The 19th chapter of Uttaratantra of Sushruta Samhita is named as Nayanābhighāta Pratiṣedha Adhyaya. This chapter deals with the Treatment of Injury of the Eyes.

अथातो नयनाभिघातप्रतिषेधं व्याख्यास्यामः ।। १ ।।
यथोवाच भगवान् धन्वन्तरिः ।। २ ।। 

We will now expound Nayanābhighāta pratiședha – treatment of injuries of the eyes; as revealed by the venerable Dhañvañtari . 

अभ्याहते तु नयने बहुधा नराणां संरम्भरागतुमुलासु रुजासु धीमान् ।।
नस्यास्यलेपपरिषेचनतर्पणाद्यमुक्तं पुनः क्षतजपित्तजशूलपथ्यम् ।। ३ ।। 

Swelling, redness and very severe pain are the main symptoms which occur when the eyes of human beings are greatly injured in many ways.

In such conditions, the intelligent physician should adopt the below mentioned therapies described earlier –

–       Nasya – nasal medication / errhines,

–       Asyalepa / Mukhalepa – application of medicinal pastes on the face,

–       Parisecana – bathing the eye with medicinal liquids,

–       Tarpana – bathing the eye with medicated ghee,

According to Acharya Dalhana, treatments indicated for Ksataja and Pittaja Aksi Sula (eye pain) or Abhisyanda should be adopted. . 

दृष्टिप्रसादजननं विधिमाशु कुर्यात् स्निग्धैर्हिमैश्च मधुरैश्च तथा प्रयोगैः ।।
स्वेदाग्निधूमभयशोकरुजाभिघातैर भ्याहतामपि तथैव भिषक् चिकित्सेत् ।।४ ।।

Treatments which produce clarity of vision should be quickly administered. It should be done with herbs having unctuous properties, cold potency and sweet taste.

The physician should also administer the same treatments when injury is caused by below mentioned causes –

–       Sudation,

–       Exposure to fire and smoke,

–       Fear,

–       Grief and

–       Pain

सद्योहते नयन एष विधिस्तदूर्ध्वं स्यन्देरितो भवति दोषमवेक्ष्य कार्यः ।।
अभ्याहतं नयनमीषदथास्यबाष्पसंस्वेदितं भवति तन्निरुजं क्षणेन || ५ || 

When the eyes are injured suddenly i.e. just then, these treatments are advocated. Afterwards, the treatments prescribed for Abhisyanda should be adopted after having considered the aggravated dosha.

Injury which has suddenly or immediately occurred and is mild in nature gets relieved of pain by blowing warm air from the mouth.

साध्यं क्षतं पटलमेकमुभे कृच्छ्रे त्रीणि क्षतानि पटलानि विवर्जयेत्तु ।।
स्यात् पिच्चितं च नयनं ह्यति चावसन्नं स्त्रस्तं च्युतं च हतदृक् च भवेत्तु याप्यम् ।। ६ ।।
विस्तीर्णदृष्टितनुरागमसत्प्रदर्शि , साध्यं चथास्थितमनाविलदर्शनं च ।।

Injury to one patala – layer of the eye is curable.

Injury to two patala is curable with difficulty.

Injury to three patala should be rejected, since they cannot be treated.

In the presence of the below mentioned features related to the eye, the condition is considered to be yapya i.e. incurable and persistent –

–       Eyes are crushed,

–       Eyes gone in very deep,

–       Drooping of eyes,

–       Displacement of eyes,

–       When eyes are unable to see things

When the drishti mandala i.e. pupil is broad (greatly dilated) and has thin red color, it is considered yapya.

The same condition is curable when the vision is not turbid (hazy).

प्राणोपरोघवमनक्षुतकण्ठरोधैरुन्नम्यमाशु नयनं यदतिप्रविष्टम् ।।७ ।।
नेत्रे विलम्बिनि विधिर्विहितः पुरस्तादुच्छङ्घनं शिरसि वार्यवसेचनं च ।।

Below mentioned measures should be done to lift (made to come forward) the eye which has gone very deep –

–        Obstructing the breathing,

–        Inducing vomiting and sneeze and

–        Obstructing the throat

Treatments such as sucking the air through the nose with force and pouring water on the head should be done when the eyes are found hanging loose.

Kukūnaka 

षट्सप्ततिर्नयनजा य इमे प्रदिष्टा रोगा भवन्त्यमहतां महतां च तेभ्यः ।।८ ।।
स्तन्यप्रकोपकफमारुतपित्तरक्तैर्बालाक्षिवर्त्मभव एव कुकूणकोऽन्यः ।। 

Both children and adults are affected by the seventy six diseases of the eyes described so far. Apart from these diseases, another disease kukunaka is manifested in the eyelids of the children. It is caused by drinking vitiated breast milk which aggravates kapha, vata, pitta and rakta.

मृनाति नेत्रमतिकण्डुमथाक्षिकूटं नासाललाटमपि तेन शिशुः स नित्यम् ।। ९ ।।
सूर्यप्रभां न सहते स्रवति प्रबद्धं , तस्याहरेद्बुधिरमाशु विनिर्लिखेच्च ।।
क्षौद्रायुतैश्च कटुभिः प्रतिसारयेत्तु मातुः शिशोरभिहितं च विधिं विदध्यात् ।। १० ।। 

Symptoms of this disease –

–        The child rubs the eyes, eye-socket, nose and forehead constantly due to itching in the eyes,

–        Does not tolerate sunlight,

–        Great discharge of tears etc.

