adjim, oct -dec 2019; vol. 4 issue 4 issn(online): 2455 ... · literature review of the topic is...

ADJIM, Oct - Dec 2019; Vol. 4 Issue 4 ISSN(Online): 2455-9989

Web: www.ayurveddarpan.com Email: [email protected]

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Ayurved Darpan

Journal of Indian Medicine An International Quarterly Publishing Peer Reviewed Journal

Conceptual study of Kukunaka with special reference to Ophthalmia

Neonatorum in Neonates

Assistant professor1, Associate professor2

Kalyani P. Aher1,*, Gajanan A. Cheke2

1,2Department of Kaumarbhritya

Conceptual Study

ABSTRACT:

Ophthalmia Neonatorum is one of the diseases of neonates. In Ayurveda Kukunaka vyadhi was explained in

samhita has similar features like Ophthalmia Neonatorum, so Kukunaka can be related to Ophthalmia

Neonatorum. It is the conjunctivitis of newborns occurring during first month of life. It may be infectious or non

infectious. It causes pain & tenderness in eyeball, purulent, mucoid/ mucopurulant discharge, hyperaemia,

photophobia and blindness if left untreared. Hence I decided to address Kukunaka (Ophthalmia Neonatorum) as

it may lead to blindness, if left untreated.

In Ayurveda, Acharya Sushruta, Vagbhata & Kashyapa

have described similar features as that of Ophthalmia

Neonatorum under the disease named ‘Kukunaka’.

Sushruta says that it is caused due to ingestion of

breast milk vitiated by vata, pitta and kapha & rakta

while Vagbhata says that the disease is due to eruption

of teeth.

The bacterial conjunctivitis caused in newborns

during passage through infected birth canal. The risk

of infections in neonates increases due to inadequate

maternal care & lack of widespread use of

prophylactic treatment to prevent infections following

birth

An eye can perceive forms, it adorns the face. It is a

source of direct knowledge, it is a guide for right and

wrong deeds and hence eye is most important of all

sense organs.

Neonatal period is initiation of life. To have healthy

child, parents must look after the neonate, as it may

get diseased soon due to immaturity (Apakvdhatu).

A neonate is fully dependant on mother and is prone

for many diseases due to negligence.

xÉuÉïÇ ÌlÉuÉÉrÉïiÉå oÉÉsÉå xiÉlrÉÇ lÉãuÉ ÌlÉuÉÉrÉïiÉå | rÉÉå. U. oÉÉsÉUÉåaÉÉÍkÉMüÉU

Though it is a dushta stanya janit vyadhi i.e. caused

due to vitiated breast milk, one can not stop breast

feeding of the baby. Aacharyas also stated that mother

is responsible for wellness of a child. Thus the

importance of eye among all sensory organs has

provoked me to select a subject related to eye.

Conceptual Study of Kukunaka:

Literature review of the topic is done from Kashyap

Samhita, Charak Samhita, Sushruta Samhita, Ashtanga

Sangraha and Hridaya, Madhava Nidana,

Bhavaprakasha, Sharangadhara Samhita and Modern

Textbook of Pediatrics.

Ayurvedic Concept

MÑüMÑühÉMü MüÉåjÉ CÌiÉ ZrÉÉiÉ: | ´ÉÏMühPû

Kukunaka is an eye disease, hence anatomy is

described first.

Chakshu – ‘Chaksha’ i.e. Darashan meaning which is

responsible for sight.

Netrabudabuda – meaning bubble floating in water

which explains glossy appearance of eye ball which is

soft in consistency and floating in orbit.

