Pterygium eye disease आर्म रोग का वर्णन

1. अर्म
Pterygium

2. Introduction
यह एक शुक्लगत रोग है ।
इसका वर्णन शुश्रुत संहहता क
े उत्तर तंत्र क
े शुक्लगत रोग
हवज्ञाहनयां अध्याय में हकया गया है।
इसका आधुहनकमतानुसार pterygium से संबंध स्थाहित
करते है।

3. निदाि
• प्राचीन तथा आधुहनक दोनों ग्रन्ों में इस रोग क
े वास्तहवक
कारर्ों का कोई उल्लेख नहींहमलता है।
• क
ृ ष्णमण्डल की िररहध िर सूक्ष्म क्षत होने से या नेत्र में हकसी
बाह्य िदाथण (Foreign body) क
े प्रहवष्ट हो जाने से वहााँ िर सूक्ष्म
घर्णर्जन्य व्रर् होकर उसक
े रोहर् होने क
े समय नेत्रश्लेे्ावरर्
क
े हकसी हहस्से क
े भीतर आ जाने से अमण की उत्पहत्त हो सकती
है।

4. पूर्मरूप
• नेत्रों में अहवलता
• नेत्रों में लाहलमा और वेदना
• नेत्रों से अश्रु का हनकलना
• नेत्रों में खुजली
• नेत्रों में दाह और तोद
• वर्त्णकोर् में शूल

5. भेद और लक्षण
• आचायण सुश्रुत ने आमण क
े िांच भेदों और उसक
े लक्षर्ों वर्णन हकया है।
1. प्रस्तरी अमण – हवस्तीर्ं तनु रुहधरप्रभं सनीलम्
2. शुक्लामण - शुक्लाख्यं मृदु कथयन्ति शुक्लभागे सश्चेतं समहमह वर्द्णते हचरेर्।
3. लोहहतामण -. यमनंसं प्रच्यमुिैहत शुक्लभागे िद्माभं तदुिहदशन्ति लोहहतामण
4. अहधमांसज- हवस्तीर्ण मृदु बहलं यक
ृ त्प्रकाशं श्यावं वा तदहधकमांसजामण हवद्यात्।
5. स्नाय्वमण- शुक्ले यन्तत्पहशतमुिैहत वृन्तर्द्मेतत् स्नायवमेत्यहभिहितं खरं प्रिाण्डु

6. अर्म का दोषोोंक
े साथ सोंबोंध
1. प्रस्तारीअमण- सहििातज
2. शुक्लमण - कफज
3. लोहहतमण- रक्तज
4. अहधमंसज- सहििातज
5. स्नायुअमण - सहििाताज

7. अर्म की साध्यातासाध्यता
• सभी अमण रोग साध्य होते हैं।

8. अर्म रोग की निनकत्सा
1. छे दन कमण
2. प्रहतसारर्- छे दन करने क
े िश्चात् यवक्षार, सोंि, मररच, हिप्पली और लवर् इनक
े
चूर्ण से नेत्र क
े हछिामण क
े स्थान का प्रहतसारर् करे।
3. उिद्रव की हचहकत्सा- करजबीज, आंवला और मुलेिी इनक
े कल्क और कर्ाय से
हसर्द् हकया हुआ दुग्ध लेकर उसमें मधु का प्रक्षेि दे क
े उससे हदन में दो बार नेत्र का
आश्व्योतन करना चाहहये ।
4. शूलहर प्रलेि- आश्व्च्योतन क
े साथ-साथ मुलेिी, कमलक
े शर और दू वाण इन्हें दुग्ध क
े
साथ िीस कर घृतहमहश्रत करक
े हसर िर या आंख िर उससे प्रलेि करने से शूल नष्ट
होता है।।
5. अमणशेर् हचहकत्सा- लेख्य अंजन

10. Pterygium

11. •Also known as ‘SURFER’S EYE’.
•The word Pterygium is derived from the Latin word,
•“Pterygos” which means a wing
•Pterygium is a common ocular surface lesion
characterized by a wing shaped fibrovascular fold of
bulbar conjunctiva which encroaches upon the cornea.
Introduction

12. ETIOLOGY
The etiology of pterygium is still unknown. But there are various theories that are proposed that contributes
to the development of pterygium which includes:-
1. Point mutations of proto-oncogenes K-ras. Alterations in the expression of tumor suppressor genes as
p53/p63
2 UV radiations--- exposure to these rays results into induction of mediators for growth of pterygium.
It is called “TWO HIT” Mechanism.
The first hit is the process of tumor suppressor gene deactivation.
The second hit is the environmental factors that includes viral infection or the exposure of UV radiations.

