Savrana Shukra, Avrana Shukla Eye Disorder – Symptoms, Treatment

By Dr Raghuram Y.S. MD (Ay) & Dr Manasa, B.A.M.S
Savrana Shukra / Shukla is a Netra Krishna Gata Roga i.e. one of the diseases of the black of the eye including cornea and the iris.
Read – Netra Shuklagata Rogas – Disorders Affecting Sclera

Classification

Based on the location – Savrana Shukra is a Netra Krishnagata Roga i.e. disease occurring in the corneal part of the eye.
Based on Predominant Dosha – Raktaja Netra Roga i.e. it is caused by vitiated blood.
Based on prognosis – It is an incurable disease.
Based on predominant treatment – Since it is an incurable disease, not only medicines, but also the surgical procedures will not be effective in treating this condition effectively.
Read – Classification of Eye Diseases As Per Ayurveda

Savrana Shukra

Savrana Shukra / Shukla, definition, meaning, pathogenesis
Savrana Shukla occurs in the black of the eye i.e. cornea in which there is an ulcer, which appears like a needle puncture which is hardly seen and is located deep inside the cornea in this instance. In this condition there is hot tears and severe eye pain. It is caused by vitiation of blood and incurable condition.
Read – Anatomy of Eye: Netra Rachana: Ayurveda Perspective

Kshata Shukra – Master Vagbhata’s version of Savrana Shukra
Master Vagbhata has enlisted symptoms like hot tears, inability to see, severe pain etc and has considered the condition to be curable with difficulty.

Master Videha explains – ‘An ulcer / wound of the color of red mustard, tiny in size as much as a needle tip or as if pierced by needle occurring in the black of the eye is called savrana shukla. Hot tears get discharged from the eye in this condition’.
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Signs and Symptoms of Savrana Shukra

• Nimna rupa tu bhaveddhi krushne suchyeva viddham pratibhati yadvai – an ulcer is formed in the depth of the black of the eye i.e. cornea which is visible with difficult and appears as if formed by puncture with a needle.
• Ushna sravam sraved – excessive discharge of hot tears from the eyes
• Ativa ruk – severe pain in the eye
• Darshana akshamata – inability to see things
• Raktavarnata – redness of white of the eye
  Read – Watery Eyes: Causes, Ayurvedic Treatment, Remedies

Prognosis

1. Prognosis as explained by master Vagbhata
Master Vagbhata has beautifully explained the prognosis of Savrana Shukra based on the damage that the vitiated pitta causes in various layers of the eye.
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Savrana Shukra is difficult to cure when it happens in the first layer of the eye –
When the vitiated pitta gets located in black of the eye (cornea) or vision (iris and pupil) it causes Savrana Shukra presenting with
pricking pain,
tearing of the eye and
redness of the eyes.
Perforating through the layers of the black of the eye the vitiated pitta produces an ulcer in the depth of the cornea, having the colour of ripened Jamun fruit. This is difficult to cure when it happens in the superficial i.e. first layer of the eye.

Savrana Shukra is manageable when it happens in the second tunic / layer of the eye –
When vitiated pitta perforates and damages the second tunic, savrana shukra occurs in the second tunic, deeper than the first layer, it will be manageable but cannot be cured completely. The above said symptoms occurring in the first layer are present here too but the intensity will be more. The ulcer / wound will be of a pin point / as if pricked by a needle and will be black in color.
Read – Alaji Eye Disorder Definition, Location, Symptoms, Treatment

Savrana Shukra is incurable when it happens in the third tunic / layer of the eye –
When vitiated pitta perforates and damages the third layer of the eye, the savrana shukra occurs in the third and deepest layer of the eye, it will be more complicated and becomes difficult to cure. This condition will have accumulation of many ulcers in the third layer of the eye with severity of the symptoms. The ulcer present in the third layer of the eye is called Kshataja Shukra.
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2. Prognosis as explained by master Sushruta

The avrana shukra with below said features probably gets cured when treated promptly –