28

KEY WORDS: Kukunaka, Ophthalmia neonatorum, Dhatri, Netra, Stanya, Dushti, Dhatus Infection

INTRODUCTION:

* Corresponding Author: Dr. Kalyani P. Aher, E-mail: [email protected]

Article Received on: 07/12/2019 Accepted on: 26/12/2019 Published on: 31/12/2019

1Ashtang Ayurved College, Pune-411030, 2Tilak Ayurved College, Pune-411011, Maharashtra, India.

http://www.ayurveddarpan.com



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Kukunaka Nidan or Causes

Hetu (causes of Kukunaka) –

xiÉlrÉmÉëMüÉåmÉ MüÄTüqÉÉÂiÉÌmÉ¨ÉU£ü oÉÉsÉÉÍ¤ÉuÉiqÉï pÉuÉ LuÉ MÑüMÔühÉMüÉålrÉ:|

xÉÑ. E. 19/9

MÑüMÔühÉMüÈ ÍzÉzÉÉåUåuÉ SliÉÉåimÉÌ¨ÉÌlÉÍqÉ¨ÉeÉÈ || uÉÉ. E. 8/19-20

rÉSÉ qÉÉiÉÉ MÑüqÉÉUxrÉ qÉkÉÑUÉÍhÉ ÌlÉwÉåuÉiÉå |

qÉixrÉÇ qÉÉÇxÉÇ mÉrÉÈ zÉÉMÇü iÉjÉÉ SÍkÉ ||

xÉÑUÉxÉuÉÇ ÌmÉ¹qÉrÉÇ ÌiÉsÉÌmÉ¹ÉqsÉMüÉÇÎeÉMüqÉ |

AÍpÉwrÉlSÏÌlÉ xÉuÉÉïÍhÉ MüÉsÉå MüÉsÉå ÌlÉwÉåuÉiÉå ||

pÉÑYiuÉÉ pÉÑYiuÉÉ ÌSuÉÉ zÉåiÉå ÌuÉxÉÉ¥ÉèæÈÇcÉ ÌuÉoÉÑkrÉiÉå |

iÉxrÉ SÉåwÉÉÈ mÉëMÑüÌmÉiÉÉ SÕUÇ aÉiuÉÉ cÉ ÌiÉ¸iÉå ||

SÉåwÉåhÉÉuÉ×iÉqÉÉaÉÉïrÉÉxiÉiÉÈ xiÉlrÉÇ cÉ SÒwrÉiÉå || MüÉ.ÎZÉsÉ. 13/3-5

There are two thoughts regarding the concepts of

etiological factors. Sushruta, Kashyapa and Madhava

have considered it as a disorder of vitiated milk, while

Vagbhata says it as a complication of dentition.

Kashyapa has listed the factors responsible for

vitiation of breast milk and ultimately for

development of Kukunaka.

1. Aaharaj (Diet):

a. Consumption of too much sweet articles –

Causes diseases due to vitiation of kapha dosha

like netra roga and abhishyanda etc.

(cÉ. xÉÑ. 26/42)

b. Leafy vegetables

c. Fish and meat –

Mansahar have gunas like ushna, tikshna and

abhishyandi which causes aggrevation of pitta

dosha and rakta dhatu.

d. Milk & milk products like butter, ghee –

Dugdhahar causes abhishyand which is responsi-

ble for vitiation of kapha & rakta.

e. Products of flour

f. Grinded tila.

g. Sour articles like kanji.-

Among six rasas, amla is more prone to eye dis-

eases. Vidahi items also leads to eye diseases.

h. All abhishyandi articles.

Ahara is the basis of all functions of the body. The

doshas and dhatus of the body are created,

maintained and destroyed mainly by ahara. These all

dietary factors are Achakshushya. Dietary items

having ushna veerya always vitiate pitta, pitta being

the functional factor for eye, any vitiation of pitta,

always lead to eye diseases.

2. Viharaj (Mode of life):

Sleeping in day, after taking meal –

Sleep in day time and keeping up late hours in the

night, Eyes are modified organs to work in presence

of sunlight and to rest in absence of light. Also,

Divaswap is said to be trishokar.

All the above causes are tridoshkar and raktdushtikar.

Doshas get vitiated, following above causes and

spread in whole of the body, thus blocking milk

carrying channels. On consuming such vitiated milk

for long time, the vitiated dosha enters the body of

child, producing this eye disorder by vitiating kapha

and rakta.

