bubble_chart Concept

Drooping pannus (trachomatous pannus) refers to the condition where small blood vessels appear at the upper edge of the black of the eye, gradually developing into a red membrane that extends downward, covering the pupil and even obscuring the black of the eye.

In its early stages, red vessels descend from the white of the eye along the upper edge of the black of the eye, sparse and fine, and are referred to as "drooping pannus (trachomatous pannus)" (from "Ophthalmology Essence Record"). As the red vessels increase in number and thicken into a membrane, it is still called "drooping pannus (trachomatous pannus)." In Michuan Yanke Longmu Lun, it is referred to as "eye drooping pannus (trachomatous pannus) external ophthalmopathy." Due to its appearance resembling a hanging curtain, it is also known as "hanging curtain nebula" or "hanging curtain membrane." Over time, the red membrane thickens, resembling red flesh, and invades from all sides, completely covering the black of the eye, a condition known as "pannus covering cornea (keratic pannus)" (Yinhai Jingwei). Therefore, this section discusses both "drooping pannus (trachomatous pannus)" and "pannus covering cornea (keratic pannus)" together.

bubble_chart Pattern Analysis

1. Spleen and Lung Heat Accumulation︰The inner surface of the eyelid is covered with millet sores (conjunctival folliculitis) and prickly-ash-like sores (trachoma). The white of the eye shows red streaks and vessels that extend downward to the upper border of the black of the eye. Symptoms include itching, dryness, redness, pain, and thick yellow eye discharge. There is also a bitter taste in the mouth, dry throat, dry stool, a yellow and greasy tongue coating, and a slippery, rapid pulse. This condition is often caused by dietary irregularities, excessive consumption of spicy and rich foods, leading to accumulated heat in the spleen and stomach. The eyelid belongs to the spleen, and the white of the eye belongs to the lung. When spleen heat steams the lung collaterals, millet sores (conjunctival folliculitis) and prickly-ash-like sores (trachoma) proliferate on the inner eyelid, irritating the eyeball and causing red streaks in the white of the eye that extend to the upper part of the black of the eye. This results in eye itching, dryness, redness, pain, and yellow discharge. The body fluids are scorched, leading to a bitter taste in the mouth, dry throat, dry stool, a red tongue with yellow and greasy coating, and a slippery, rapid pulse. Treatment should focus on clearing and draining spleen and lung heat. The recommended formula is Rhubarb and Angelica Powder. Once the accumulated heat subsides, nourishing yin and clearing heat should follow, using Unprocessed Rehmannia Root Yellow Powder to consolidate recovery. Since spleen heat affects the lung collaterals, eyelid millet sores (conjunctival folliculitis) involve the white of the eye, and the red streaks in the white of the eye extend downward to the black of the eye.
2. Liver-Lung Wind-Heat︰Hyperemia of the ocular conjunctiva, with engorged blood vessels clustering and thickening into a membrane, involving the upper part of the black of the eye, accompanied by gritty irritation, stabbing pain, burning sensation, tearing, heat intolerance, photophobia, excessive eye discharge, thin yellow tongue coating, and wiry rapid pulse. This is mostly caused by external contraction of wind-heat invading the lungs, leading to impaired lung dispersion and descent, with lingering pathogenic heat in the lungs. The white of the eye belongs to the lungs, and lung-heat ascending disturbs it, resulting in hyperemia of the ocular conjunctiva, dry eyes with stabbing pain, and excessive eye discharge. The black of the eye belongs to the liver, and when lung-heat accumulates and invades the liver collaterals, it leads to drooping pannus (trachomatous pannus), clustering into a membrane that spreads to the black of the eye. In severe cases, symptoms such as eye pain, tearing, and pronounced heat intolerance and photophobia may occur. The tongue coating is thin and yellow, and the pulse is wiry and rapid. Treatment should focus on clearing lung-heat and draining heat, cooling the liver to resolve nebula. The modified Guishao Honghua Powder is recommended. Since lung-heat affects the liver collaterals, the red vessels in the white of the eye extend to the black of the eye.
3. Exuberant Fire in Liver and Gallbladder︰The upper edge of the black of the eye exhibits red, thickened blood vessels forming a membrane. At the ends of these vessels, star-like nebulae appear, grayish-white and sunken, or crescent-shaped. In severe cases, they resemble blood nebulae formed by knotted tendons and red flesh, enveloping the black of the eye and obscuring the pupil. The canthus becomes tight and constricted, making it difficult to open the eyes. Symptoms include headache, facial redness, dysphoria, irritability, dry mouth, constipation, a red tongue with yellow and rough coating, and a wiry, rapid pulse. This condition often arises from the stagnation of the seven emotions, violent rage damaging the liver, or excessive liver-gallbladder fire attacking the seven orifices. When the eyes are affected, they become red, astringent, and photophobic, with thick, red membranes. Fire attacking the black of the eye leads to star-like nebulae at the ends of the vessels, grayish-white and sunken or crescent-shaped. In severe cases, they resemble knotted tendons and red flesh, enveloping the black of the eye and obscuring the pupil. The liver-gallbladder fire scorches the blood, failing to nourish the tendons, resulting in a tight and constricted canthus and difficulty opening the eyes. Internal disturbance by liver fire causes headache, facial redness, dysphoria, irritability, dry mouth, constipation, a red tongue with yellow and rough coating, and a wiry, rapid pulse. Since this condition stems from excess liver-gallbladder fire, the pain is more acute and severe than in the previous two syndromes. Treatment should focus on clearing the liver and draining fire, cooling the blood, and harmonizing the collaterals. Recommended formulas include Gentian Liver-Draining Decoction or Heart-Draining Decoction with additions such as Gentian, fried Gardenia, Tail of Chinese Angelica, Carthamus, and Moutan Bark.