• That which is not very close to the vision
• Not located deep in the cornea
• That which is not associated with pain
• That which is not associated with discharge
• That which is not two in number i.e. no presence of dual ulcers
  Read – Tested Remedies For Eye, Ear, Nose, Throat Problems: Ramdas Pai

On the other hand, when the opposite features are present, the savrana shukla should not be treated. They are –

• The cornea is torn due to the destruction of the tissues around the cornea
• The ulcer is surrounded with raised muscular tissue
• Pulsating being enveloped by engorged veins
• Causes obstruction to the vision
• Which occurs in two layers or that which is located in the second layer of the eye
• Whose margins are red in color
• Which has become chronic
  Read – Utsangini, Vartma Sharkara Eye Disorders – Symptoms, Treatment

Apart from the above said symptoms, if the below mentioned symptoms are present in savrana shukra eye disorder, it is considered to be incurable. They are –

• Excessive discharge of hot tears
• Lot of boils / lumps erupting in and around the cornea
• Lumps / swellings of the size and shape of green gram occurring in the cornea
• The ulcer having tinge / color and appearance of the wings of titira bird (quail / partridge)
  Read – Lagana, Nimesha Eye Disorder – Symptoms, Treatment

Here, Sushruta has used the word avrana shukra while explaining the condition which is curable and mentions savrana shukra while explaining the later part i.e. incurable forms of the disease. But both conditions are different. Avrana shukra is another type of disease occurring in cornea and is different from savrana shukra.

There may be possibility that the first half (curable) explanation is related to avrana shukra and the second half (incurable) explanation is related to savrana shukra in true terms, if the meaning of the verses is taken as such.
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Alternatively there is a possibility that Sushruta might have considered the shukra which is curable and located in the upper layers of cornea as avrana or avrana like (devoid of ulcer / wound) and that which is located in the deep layers i.e. 2^nd and 3^rd layers of the eye and which is incurable as savrana shukra.

This explanation matches with that of master Vagbhata. Sushruta too has mentioned about the ulcer lodged in two layers is incurable, which has to be the 2^nd and 3^rd layers. Sushruta has mentioned ‘Na cha avagadham’ as a feature of curable shukra which means ‘that which is not located too deep’ which also means ‘that which is located superficially’ which also means ‘that which is located in the first tunic or layer’. Vagbhata too is of the same opinion.
Read – Bisavartma, Vartmarsha Eye Disorder – Definition, Symptoms, Treatment

In Sushruta’s verses –
The first set of symptoms i.e. ‘that which is not very close to the vision’ to ‘no presence of dual ulcers’ indicating curability of shukra are the symptoms of the ulcer located in the first layer of the eye.

The symptoms which indicate that the disease should not be treated i.e. starting from ‘the cornea is torn’ to ‘the condition becoming chronic’ are the symptoms of the disease / ulcer located in the second layer of the eye.

The last set of symptoms which indicate incurability of shukra i.e. ‘hot tears’ to ‘color of partridge’ are the symptoms of the disease located in the third layer of the eye. Thus the prognosis of savrana shukra explained by master Vagbhata ‘layer wise’ syncs with the explanation of that of master Sushruta.
Read – Balasagrathita, Siraajala, Sirajapidaka Eye Disorder – Definition, Symptoms, Treatment

Modern correlation – Savrana Shukra

Savrana Shukra is compared to Ulcerative Keratitis / Corneal ulcer.

A corneal ulcer is loss of corneal tissue. It is often associated with inflammation. Group of disease processes leading to corneal ulceration is called Ulcerative keratitis. It is also the term which explains inflammation that accompanies ulceration in cornea. 

