena sarvam doshena yasya asita mandalamtu – whitish doshas / layer covers the entire black of the eye i.e. cornea
• Tivra rujam – severe pain in the eyes

Prognosis of Akshipakatyaya
Akshipakatyaya is an incurable eye disorder.

Modern correlation
Akshipakatyaya is compared to hypopyon. (read)

Hypopyon is a condition presenting with inflammatory changes in the anterior chamber of the eye. Anterior chamber of the eye too is a part of the Krishna bhaga i.e. black of the eye as per Ayurveda explanation. They are leukocytic exudates which occur in the anterior chamber. It is usually accompanied by redness of the conjunctiva and the underlying episclera. It is a sign of inflammation of the anterior uvea and iris i.e. iritis. Iritis is a form of anterior uveitis. In bacterial corneal ulcer, the exudate is sterile whereas in fungal corneal ulcer, the exudates are non-sterile.
Read – Chaturvidha Netra Srava – 4 types of eye discharges, symptoms, treatment

Hypopyon is often associated with corneal ulcer. Since hypopyon occurs due to release of toxins and not by actual invasion of pathogens, it is also known as ‘sterile pus’. The toxins secreted by pathogens mediate the outpouring of leukocytes. These leukocytes settle in the anterior chamber of the eye and trigger inflammatory reaction.

Since there is presence of white blood cells in the hypopyon, it offers protection against the invading pathogens. Therefore a hypopyon should not be drained. Long standing hypopyon can cause close-angle glaucoma and anterior synechiae. If endophthalmitis is suspected, intravitreal antibiotics can be used.
Read – Alaji Eye Disorder Definition, Location, Symptoms, Treatment

Treatment of Akshipakatyaya
Akshipakatyaya is an incurable corneal disorder and hence its treatment has not been detailed.

Ajakajata Eye Disorder – Definition, Symptoms, Treatment

Ajakajata Shukra is one of the diseases of the black of the eye (netra krishna gata roga) cornea to be precise.
Read – Netra Shuklagata Rogas – Disorders Affecting Sclera

Classification
Based on the location – Ajakajata is a Netra Krishnagata Roga i.e. disease occurring in the corneal part of the eye.
Based on Predominant Dosha – Ajakajata is a Raktaja Netra Roga (caused by vitiation of blood).
Based on prognosis – It is an incurable disease.
Based on predominant treatment – Since Ajakajata is an incurable disease, neither medicines nor the surgical procedures will be effective in treating this condition.
Read – Krimigranthi, Jantugranthi Definition, Location, Symptoms, Treatment

Ajakajata, definition, meaning, pathogenesis and prognosis
Ajakajata occurs in cornea. In this condition a secretion resembling excreta of a goat, red in colour, mixed with blood and associated with red colored slimy discharge of tears which come out rupturing the cornea. This condition is also associated with severe pain in the eyes.
Read – Watery Eyes: Causes, Ayurvedic Treatment, Remedies

Master Videha explains this condition as – ‘The ulcer which has formed deep inside the eye (2^nd and 3^rd layers) causes expulsion of thick, slimy, blood mixed tears resembling the feces of goat emerging from the third layer of the earth to the surface, rupturing the cornea. This condition is called Ajakajata’.
Read – Stye – Causes, Symptoms, Remedies, Treatment

When ulcers occur in the deeper layers of the cornea, they cause sufficient damage of the tissues therein. These tissue debris increases in quantity over period of time. These tissues along with the deeper layers cause damage and rupturing of the first layer of the cornea and emerge through it.

Signs and Symptoms – Ajakajata

• Aja purisha pratimo – material resembling the excreta of a goat comes out rupturing the black of the eye i.e. cornea
• Rujavan – associated with pain in the eyes
• Sa lohito – along with blood
• Lohita pichchila ashru – associated with reddish sticky discharge of tears from the eye
  Read – Netra Tarpana Treatment For Eye Care Benefits, How To Do?

Prognosis of Ajakajata
Ajakajata is an incurable eye disorder.

Modern correlation
Ajakajata is compared to Anterior Staphyloma.

Staphyloma means thinning of the uvea and sclera layers of the globe of the eye (eyeball). This results in enlargement of the globe with a focal bulge, usually in the posterior wall.
Read – Chalazion – Causes, Pathogenesis, Symptoms, Treatment

In simple terms staphyloma is ‘an abnormal protrusion of the uveal tissue through a weak point in the eyeball’. Since the inner layers are protruding through the cornea, it is usually black in color. This is explained as ‘mass or material resembling the excreta of goat’ in Ayurveda. It occurs due to weakening of the outer layers of eye, i.e. cornea or sclera, caused due to inflammation or degeneration of these parts.

Anterior Staphyloma can occur due to inflammatory / infectious process or secondary to development defect.

Clinical features of anterior staphyloma include enlarged protruding and opacified eye with loss of vision.
Read – Trachoma – Causes, Symptoms, Prognosis, Treatment, Remedies

Staphyloma is diagnosed through imaging. In this condition there is ecstatic protruding cornea with focal out-pouching and enlargement of anterior segment of the eye and absence of an intra-ocular mass.

Interventions include penetrating keratoplasty and enucleation.

Intercalary, Ciliary, Equatorial and Posterior Staphyloma are the other four types of staphylomas, but anterior staphyloma is the only condition which matches with the description of ajakajata and hence compared.
Read – Excision and Scraping – Chedana And Lekhana Karma In Eye Disorders

Treatment of Ajakajata

Ajakajata is an incurable condition of the cornea. Still, Master Sushruta has mentioned methods of dealing with ajakajata.

The protruding part of ajaka should be punctured with the help of a needle. This causes flow of discharges easily (aqueous humor). This subsequently lessens the intra-ocular pressure and the contents which had protruded would settle down to their places. Later, the wound healing should be promoted by applying the paste of mixture of meat of cow and ghee. If the protruded part is big and has reached to the level of eyelids or beyond it, the extra portion should be scraped off using a sharp instrument.
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