E-ISSN:2456-3110

Case Report

Shushkakshipaka

Journal of Ayurveda and Integrated Medical Sciences

2022 Volume 7 Number 5 June
Publisherwww.maharshicharaka.in

Management of Shushkakshipaka w.s.r. to Dry Eye Syndrome - A Single Case Study

Premcy C.1*
DOI:

1* C R Premcy, Assistant Professor, Dept of Shalakya Tantra, Vaidyaratnam Ayurveda College, Ollur, Thrissur, Kerala, India.

Introduction: Shushkakshipaka is a Sarvagatha Netra Roga characterised by Daruna Ruksksha Varthma, Avila Darshanam. Tears are clear liquid which keep the eyes wet, smooth, lubricant and help to see clearly by focusing the light. Dry eye syndrome is a condition when the tears aren’t able to provide adequate lubrication for eyes. Shushkakshipaka can be correlated with dry eye syndrome. Materials and Method: This is a case report of 42 years old woman who approached Shalakya Tantra eye OPD of Vaidyaratnam Ayurveda College, Ollur with feeling of dryness on both eyes associated with blurring of vision, redness of eyes and head ache since 2 months. The subject was thoroughly examined and diagnosed as Shushkakshipaka. The treatment was planned according to the Chikitsa Sutra of Shushkakshipaka. The subject was treated with Virechana, Nasya, Kriyakalpa and Shamanoushadhis. Result: The subject had shown good improvement both subjectively and objectively. Discussion: The conventional and effective treatment of dry eye are artificial tear drops and lubricants which gives a temporary relief from the symptoms. Here the Ayurvedic treatment are adopted which are effective and not having side effects.

Keywords: Shushkakshipaka, Dry eye syndrome, Kriyakalpa, Shamanoushadhis, Case Report

Corresponding Author How to Cite this Article To Browse
C R Premcy, Assistant Professor, Dept of Shalakya Tantra, Vaidyaratnam Ayurveda College, Ollur, Thrissur, Kerala, India.
Email: 		C R Premcy, Management of Shushkakshipaka w.s.r. to Dry Eye Syndrome - A Single Case Study. J Ayu Int Med Sci. 2022;7(5):171-174.
Available From
https://jaims.in/jaims/article/view/1965

Manuscript Received Review Round 1 Review Round 2 Review Round 3 Accepted
2022-05-03 2022-05-05 2022-05-12 2022-05-19 2022-05-26
Conflict of Interest Funding Ethical Approval Plagiarism X-checker Note
Nil Nil Yes 16%

© 2022by C R Premcyand Published by Maharshi Charaka Ayurveda Organization. This is an Open Access article licensed under a Creative Commons Attribution 4.0 International License https://creativecommons.org/licenses/by/4.0/ unported [CC BY 4.0].

Journal of Ayurveda and Integrated Medical Sciences 2022;7(5)171
Premcy C: Management of Shushkakshipaka w.s.r. to Dry Eye Syndrome

Introduction

Dry eye is a multifactorial disease of the ocular surface characterised by a loss of homeostasis of the tear film, and accompanied by ocular symptoms, in which tear film instability and hyper osmolarity, ocular surface inflammation and damage, and neurosensory abnormalities play etiological roles.[1]

Main causes of dry eye include certain diseases such as Rheumatoid arthritis, Sjogren’s syndrome, Thyroid diseases and Lupus, Entropion and Ectropion, Blepharitis, Increased screen time at computer or mobile, using contact lenses for long time, being in smoke, wind or very dry climate, taking certain medicines such as diuretics, beta blockers etc.[2]

Etiologically it is divided into aqueous deficiency dry eye and evaporative dry eye.[3]

Causes of aqueous deficiency dry eye includes Sjogren’s syndrome and non Sjogren’s syndrome. Causes of evaporative dry eye includes Meibomian gland dysfunction, evaporative any eye disorders like Lagophthalmus, defective blinking during increased screen time and ocular surface related diseases such as vitamin A deficiency, contact lens uses. It is managed by tear substitutes and treatment of causative diseases.

In extreme condition transplantation of Submandibular gland can be done.

Shushkakshipaka is a Vatapithaja Sarvagatha Netra Roga. In this condition eyelid found drooping, hard and dry, vision is turbid, very difficult to open the eyes.[4]

Hence the treatment principle adopted here are the treatments told in Shushkashipaka with some Kriyakalpa which reduces the Vata Pitta Doshas. i.e., Virechana, Nasya, Tarpana, Aschothana, Seka and Vidalaka.

Case Report

A female aged 42 years consulted Shalakya Tantra OPD of Vaidyarathnam Ayurveda College, Thaikkattussery on 24/5/2022 complaining of feeling of dryness on both eyes since 2 months. She also complaints of redness of eyes, frontal head ache and blurring of vision since 6 months.