Many Acharyas have mentioned that, the baby

receives milk (stanya) which is a part of mother’s

ahar rasa. So her diet is very important in transfer-

ring vyadhis to baby.

xÉpÉÇuÉÎliÉ qÉWûÉUÉåaÉÉ AzÉÑkS¤ÉÏUxÉåuÉlÉÉiÉç | MüÉ.xÉÇ.xÉÑ.19/27

SÒwÉrÉÌiÉ mÉrÉxiÉålÉ zÉÉËUUÉ urÉÉkÉrÉ: ÍzÉzÉÉå: | xÉÑ.xÉÇ.zÉÉ. 10/33

Í¤ÉUÇ ÌWû rÉjÉÉå£æüSÉåïwÉMüÉåmÉlÉæUÉWûÉUÌuÉWûÉkÉÉï§rÉÉ urÉÉmÉ³ÉÇ ÌuÉÌuÉkÉÉqÉrÉÉåSrÉÉcÉ

oÉÉsÉxrÉ mÉëMüsmÉiÉå | A.xÉÇ.E. 2/3

aÉÑÂÍpÉÌuÉïÌuÉkÉæUlÉæSÒï¹æSÉåïwÉæ: mÉëSÒÌwÉiÉqÉç |

¤ÉÏUÇ qÉÉiÉÑ: MÑüqÉÉUxrÉ lÉÉlÉÉ UÉåaÉÉrÉ MüsmÉiÉå || qÉÉ.ÌlÉ. 67/5

kÉÉ§rÉÉ aÉÑÂÍpÉÌuÉïÌuÉkÉæU³ÉæSÒï¹æSÉåïwÉsÉæxiÉjÉÉ |

SåWåû SÉåwÉÉ: mÉëMÑümrÉÎliÉ iÉiÉ: xiÉlrÉÇ mÉëSÒwrÉÌiÉ ||

ÍqÉjrÉÉWûÉU ÌuÉWûÉËUhÄrÉÉ SÒ¹É uÉÉiÉÉSrÉ: Îx§ÉrÉÉ: |

SÒwÉrÉÎliÉ mÉrÉxiÉålÉ zÉËUUÇ urÉÉkÉrÉ: ÍzÉzÉÉå: || pÉÉ.mÉë.mÉÔ. 4/16,17

Thus mithya ahara vihar by mother causes

stanyadushti or vitiation of milk by doshas, causing

many vyadhis in child.

Poorva Roop – Prodromes:

Prodromes of Kukunaka are not described in the text.

Roop - Symptoms and Signs:

ApÉÏ¤hÉÇqÉx§ÉÇ x§ÉuÉiÉå lÉ cÉ ¤ÉÏuÉÌiÉ SÒqÉïlÉÉ: |

lÉÉÍxÉMüÉÇ mÉËUqÉ×SèlÉÉÌiÉ MühÉïÇ uÉÉÇNûÌiÉ SÒ:ÎZÉiÉ: ||

sÉsÉÉOûqÉÍ¤ÉMÑüOÇû cÉ lÉÉxÉÉÇ cÉ mÉËUqÉSïÌiÉ |

lÉå§Éå MühQÒûrÉiÉåÅpÉÏ¤hÉÇ mÉÉÍhÉlÉÉ cÉÉmrÉiÉÏuÉ iÉÑ |

xÉ mÉëMüÉzÉÇ lÉ xÉWûiÉå A´ÉÑ cÉÉxrÉ mÉëuÉiÉïiÉå |

uÉiqÉïÌlÉ µÉrÉjÉÑ¶ÉÉxrÉ eÉÉlÉÏrÉÉ¨ÉÇ MÑü‚ÑühÉMüqÉ || MüÉ. ÎZÉsÉ. 13

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qÉ×SèlÉÌiÉ lÉå§ÉqÉÌiÉMühQÒûqÉjÉÉÍ¤ÉMÔüOÇû lÉÉxÉÉsÉsÉÉOûqÉÌmÉ iÉålÉ ÍzÉzÉÑÈ

