The patient should be first treated with a Sneha-predominating food before being surgically operated upon in a case of Annan marked by the manifest vegetation or polypus (on the affected eye). The patient should then be made carefully to sit at ease and the affected eye should then be irritated by casting powdered Saindhava-salt into its cavity after which the eye-ball, without any loss of time, should be duly fomented and rubbed with the hand. The intelligent physician will then ask the patient to look at his Apanga (the interior corner of his own affected eye) and the cyst or the polypus (thus turned up), should be carefully secured with a hook (Vadis'a) and held with a Muchundi instrument or with a thread-needle. It is dangerous to suddenly uplift the eye-lid under the circumstances. The two eye-lids should be firmly drawn asunder so as to guard against their being anywise hurt during the operation. The polypus, thus made flabby and pendent with the means of the three aforesaid accessories, .should be fully got rid of by scraping it with a sharp Mandalagra instrument. The root of the polypus should be pushed asunder from the Krishna-mandala (Sclerotic region) and the Sukla-mandala (region of the cornea), to the extremity of the Kaninaka (pupil) and then removed. The Kaninaka (pupil) should be duly guarded so as not to be hurt. A quarter layer of the flesh (of the polypus) should be lefl link and then the operation would not in any way hurl or injure the eye. An operation at a point beyond the aforesaid limit of the Kaninaka (might hurt the pupil and) would set up a haemorrhage and beget a sinus (as well as pain) in the locality. The vegetation or polypus is sure to grow up again to its former size if it is cut off insufficiently. 2.
A shreddy or netted Arman in the form of a membranous growth (Jala) in the eye should be made pendent by rubbing it (with Saindhava-salt) and then cut with a bent Vadis'a instrument at the junction of the Sukla-mandala (cornea) and the Vartma-mandala (conjunctiva or eye-lid). The affected part should then be rubbed with a compound consisting of Yava-kshsara, Trikatu and Saindhava-salt (pounded together) and then (duly) fomented and bandaged up by the skilful physician. Lardaceous or oily (Sneha) application should thereafter be prescribed with due regard to the nature of the place *, the season, the time (day or night) and the strength of the patient, and the incidental wound should be treated as an ulcer. The bandage should be removed after three days and the affected part should be (mildly) fomented with the application of heated palms of the hands and treated with corrective or purifying remedies. 3.
Milk duly cooked with Karanja seed, Amalaka and Yashti-madhu and mixed with honey (when cold), should be dropped twice a day (morning and evening) into the affected eye in the event of there being any pain in it. A cold plaster composed of Yashti-madhu, polens of lotus (Utpala) and Durva-grass pasted together with milk and mixed with clarified butter is recommended in such cases to be applied to the scalp. 4.
* In place of - the particular part and nature of the country, some read - the particular Dosha involved in each case.
Any residue of the Annan, left after the excision, should be removed with the application of Lekhya * (scraping) Anjana or eve-salve. An Arman (Cyst-like papilla or protruberance) which is as white as curdled milk (Dadhi), or which looks blood-red or blue or grey, should be treated like a case of Sukrarman (Opacity of the cornea or a flimy and fleshy growth in the eye). An Arman which is very thick and looks like a piece of skin and covered over with fibres of flesh and nerves †, as well as one occurring on the Krishna-mandala (region of the iris) should be excisioned. The eye assumes its former and natural colour and function, and becomes free from pain and other complications by the proper excision of an Arman. 5-8.