Dry Eye Syndrome: A Comprehensive Review of Shushkakshipaka in Ayurvedic and Modern Perspective

Shushkakshipaka has been elaborately described by ancient Ayurvedic scholars, reflecting its clinical significance through detailed explanations of etiology, symptomatology, prognosis, and management in classical Samhitas. Ayurveda considers Shushkakshipaka a curable condition when managed with appropriate therapeutic interventions. A critical analysis of classical descriptions reveals a close resemblance between Shushkakshipaka and Dry Eye Syndrome (DES), a contemporary ocular surface disorder with increasing global prevalence. Dry Eye Disease (DED) is a multifactorial condition characterized by tear film instability, ocular discomfort, visual disturbance, and fatigue, significantly affecting quality of life, occupational efficiency, and psychosocial well-being. Among its subtypes, evaporative dry eye is the most prevalent form. Current conventional management of DED largely focuses on symptomatic relief through artificial tear substitutes; however, these measures often fail to address the underlying inflammatory pathology of the disease. In contrast, Ayurvedic management of Shushkakshipaka emphasizes therapeutic procedures such as Tarpana, Seka, Aschyotana, and Anjana, which aim to restore ocular lubrication, stabilize the tear film, and improve ocular surface health. Dry Eye Syndrome, also known as keratoconjunctivitis sicca, arises due to decreased tear secretion or excessive tear evaporation and presents with diverse clinical manifestations. Multiple physiological systems contribute to the integrity of the ocular surface, and disruption of these mechanisms may or may not produce overt symptoms, making accurate diagnosis essential. This comprehensive review critically compiles and correlates Ayurvedic and modern literature regarding the types, etiology, pathophysiology, diagnostic approaches, and management strategies of Shushkakshipaka and Dry Eye Disease, with special emphasis on evaporative dry eye. Additionally, recent advances in diagnostic techniques, drug delivery systems, and emerging therapeutic challenges are discussed to provide a holistic understanding for clinicians, researchers, and healthcare professionals.