–        Eyes adhere tightly

Treatment –

–        Bloodletting and scraping of the eyelid should be quickly done and

–        Paste of herbs having pungent taste added and mixed in honey should be smeared,

–        Treatments advocated for the mother having vitiated breast milk (chikitsa sthana, chapter 17) should also be prescribed

तं वामयेत्तु मधुसैन्धवसम्प्रयुक्तैः पीतं पयः खलु फलैः खरमञ्जरीणाम् ||११||

स्यात्पिप्पलीलवणमाक्षिकसंयुतैर्वा नैनं वमन्तमपि वामयितुं यतेत ||

Paste of fruits of Kharamanjari (Apamarga) added with honey and saindhava lavana should be administered to the child and he should be made to vomit.

Alternatively, Pippali, Saindhava lavana and honey is used. On the other hand, if the child is vomiting on his own accord, vomiting need not be induced again i.e. emetics should not be used.

दत्त्वा वचामशनदुग्धभुजे प्रयोज्यमूर्ध्वं ततः फलयुतं वमनं विधिज्ञैः ||१२||

Vaca should be used for inducing emesis in children who consume both milk and solid food.

Madanaphala should be used to induce vomiting in children who consume only solid food.

जम्ब्वाम्रधात्र्यणुदलैः परिधावनार्थं कार्यं कषायमवसेचनमेव चापि |१३|
आश्च्योतने च हितमत्र घृतं गुडूचीसिद्धं तथाऽऽहुरपि च त्रिफलाविपक्वम् ||१३||

For washing and bathing the eye, the decoction prepared from the below mentioned ingredients should be used –

–        Jambu,

–        Amra and

–        Dhatri

For Ascyotana, ghee boiled and prepared with Guduci or Triphala is beneficial.

नेपालजामरिचशङ्खरसाञ्जनानि सिन्धुप्रसूतगुडमाक्षिकसंयुतानि |
स्यादञ्जनं, मधुरसामधुकाम्रकैर्वा कृष्णायसं घृतपयो मधु वाऽपि दग्धम् ||१४||

Anjana prepared with the below mentioned ingredients is applied to the eyes –

–        Nepalaja – Manassila,

–        Marica,

–        Sankha,

–        Rasanjana,

–        Saindhava,

–        Guda and

–        Maksika

Alternatively, Anjana prepared from below mentioned can be used –

–        Madhurasa (Murva), Madhuka and Amra or

–        Krsnayasa (iron burnt inside a closed pot), ghee, milk (breast milk) and honey

व्योषं पलाण्डु मधुकं लवणोत्तमं च लाक्षां च गौरिकयुतां गुटिकाञ्जनं वा |
निम्बच्छदं मधुकदार्वि सताम्रलोध्रमिच्छन्ति चात्र भिषजोऽञ्जनमंशतुल्यम् ||१५||

Below mentioned collyrium are praised by the physicians –

1. Collyrium prepared from the below mentioned ingredients in the form of pills –

–        Vyosa,

–        Palandu,

–        Madhuka,

–        Lavanottama – Saindhava Lavana,

–        Laksa and

–        Gairika

2. Collyrium prepared from the below mentioned ingredients taken equal in quantity –

–        Nimba,

–        Madhuka,

–        Darvi – Daruharidra,

–        Tamra and

–        Lodhra

स्रोतोजशङ्खदधिसैन्धवमर्धपक्षं शुक्रं शिशोर्नुदति भावितमञ्जनेन |
स्यन्दे कफदभिहितं क्रममाचरेच्च बालस्य रोगकुशलोऽक्षिगदं जिघांसुः ||१६||

Anjana – collyrium should be prepared from Srotonjana, Sankha, Dadhi and Saindhava Lavana. It should be applied to the eye of the patient for half a fortnight i.e. seven days by a physician specialized in diseases of children and desirous of curing eye diseases.

In kaphaja abhisyanda, treatment indicated for it in chapter 11 should also be done.

समुद्र इव गम्भीरं नैन शक्यं चिकित्सितम् ।।
वक्तुं निरवशेषेण श्लोकानामयुतैरपि ।। १७ । ।
सहस्त्रैरपि वा , प्रोक्तमर्थमल्पमतिर्नरः ।।
तर्कग्रन्थार्थरहितो नैव गृह्णात्यपण्डितः ।। १८ ।। 

The science of medicine is like a vast and deep ocean. Therefore it is very difficult, in fact impossible to describe it in just either a hundred or thousand verses. The physician will not be able to understand them completely if he is devoid of reasoning ability and knowledge or purpose of the texts.

तदिदं बहुगूढार्थं चिकित्साबीजमीरितम् ।।
कुशलेनाभिपन्नं तद्बहुधाऽभिप्ररोहति ।।१९ ।।
तस्मान्मतिमता नित्यं नानाशास्त्रार्थदर्शिना ।।
सर्वमूह्यमगाधार्थ शास्त्रमागमबुद्धिना ।।२० ।। 

Therefore, only the essence of the science of cikitsa (treatment or therapeutics) which has deeper meaning has been mentioned in here. This essence would grow in many ways when they are understood by intelligent physicians. It should in fact be understood by the physician who has grasped and understood the essence of many sciences by having studied and practiced them daily. He should have understood these things through the means of logical reasoning and through the light of knowledge of scriptures i.e. texts of Ayurveda in this context.

इति श्रीसुश्रुतसंहितायामुत्तरतन्त्रान्तर्गते शालाक्यतन्त्रे नयनाभिघातचिकित्सितं नामैकोनविंशोऽध्यायः ।। १ ९ ।।
Thus ends the nineteenth chapter by name Nayanābhighāta pratişedha in Uttara sthana of Suśruta samhita.