The general course of treatment to be adopted in the nine kinds of eye diseases which are amenable to Scarifying (Lekhana) operations is as follows: - The patient should be laid in a chamber not exposed to the sun and the gales of wind, after having been treated with proper emulsive measures (Sneha-karma) * and subjected to a course of emetics and purgatives. The eyelid should be over-turned with the thumb and the index finger and should be very carefully fomented with a piece of linen soaked in lukewarm water and squeezed. The eye-lid should be covered with a piece of linen and over-turned with the thumb and the index finger at the time to guard against its movement and enclosing. The (part of the) eye-lid to be scraped, should be wiped with a linen and marked with a surgical instrument and the scraping should be effected therein with a scraping knife or any (rough) leaf according to the exigencies of the case. After the subsidence of the bleeding, the part should be fomented and then gently rubbed (Prati-sarana) with a medicinal compound consisting of Manah-s'ila (Realgar), Kas'isa (Sulphate of iron), Trikatu, Anjana (black antimony), Saindhava salt and Makshika finely pounded together. After this the part should be washed with lukewarm water and lubricated with clarified butter. The subsequent treatment thereof should be like that of an ulcer (Vrana). * Fomentations, Avapida, etc., should also be employed after three days. Thus I have described to you the general measures to be observed in scraping an affected locality in the eye. 2.
* It should be noted that the patient should also be fomented (Sveda) after being treated with the emulsive measures.
Stoppage of bleeding, subsidence of the swelling and itching, a smooth level aspect of the part like the surface of a finger nail are the features, which mark a proper and satisfactory scarification. Redness of the eyes, swelling and discharge of blood from the operated locality, occurrence of Timira (blindness or darkness of vision), non-ameliorations of the disease under treatment, brownness, heaviness, numbness, itching, horripilation and coating (as if with foreign matter) of the eye-lids and a consequent high inflammation of the eye if not attended to in time, are the symptoms which attend an incomplete and unsatisfactory scarification, and this should be remedied by anointing † and scarifying the affected part again. 3-4.
Excessive discharge and pain in the locality together with an upturning of the eye-lids and spontaneous uprooting of the eye-lashes should be ascribed to excessive scraping. Fomentation, application of Sneha and employment of Vayu-subduing measures should be resorted to in such cases. 5.
In the following diseases of the eye, viz., Vartma-vabandha, Klishta-vartma, Bahala-vartma and Pothaki, the affected part should first be gently scraped and then scarified. In Syava-vartma and Kardama-vartma, the intelligent physician will gently scarify the affected part neither deeply nor superficially. In cases of Ut-sangini, Sarkara and Kumbhikini, the seat of the disease should be first cut (with a knife) and then carefully scarified. An incision should be followed by a scarification in the case of small, very hard, supperated, copper-coloured, Pidakas (pustules) occurring on (the inner membrane of) the eye-lid. Small and slightly swelling Pidakas (pustules) occurring on the exterior surface of the eye-lid should be remedied with fomentations, plasters and the general corrective remedies, 6.
* For the first seven days the treatment should be like that of an incidental ulcer (Sadyo-vrana) after which period, the case should be treated, if necessary, as a case of S';irira-Vrana.
† Dallana says that sonic read (fomenting) in place <>!
Thus ends the thirteenth chapter of the Uttara-Tantra in the Sus'ruta Samhita which treats of the curative treatment of (eye-) diseases amenable to scarification.