History of Present Illness

The subject was apparently normal 2 months ago and she gradually developed dryness of bilateral eyes. It was associated with redness of eyes, frontal head ache and blurring of vision for both eyes. But gradually the severity of dryness increased and she approached shalakya tantra OPD of Vaidyarathnam Ayurveda College, Thaikkattussery.

History of Past Illness

No history of systemic diseases like asthma, hypertension, diabetes. No history of diseases like Sjogren’s syndrome, Lagophthalmus, Meibomian gland dysfunction etc. No history of any surgery.

Family history

Nothing significant.

Personal history

  • Bowel: Regular
  • Appetite: Good
  • Micturition: 4-6 times/day
  • Sleep: Sound

Ashtasthana Pareeksha

  • Nadi: 78/min
  • Mutra: 4-5times/day
  • Mala: Regular
  • Jihwa: Aliptha
  • Shabda: Prakrutha
  • Sparsha: Anushna Sheetha
  • Druk: Vikrutha
  • Akruthi: Krusha

Vitals

  • Pulse rate: 78/min
  • Respiratory rate: 24/min
  • Temp: 98.60 F
  • BP: 120/80mm of Hg

Systemic examinations

All the systemic examinations revealed no abnormalities.

Ophthalmic examinations

Slit lamp examinations explained in Table no: 1



Journal of Ayurveda and Integrated Medical Sciences 2022;7(5)172
Premcy C: Management of Shushkakshipaka w.s.r. to Dry Eye Syndrome

Table 1: Slit lamp examination

Ocular Structures Right Eye Left Eye
Eye brow No abnormalities detected No abnormalities detected
Eyel lashes No abnormalities detected No abnormalities detected
Eye lid No abnormalities detected No abnormalities detected
Conjunctiva Congestion present Congestion present
Sclera No abnormalities detected No abnormalities detected
Cornea No abnormalities detected No abnormalities detected
Anterior chamber No abnormalities detected No abnormalities detected
Pupil Round, Regular, Reactive Round, Regular, Reactive
Lens No abnormalities detected No abnormalities detected
IOP Normal Normal

Visual acuity explained in Table no: 2

Table 2: Visual acuity

Visual acuity Without spectacles With spectacles
BE OD OS OD OS BE
Distant vision 6/24 6/24 6/24 6/12 6/9 6/6
Near vision N18 N24 N24 N8 N10 N8

Schirmer’s test - before treatment shown in table no: 3

Table 3: Schirmer’s test - Before treatment

Schirmer’s test – Before treatment
OD 6mm
OS 5mm

Diagnosis: Shushkakshipaka.

Treatment

1. Ama Pachana with Vaishwanara Churana 1 tsp before food at night for 3 days

2. Snehapana with Jeevanthyadi Ghrutha for 3 days at the dosage of 30ml, 60ml, and 90ml respectively.

3. Virechana with

4. Nasya with Anuthaila 8 drops in each nostrils for 7 days.

5. Tarpana with Jeevanthyadi Ghrutha[5] for 5 days.

6. Seka with Yashtimadhu Ksheerapaka for 14 days

7. Vidalaka with Yashtimadhu Churna with Ghrutha for 14 days

8. Internal medicines

  • Drakshadi Kashayam[6] 15ml BD with 60ml luke warm water.
  • Kaishora Guggulu[7] 1 BD with Kashaya.
  • Sapthamrutha Loha[8] 2 tablet with honey and ghee at night.
  • Avipathi Churna[9] 1/2 tsp with luke warm water.

Results

Total treatment duration was 22 days, subject showed improvement both subjectively and objectively. After treatment Schirmer’s test[10] result are shown in table no: 4. After treatment Visual acuity are shown in table no: 5.

Table 4: Schirmer’s test - After treatment

Schirmer’s test – After treatment
OD 30mm
OS 30mm

Table 5: After treatment Visual acuity test

Visual acuity test Without spectacles
BE OD OS
Distant vision 6/12 6/12 6/12
Near vision N6 N6 N6(P)

Discussion

The present case was Shushkakshipaka and the aim of treatment was to achieve Vata Pithahara and Brumhana action through proper Shodhana, Shamana Chikitsa and certain Kriyakalpas.

Mode of action of treatments

Vaishwanara Churna was given at first for the Pachana of Amadosha prior to Snehapana. Jeevanthyadi Ghrutha is selected for the Snehapana. Even though it was given for bringing Doshas to Koshta it acts as Brumhana also. Then Virechana was given with Avipathi Churna. Avipathi Churna is specially indicated in Pitharoga. It contains Sitha as a major content. So, it can reduce Vatha Dosha also along with Pitha Dosha. Sushkakshipaka is a Vatha Pithaja Saravagatha Netra Roga.[11] After Kaya Shodhana Urdhwa Shodhana was planned with Anuthaila. Anuthaila Nasya is indicted in the Shushkakshipaka and Urdhwa Jathrugatha Vikaras.