Drooping pannus (trachomatous pannus) is a condition often seen clinically where heat and fire pathogens invade the eyes, causing the white of the eye to develop red streaks that form a membrane, which droops down to the black of the eye. This condition is closely related to the lungs, spleen, and liver. Treatment should primarily focus on clearing the liver and draining fire, while also addressing the accumulated heat in the lungs and spleen according to the symptoms, in order to be effective.

bubble_chart Documentation

1. Zhangshi Yitong．Seven Orifices Chapter: "Blood Nebula Covering the Eye Syndrome: This is due to heart channel fever and liver deficiency being invaded by pathogens, causing redness, swelling, pain, and tearing of the eyes, which frequently recur. Over time, the red vessels thicken and cover the black part of the eye. Take medicine to purge heart fire and break blood stasis, and cool the liver. Use blood-stasis-breaking medicine during pain, along with purgation using nitre and rhubarb."
2. Zhangshi Yitong．Seven Orifices Chapter: "Drooping Pannus (Trachomatous Pannus) Syndrome: Initially very thin, later becomes very large, with red vessels running through the white part of the eye and down, a patch of obstruction near the upper half of the black part of the eye close to the white part, still with red threads pulling and hindering. If the obstruction is large and the threads are thick, with redness, tearing, and astringent pain, and the eyeball hurts with headache, the disease is acute and may change. If the threads are fine and small, slightly red, and the eyeball does not hurt, and there is no headache, the condition is slow and has not changed. ... If there are threads and stars on the obstruction growing at the tips of the threads, these are signs of delayed recovery. If the nebula is thin and the threads are not very red, just use good dispersing methods; in severe cases, it is necessary to open and guide. ... Mild cases can be dispersed, severe cases need to be opened and guided, this is the fixed method. Take Shen Xiao San internally, remove Er Tui, and add Chinese Honeylocust Fruit and Abalone Shell. Apply Jiang Xue Gao externally. Then use Chinese Honeylocust Fruit pills."