ÌlÉirÉqÉ| xÉÔÄrÉïmÉëpÉÉ lÉ xÉWûiÉå xÉëuÉÌiÉ mÉëoÉkSÇ..... xÉÑ. E. 19/9

xrÉÉ¨ÉålÉ ÍzÉzÉÑÂcNÕûlÉiÉÉqÉëÉ¤ÉÉå uÉÏ¤ÉhÉÉxÉqÉÈ |

xÉuÉiqÉïzÉÔsÉmÉãÎcNûsrÉÈ MühÉïlÉÉxÉÉÍ¤ÉqÉSïlÉÈ || uÉÉ. E. 8/19-20

eÉÉrÉiÉå iÉålÉ iÉ³Éå§ÉÇ MühQÒûUÇ cÉ x§ÉuÉålqÉÑWÒû: |

ÍzÉzÉÑ: MÑürÉÉïssÉsÉÉOûÉÍ¤ÉMühPûlÉÉxÉÉuÉbÉwÉïhÉqÉ ||

zÉ£üÉå lÉÉMïümÉëpÉÉÇSì¹ÒÇ lÉ uÉiqÉÉåïlqÉÏsÉlÉ¤ÉqÉ: | rÉÉå. U. oÉÉsÉUÉåaÉÉÍkÉMüÉU

Clinical Features:

The child suffering from Kukunaka may have

following features-

1. lÉå§Éå MühQÒûrÉiÉåÅpÉÏ¤hÉÇ - Excessive itching of eyes

2. sÉsÉÉOûqÉÍ¤ÉMÑüOÇû cÉ lÉÉxÉÉÇ cÉ mÉËUqÉSïÌiÉ - The child rubs

eye balls, nose & forehead area

3. xÉ mÉëMüÉzÉÇ lÉ xÉWûiÉå - Photophobia

4. ApÉÏ¤hÉÇx§ÉÇ xÉëuÉiÉå - Excessive lacrimation

5. uÉiqÉïÌlÉ µÉrÉjÉÑ - Swelling of eyelids

6. lÉ uÉiqÉÉåïlqÉÏsÉlÉ¤ÉqÉ: - Pain & heaviness in eye lids.

Sadhyasadhytva:

All the types of Kukunaka are curable by medicine. All

Acharya have mentioned medicinal treatment for

Kukunaka.

Samprapti of Kukunaka:

Samanya Samprapati – Pathogenesis of eye

diseases –

Samprapati can be explained as pathological changes

evoked by etiological factors, leading to manifestation

of sign and symptoms of diseases.

ÍxÉUÉÅlÉÑxÉÉËUÍpÉSÉåïwÉãÌuÉïaÉÑhÉãÂkuÉïqÉÉaÉiÉã: |

eÉÉrÉliÉå lÉå§ÉpÉÉaÉåwÉÑ UÉåaÉÉ: mÉUqÉSÉÂhÉÉ: | xÉÑ. E. 1/20-21

The vitiated doshas, as they course through the

vessels and reach upward, produces excessively

formidable diseases in different parts of the eye.

mÉëSÒ¹SÉåwÉxÉÇ iÉÑ rÉSÉ ÌmÉoÉÌiÉ SÉUMüÈ ||

sÉuÉhÉÉqsÉÌlÉwÉåÌuÉiuÉÉlqÉÉiÉÉmÉÑ§ÉÉã UxÉÉÌSWû |

AÉWûÉUSÉåwÉÉ¨ÉxrÉÉxiÉÑ oÉÉsÉÉxrÉÉlÉ³ÉpÉÉåÎeÉlÉÈ ||

AlÉÑmÉëuÉåzÉÉSÉ¤ÉåmÉÉSÒwhÉxÉiuÉÉuÉlÉÉSÌmÉ |

eÉÉrÉiÉå lÉrÉlÉurÉÉÍkÉÈ zsÉåwqÉsÉÉåÌWûiÉxÉÇpÉuÉÈ || MüÉ. ÎZÉ. 13/6-8

When the breast milk vitiated by doshas & also due to

consumption of salty & sour rasas by mother is

consumed by the infant, the abnormalities caused by

her diet enter the child who is totally dependent on

her milk. Then by action of throwing/ convulsing,

being of hot character & also due to desire (of god)

the disease of eye due to kapha & rakta develops.