Most of these ulcers of cornea are caused by infection. Non-infectious forms of ulcers are generally caused by chemical burns, autoimmune, toxic or other causes. Corneal ulcer is considered as an ophthalmologic emergency since it tends to impair the vision permanently or progress to perforation. Ayurveda too has explained this condition as incurable.
Read – Trachoma – Causes, Symptoms, Prognosis, Treatment, Remedies

Treatment of Savrana Shukra
As per the prognosis, savrana shukra is an incurable condition. But the earlier stages can be treated. The clue is given in the ‘layer wise’ description of savrana shukra in terms of prognosis and also in the mention of formulations which can treat this condition while discussing the treatment strategies for shukra disorders i.e. corneal disorders, mainly savrana and avrana shukras.
Read – Excision and Scraping – Chedana And Lekhana Karma In Eye Disorders

Avrana Shukra Eye Disorder – Definition, Symptoms, Treatment

Avrana Shukra / Shukla is an eye disorder affecting cornea.
Read – Lacrimal Cyst – Causes, Symptoms, Complications, Prognosis, Treatment

Classifications of avrana shukla

Based on the location – Avrana Shukra is a Netra Krishnagata Roga .
Based on Predominant Dosha – It is a Raktaja Netra Roga i.e. it is caused by vitiated blood.
Based on prognosis – curable disease.
Based on predominant treatment – It is one of the eye disorders which have been included in the list of disorders wherein surgical methods are contraindicated i.e. Ashastra krutya rogas. Avrana Shukra is an aushadha sadhya vyadhi i.e. treatable through medicines.
Read – Klinna vartma, Aklinna vartma Eye Disorder: Symptoms, Treatment

Avrana Shukra / Shukla, definition, meaning, pathogenesis and prognosis
Avrana Shukra eye disorder is said to be caused by vitiated blood and is curable in nature.

Avrana Shukra occurs in cornea. In this condition whiteness occurs in the black of the eye as an effect of abhisyanda i.e. conjunctivitis. This disease is not associated with pain or tearing of the eye. The whiteness covering the cornea appears like a thin layer of cloud covering the cloud, the whiteness being the cloud and the cornea being the sky in this instance.
Read – Arshovartma, Shushkarsha Eye Disorders – Symptoms, Treatment

Though this condition is curable, avrana shukra located in the depth of cornea i.e. in the second and third layers / tunics of the eye, is thicker and is chronic is said to be difficult to treat.

Signs and Symptoms

• Sitam yadaa bhati asita pradeshe – whiteness of the black of the eye i.e. cornea
• Na ati rujam – no severe pain
• Na ati ashru yutam – no excessive discharge of tears from the eye
  Read – Kumbhika – Anjananamika Eye Disorders – Symptoms, Treatment

Prognosis of Avrana Shukra
Avrana shukra is generally a curable disease, especially when it is localized in the first layer of the eye. But it is said to be difficult to cure when it has the below mentioned criteria –

• when it is located in the second and third layers of the eye
• when it is thicker in size
• when it has become chronic
  Read – Ayurveda Eye Treatment Types, Methods – Ashtanga Hrudaya Sutrasthana 23

Modern correlation of Avrana Shukla

Avrana Shukra is compared to opacity of the cornea.

As said Avrana Shukra is caused as a complication of conjunctivitis. As a result of conjunctivitis, an ulcer is formed on the cornea, which in due course of time heals leaving a coating of whiteness over the cornea. This is avrana shukra.
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The ulcer formed on the cornea, when gets healed, scar tissue is formed. This scar tissue changes the configuration of cornea. The cornea loses its transparency and becomes opaque. These opacities may be one or more in number, may occur in the periphery of the cornea, at the centre or everywhere. The opacity prevent the light from passing through the cornea to the retina and may cause the cornea to appear white or clouded over. Similar explanation has been given in Ayurvedic part of Avrana Shukra wherein the opacity is explained as whiteness, appearing like a cloud covering the cornea.
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Treatment

Avrana shukra is the only disorder among the four diseases occurring in the black of the eye i.e. cornea which is curable.

Lekhana Karma i.e. scraping treatment is the best option in treating both savrana and avrana shukras.
Read – Anjana – Collyrium Types, Method, Uses, Side Effects, Contra Indications

Master Vagbhata opines that unctuous or drying therapies shall be done in treating shukra disorders after having considered the predominant dosha involvement in the causation of the disease. Some useful collyriums are also mentioned by master Sushruta in the treatment of Shukra.
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