13. SIGNS
Triangular encroachment of
conjunctiva on the cornea.
Numerous small opacities may
lie in front of apex of
pterygium.
SYMPTOMS
1. It is usually asymptomic.
2. There is cosmetic disfigurement.
3. Visual disturbances occur when it encroaches the
papillary area.
4. Occasionally diplopia due to limitation of ocular
movement.
5. Other symptoms includes:-
Discomfort
Foreign body sensation
Congestion

14. TYPES OF PTERYGIUM
• Depending upon the progression it may be of 2 types:
•
• 1. Progressive pterygium is thick, fleshy and vascular with a few infiltrates in the cornea, in front of the head of the
pterygium (called cap of pterygium).
•
• 2. Regressive pterygium is thin, atrophic, attenuated with very little vascularity. There is no cap. Ultimately it becomes
membranous but never disappears.

15. Parts of pterygium
• It consists of 3 parts:-
•
• Head:- present on cornea (apical part).
•
• Neck:- narrow part near limbus (limbal part).
•
• Body:- extending between limbus and canthus (scleral part).
•
• Stocker’s Line
•
• A Stocker line is the brown iron line in the cornea anterior to the head of the pterygium.

17. Grading of pterygium
• CLINICAL GRADING
•
• GRADE 1: extends 2mm on the cornea
•
• GRADE 2: involves upto 4 mm of the cornea it can be primary or secondary.
•
• GRADE 3: encroaches more than 4mm of the cornea & it can hamper visual axis.
•
• TAN’S CLASSIFICATION
•
• TI GRADE: clearly visible episcleral vessels under the pterygium
•
• T2 GRADE: partially visibility of the episcleral vessels under the pterygium.
•
• T3 GRADE: total obscured view of the episcleral vessels under the pterygium.

20. Treatment
• Early in the disease process, physicians often take a conservative
approach, limiting therapy to lubricating medications. Since UV
radiation is believed to be an important risk factor, the clinician
should recommend that patients with early-stage pterygia use proper
protective eyewear. If the lesion grows, surgical intervention becomes
more compelling.

21. Procedure
• Transplantation of pterygium in the lower fornix (McReynold’s
operation) is not performed now.
• Postoperative beta irradiations (not used now).
• Postoperative use of antimitotic drugs such as mitomycin-C or
thiotepa.
• Surgical excision with bare selera.
• Surgical excision with free conjunctival graft taken from the same eye
or other eye is presently the preferred technique.
• In recurrent recalcitrant pterygium, surgical excision should be
coupled with lamellar keratectomy and lamellar keratoplasty.

22. • In simple excision the conjunctiva is sutured back to cover the sclera.
•
• In bare sclera technique, some part of conjunctiva is excised and its
edges are sutured to the underlying episcleral tissue leaving some
bare part of sclera near the limbus.
•
• Free conjunctival membrane graft may be used to cover the bare
sclera. This procedure is more effective in reducing recurrence. Free
conjunctiva from the same or opposite eye may be used as a graft.
•
• Limbal conjunctival autograft transplant- ation (LLAT) to cover the
defet after pterygium excision is the latest and most effective
technique in the management of pterygium.

25. Indications
• Surgical excision is the only satisfactory treatment, which may be indicated for:
•
• (1) Cosmetic reasons
•
• (2) Continued progression threatening to encroach onto the pupillary area (once the
pterygium has encroached pupillary area, wait till it crosses on the other side)
•
• (3) Diplopia due to interference in ocular movements.
•
• (4) Visual Impairment
•
• Recurrence of the pterygium after surgical excision is the main problem (30-50%).