The description given by other authors is very short.

Sushruta & Vagbhata accepts that Kukunaka (acute

conjunctivitis) develops to the children. Sushruta says

that it is caused due to ingestion of breast milk

vitiated by kapha, vata, pitta, & rakta while Vagbhata

say that the disease is due to eruption of teeth.

Chikitsa of Kukunaka:

Kashyapa extensively described about treatment of

Kukunaka.

Measures to be applied on Dhatri –

iÉxrÉ ÍcÉÌMüÎixÉiÉÇ ´Éå¸Ç urÉÉZrÉÉxrÉÉÍqÉ rÉjÉÉ iÉjÉÉ |

kÉÉ§ÉÏÇ iÉÑ iÉxrÉ uÉÉqÉrÉåiÉ cÉãuÉ ÌuÉmÉÉcÉrÉåiÉ ||

iÉxrÉÉ uÉÉliÉÌuÉËU£ürÉÉ ÌlÉSÒï½ cÉ xiÉlÉÉuÉÑpÉÉã |

pÉÉåeÉlÉÉÌlÉ cÉ xÉuÉÉïÍhÉ rÉjÉÉrÉÑ£Çü mÉëSÉmÉrÉåiÉ ||

mÉjrÉÇ pÉÑÇeÉÏiÉ ZÉÉSåiÉ ÌuÉmÉËUiÉÇ cÉ uÉerÉïrÉåiÉ |

mÉërÉiÉÉ zÉÑkSuÉx§ÉÉ xrÉÉSÎYsÉ¹ÉÅqÉÍsÉlÉÉ iÉjÉÉ || MüÉ. xÉÇ. ÎZÉ. 13

Dhatri of affected child should be given emetics.

MÑü‚ÔühÉå ZÉÌSU´Éå¸É ÌlÉqoÉmÉ§ÉãÈ zÉ×iÉÇ bÉ×iÉÇ |

mÉÏiuÉÉ kÉÉ§ÉÏ uÉqÉåiM×üwhÉÉrÉ¹Ï xÉwÉïmÉxÉãlkÉuÉãÈ || uÉÉ. E 9/24

After performing emesis & purgation properly,

her breast milk should be expressed out and she

should be advised to take congenial diet.

Vagbhata advised medicated ghrita for dhatri.

Breasts should be pasted with Haridra, Pippali,

Nagarmotha & fumigated with ghrita & sarsapa.

Dhatri should remain clean. It may provide

further spread to other children.

Measures applicable to child –

Eyes of the children should be washed with water

very thoroughly, after expressing out impure

blood from the lids. This process may help in

relieving the congestion.

After performing above procedures, drugs are

applied in the eyes through Parisheka,

Aaschotana and application of Lepas & Vartis.

Expression of impure blood using Jalauka, madhu

& trikatu pratisaran. And treatment to Dhatri.

iÉxrÉÉWûUåS ÂÍkÉUqÉÉzÉÑ ÌuÉÌlÉÍsÉïZÉåŠ|

¤ÉÉæSìÉrÉÑiÉåÈ MüOÒûÍpÉÈ mÉëÌiÉxÉÉUrÉå¨ÉÑ

qÉÉiÉÑÈ ÍzÉzÉÉåUÍpÉÌWûiÉÇ cÉ ÌuÉÍkÉÇ ÌuÉSkrÉÉiÉ || xÉÑ. E. 19/10

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Instillation of medicated ghrita.

AÉ¶rÉÉåiÉlÉå cÉ ÌWûiÉqÉ§É bÉ×iÉÇ aÉÑQÒûcÉÏÍxÉkSÇ iÉjÉÉÅÅWÒûUÌmÉ cÉ

Ì§ÉTüsÉÉÌuÉmÉYuÉqÉ ÿ xÉÑ. E. 19/13

Instillation of Triphala Ghrita or Guduchi Ghrita.