After Urdhwashodhana, Tarpana with Jeevantnyadi Ghrutha was adopted for 5 days. Dry eye is a ocular surface disease and by doing Tarpana the medicines directly coming contact with ocular surface and there by easy absorption of medicine occurs. Here, the selected medicine is Jeevanthyadi Ghrutha. It contains drugs like Jeevanthi, Prapoundareeka, Kakaoli, Sitha, Ksheera, Madhuka, Draksha which


Journal of Ayurveda and Integrated Medical Sciences 2022;7(5)173
Premcy C: Management of Shushkakshipaka w.s.r. to Dry Eye Syndrome

are having Vatha Pithahara and Brumhana action. It contains Thriphala also which is a Chakshushya Dravya. Lodhra has Seetha Veerya and it reduces Pitha Dosha. Thus, it helps to increase the moisture content of ocular surface and repair the tissue damage occurred due to excessive evaporation.

Seka was selected for Sthanika Brumhana. Here, the formulation used are Yashtimadhu Ksheerapaka. Madhuka is a Chakshushya Dravya and Vatha Pittahara in action. Yashti in Ksheerapaka form helps the tear film to maintain the homeostasis by providing lipids and aqueous. Vidalaka was done with Yashti Churna mixed with Ghrutha. This helps to increase the Snehamsha of Netra and mitigating Vatha and Pitha Dosha.

Drakashadi Kashayam is used because it is having Anila Pithahara Karma. Kaishora Guggulu contains Thriphala which is Chakshushya and Guduchi acts as anti-inflammatory. Thus, it helps to reduce the inflammation and damage of ocular surface. Sapthamrutha Loha contains Ghrutha, Thriphala and Madhuka. They are Netrya and Pithanilahara. Since, it is indicated for Timira, it helps to reduce the Aviladarshana present in the Shushkakshipaka.

Conclusion

Tear film has three layers mucous, aqueous and lipid layer produced by goblet cells, Lacrimal gland and Meibomian gland respectively. In dry eye, homeostasis of this layer is lost due to different reasons. In Ayurveda, Netra Snehamsha is the Mala of Majja Dhadhu. So, Snehana and Brumhana line of treatment is essential for increasing the Snehamsha. Thus, it helps to maintain the homeostasis of tear film and improve the vision by rejuvenating the damaged and inflamed ocular surface and stabilising the tear film.

Reference

1. Jun Shimazaki. Definition and Diagnostic Criteria of Dry Eye Disease: Historical Overview and Future Directions. Investigative Ophthalmology and Visual Science.Volume59. Issue14. 2018 (November). page1-6.

2. https://www.aao.org/eye-health/diseases/what-is-dry-eye

3. Khurana A K. Comprehensive Ophthalmology. Jaypee Brothers Medical Publishers (P) ltd. New Delhi. Edition 7. 2019. pp 406.

4. Sushrutha. Sushrutha Samhitha. English Translation by K.R. Srikantha Murthy. Chaukhambha Orientalia.Varanasi.Uttara Tantra 2008.Edition 3.6:26

5. K.V.Krishnan Vaidyan, S. Gopala Pillai. Sahasrayogam. Vidyarambham Publishers. Alappuzha. 2006. Edition26. Ghruthayogam 45. pp332.

6. K.V.Krishnan Vaidyan, S. Gopala Pillai. Sahasrayogam.Vidyarambham Publishers. Alappuzha. 2006. Edition 26. Kashayayogam 10. pp29.

7. Brahmashankar Mishra, Govinda Das. English Translation by Kanjiv Lochan. Bhaishajyaratnavali. Chaukhambha Sanskrit Sansthan. Varanasi. 2009; 27; 98-108.

8. Brahmashankar Mishra, Govinda Das. English Translation by Kanjiv Lochan. Bhaishajyaratnavali. Chaukhambha Sanskrit Sansthan. Varanasi. 2009; 29; 130-131.

9. K.V.Krishnan Vaidyan, S. Gopala Pillai. Vidyarambham Publishers.Alappuzha. 2006. Edition26.Churnayogam7. pp165.

10. Jack J.Kanski. Clinical Ophthalmology A Systemic Approach. BH Publication.3:60

11. Vagbata. Ashtanga Hrudaya. English Translation by K.R.Srikantha Murthy. Chaukhambha Krishnadas Academy. Oriental Publishers. Varanasi. Uttara Tantra. Edition: Reprint 2008.15.16. pp140.


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