Pratisaran:

Ì²ÌlÉzÉÉUÉåkÉërÉwšÉuWûUÉåÌWûhÉÏÌlÉqoÉmÉssÉuÉãÈ |

MÑüMÑühÉMåü ÌWûiÉÉ uÉÌiÉïÈ ÌmÉ¹ãxiÉÉqÉëUeÉÉåÎluÉiÉãÈ ||

Í¤ÉU¤ÉÉãSìbÉ×iÉÉåmÉåiÉÇ SakÉÇ uÉÉ sÉÉåWûeÉÇ UeÉÈ | uÉÉ. E. 9/32

Modern Literature:

Ophthalmia Neonatorum

Introduction-

Ophthalmia Neonatorum i.e conjunctivitis in

newborns is inflammation of surface or covering of

the eye. Eye infection in 1st month of life, as a result

of carelessness at the time of birth can be classified as

Ophthalmia neonatorum.

Epidemiology –

It affects 1-2% newborns in western white, while

23% are affected in developing countries.

Predisposing factors –

Organisms in vagina shed during delivery

PROM

Prolonged delivery

Few tears & low levels of IgA.

Trauma to epithelial barrier.

Prophylaxis (silver nitrate , antibiotics)

Causative factors of Ophthalmia Neonatorum:

Causes of Ophthalmia Neonatorum are infectious or

non-infectious in origin.

1. Infections –

Most common types of bacteria that cause

infection in infant’s eye come from mother’s birth

canal, passed to infant during delivery. These

infections can include:

STDs- if untreated many of these infections can

cause serious damage to infant’s eye.

Chlamadia trachomatis – most common in vagi-

nally transmitted diseases.

Neisseria gonorrohae – is rare now-a-days, but it

is the most serious.

Staphylococcus aureus

Streptococcus pneumonia

Herpes simplex – less oftnely.

Risk factors- The biggest risk factor is maternal

infection or STD at the time of delivery. Mother may

not have any symptom during delivery & still be able

to transmit the infection.

2. Non infectious –

It is due to irritation in eye. It is due to reaction to

chemical irritants like silver nitrate.

It is a self limiting condition lasting no more than

24-36 hrs. It can be distinguished from infectious

conjunctivitis.

The cases of chemical conjunctivitis are

decreasing as silver nitrate prophylaxis is being

replaced by other agents, which in turn have

reduced the incidence of gonoccocal

conjunctivitis.

Clinical features –

Most common symptoms of Ophthalmia Neonatorum

are thick & pus like discharge from eyes, redness &

swelling of conjunctiva, and swollen eyelids. The dis-

charge may be purulent, mucopurulant or mucoid

from one or both eyes.

Bacterial conjunctivitis – depending upon pathogen,

there may be mixed picture of red eye with lid swell-

ing, & varying amount of purulent discharge.

A. Chlamydial infection –

Commonest infectious cause. Infants whose mothers have untreated

chlamydial infections antepartum have 30-40%

chances of developing chlamydial neonatal

conjunctivitis. In addition 10-20% of these children develop

pneumonia related to Chlamydia. Perinatal chlamydial infection may also cause

localized infection in nasopharynx, middle ear,

vagina and rectum. It affects in 5-14 days after birth. Unilateral or bilateral watery discharge which

becomes copious & purulent later on. There may be associated pre-septal cellulitis, and

less commonly rhinitis, otitis.

31

Sr. No. Aetiology Manifestation 1. Chemicals In Hours

(Antibiotic, Detergent) 2. Gonoccocal 1-3 Days 3. (Other) Bacterial 4-5 Days 4. Chlamydial 5-10 Days

Table No. 1: Causative factors and their manifestations




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B. Gonorrheal infection –

Occurs typically 1-5 days after birth, but may

occur later. Hyperacute conjunctival infection & chemosis, lid

oedema, severe purulent discharge. There may be associated corneal ulceration &

perforation.

C. Viral conjunctivitis –

Acute onset.

1-14 days after birth.

Unilateral/bilateral serosanguinous discharge

with/without vesicular skin lesions.

Other ocular features include –keratitis, uveitis,

cataract and retinitis.

Uncommonly systemic infections can cause

jaundice, hepato-spleenomegaly, pneumonitis

Prevention –

Antibiotic eye ointment given to the infant after

birth.

Treating the mother for any STDs prior to labour

& delivery.

A caesarean section for mother with active geni-

tal herpes lesions.

Investigations -

History of previous or concurrent STD in mother

& results of any cervical cultures obtained during

pregnancy.

Ocular examination- penlight & fluorescein

examination.

Microbiological- conjunctival swb culture.

Mother – cervical swab for gonorrhoea, Chlamy-

dia & viral infection.

Treatment:

Since the potential for serious eye damage to the

infant is so great, its standard treatment is to give the

infant antibiotic eye drop right after birth. This helps

to prevent the development of infection.

Bacterial infection-

The infants are given antibiotic topical drops/

ointment like gentamicin eye drop. Eye wash is given

to remove discharge. Treatment should be guided by

organism grown in culture. Antibiotic treatment is

very effective and infection resolves quickly.

I. Chlamydial infection –

10% sulfacetamide drop – 4 times daily.

1% tetracycline ointment 2 times daily

Oral erythromycin syrup (50 mg/kg/day qds)

for 14 days.

II. Gonnorheal –

Babies need hospitalization & evaluation for

disseminated disease.

They should receive Ceftriaxone 25-50mg/kg

IV/IM single dose or Cefotaxim 100mg/kg IV/

IM single dose.

Attention should be paid if –

Red conjunctiva,

Sudden & severe onset

Baby is distressed or unwell

Both eyes are affected

Possibility of maternal infection.

In this case prior to results from gram staining it is

appropriate to start with broad spectrum antibiotic.

e. g.: Ofloxocin 0.3% qds for a week.

Chemical conjunctivitis – Ophthalmia Neonatorum

due to irritation usually improves of its own. No

treatment is required although some favour use of

preservative free artificial tears.

Prophylaxis –

Proper antenatal care of mother & any vaginal

discharge should be treated meticulously –

The shedding of some micro organisms from cervix

during 3rd trimester is well documented. e. g. – 7-

20% of women shed CMV12% shed Chlamydia.

Some women shed herpes simplex virus (HSV 2)

during pregnancy even in absence of typical genital

lesions.

If the screening of all pregnant women can not be

accomplished, the WHO has suggested screening

women at high risk for delivering a baby who could

develop neonatal conjunctivitis.

Asepsis & care are to be maintained to protect eye

during delivery

Sulfaceyamide (10%), framycetin, or norfloxacin

eye drop 4 times daily for 7-10 days is advised

following birth.

Crede’s prophylaxis – 1 drop of 1% silver nitrate

is instilled into the eyes of the baby, just after the

birth. It should never be stronger than 1% -

otherwise corneal opacity may result.

Crede’s prophylaxis was used earlier to prevent

gonococcal ophthalmia, which is very rare now-a-

days.

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CONCLUSION:

Neonatal period is initiation of life. A neonate is fully

dependent on mother and is prone for many diseases

due to negligence as well as due to immaturity

(Apakvdhatu)

Ophthalmia neonatorum is conjunctivitis of newborns

occuring during 1st month of life.

In Ayurveda, Acharyas have described it as Kukunaka.

Acharya Sushruta have described 76 types of

netraroga which are observed in adults as well as in

children. But Kukunaka affects only children hence

not included in netraroga.

While Vagbhata included Kukunaka in Vartmagata

vyadhi (disorder of eyelids) and described it as a

disorder of dentition.

Eyes are source of direct knowledge. It is a guide for

right and wrong deeds. Hence, it is important to

prevent a baby from such diseases.

REFERENCES:

[1] Dr. Pandit Hemraj Sharma, Kashyap Samhita,

Chaukhamba Sanskrit Sansthan Varanasi, 2008.

[2] Yadavaji Trikamaji Achyarya, Charak Samhita,

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Cite this article as:

Kalyani P. Aher, Gajanan A. Cheke, Conceptual study

of Kukunaka with special reference to Ophthalmia

Neonatorum in Neonates, ADJIM 2019: 4(4), p. 28-33.

33





adjim, oct -dec 2019; vol. 4 issue 4 issn(online): 2455 ... · literature review of the topic is...

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