Management of Traumatic Optic Atrophy through Ayurveda - A Case Report

C R Premcy

Management of Traumatic Optic Atrophy through Ayurveda - A Case Report

Premcy C.^1*

DOI:

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

Introduction: Optic nerve atrophy refers to the death of the retinal ganglion cell axons that comprise optic nerve, which can adversely affect the central vision, peripheral vision and colour vision. Materials and Methods: This is a case report of 35 years old gentle man who approached OPD of Vaidyaratnam Ayurveda College, Ollur with signs and symptoms of traumatic optic atrophy in right eye since 6 years and he was totally blind in left eye since his 10 years of age. He was treated with Brumhana, Nadibalya and Rasyana line of treatment which is mentioned in the classics. i.e., Akshi Tarpana, Nasya, Chakshushya Vasthi, Taila Dhara and Shamanoushadhis. Result: The subject had shown marked improvement subjectively and in diagnostic test also. Discussion: Unfortunately there is no treatment to reverse optic atrophy in conventional medicine; however, limiting further optic nerve damage is the goal. Here the Ayurvedic treatments are adopted to restore the vision loss occurred in traumatic optic atrophy.

Keywords: Traumatic optic atrophy, Nasya, Akshitarpana, Chakshushya Vasthi, 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 Traumatic Optic Atrophy through Ayurveda - A Case Report. J Ayu Int Med Sci. 2022;7(6):213-218. Available From https://jaims.in/jaims/article/view/1966

Introduction

Optic atrophy refers to degeneration of the optic nerve, which occurs as an end result of any pathologic process that damages axons in the anterior visual system, i.e., from retinal ganglion cells to the lateral geniculate body.^[1] It is a serious condition can cause problems with vision like central vision loss, peripheral vision loss and colour blindness.

It usually occurs in individuals between 10-50 years of age. The common causes of optic atrophy are hereditary, trauma, tumour, decreased blood supply, glaucoma, optic neuritis, multiple sclerosis, toxic and nutritional optic neuropathies etc. Main symptoms of optic atrophy are blurred vision, loss of vision, usually of long duration, which initially started as a sudden loss of vision.^[2]

Optic atrophy may broadly be divided into primary and secondary. Primary optic atrophy results from degeneration of optic nerve fibers without any complicating process. Secondary optic atrophy is characterised by some evidences of past neuritis or papilledema. Ophthalmoscopic types of optic atrophy are Consecutive optic atrophy, Glaucomatous optic atrophy, Vascular atrophy, Post neuritic optic atrophy, Cavernous optic atrophy and Traumatic optic atrophy.^[3] Consecutive optic atrophy follows the posterior segment diseases of the eye as in the later stage of Retinitis Pigmentosa. Glaucomatous optic atrophy characterised by the very prominent cup. Vascular atrophy occurs due to the decreased blood supply to vessels. Cavernous optic atrophy is not associated with proliferation of neuroglial cells. Traumatic optic atrophy occurs due to mechanical trauma. In some cases there may not be any neuroradiological sign of avulsion, the optic nerve may be seen to be intact.^[4] The optic nerve head will appear normal initially, but optic atrophy can be seen 3-6 weeks after the initial traumatic event.^[5]

In total optic atrophy the pupils are dilated and immobile to light and the patient is blind, when unilateral the consensual reaction to light is exaggerated.^[6] In partial optic atrophy central vision is depressed and there is concentric contraction of the field, with or without scotoma, relative or absolute, according to the cause. Main clinical features includes loss of vision, semi dilated pupil with very sluggish and absent

direct light reflex, relative afferent pupillary defect, visual field loss.^[7] Ophthalmoscopic features of optic atrophy in general are pallor of optic disc and decrease the number of small blood vessels.

Once complete atrophy has set in, the vision cannot be recovered. No treatment is effective for optic atrophy;^[8] the prognosis depends on the possibility of controlling the causal factor. It may help to preserve the vision. Here comes the role of Ayurvedic treatment so as to improve the quality of life by improving the vision of patient. The subject was treated with Brumhana, Nadibalya and Rasyana line of treatment which is mentioned in the classics by considering the Kala or chronicity, Prakruthi and Lakshana of subject i.e., Akshi Tarpana, Nasya, Chakshushya Vasthi, Taila Dhara and Shamanoushadhis.

Case Report

A male aged years consulted Shalakya Tantra OPD of Vaidyarathnam Ayurveda College, Thaikkattussery complaining of blurring of vision in right eye since 6 years.

History of present illness: The subject was approached Vaidyarathnam Ayurveda College OPD with complaints of blurring of vision in right eye associated. His vision was totally lost in left eye since childhood. Vision in the right eye was apparently normal before 6 years. On 2016 he met a road traffic accident and hospitalised for one and half months. After discharge he was advised to take rest for 3 months. During this rest period he noticed blurring of vision in right eye for 5 mints duration. Gradually it increased and he was unable to do his daily activities correctly. He consulted an ophthalmologist and they diagnosed the condition as Traumatic Optic Atrophy. He took treatment from there, but there was no marked improvement. After 6 years of duration, he came to Shalakya Tantra OPD of Vaidyarathnam Ayurveda College and Hospital, Ollur for the same complaint.

Past history: History of motorbike accident before 6 years

Family history: Nothing significant.

Personal history

Bowel: once a day
Appetite: Good
Micturition: 4-5times/day

Sleep: sound

Ashtasthana Pareeksha

Nadi: 76/min
Mutra: 4-5times/day
Mala: Regular
Jihwa: Aliptha
Shabda: Prakrutha
Sparsha: Anushna sheetha
Druk: Vikrutha
Akruthi: Krusha

Vitals

Pulse rate: 76/min
Respiratory rate: 20/min
Temp: 98.6°F
BP: 114/70mm of Hg

Systemic examinations: All the systemic examinations revealed no abnormalities.

Ophthalmic examinations: Slit lamp examinations explained in Table no: 1

Table 1: Slit lamp examinations

Ocular Structures	Right Eye	Left Eye
Eye brow	No abnormalities detected	No abnormalities detected
Eye lashes	No abnormalities detected	No abnormalities detected
Eye lid	No abnormalities detected	No abnormalities detected
Conjunctiva	No abnormalities detected	No abnormalities detected
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, Semi dilated, Sluggish reactive.	Round, Regular, Sluggish reactive
Lens	No abnormalities detected	No abnormalities detected
IOP	Normal	Normal

Visual acuity explained in Table no: 2

While doing visual acuity he was unable to see as normal. But he can see from right side of right eye. Because of that he tilted his head while checking Visual Acuity.

Table 2: Visual acuity

Visual acuity	OD	OS
Distant vision	6/12(P)	PR (+) in right lateral and inferior quadrant
Pin Hole	6/12(P)	_
Near vision	N10	_

Confrontation test: Only nasal superior quadrant was possible in right eye.

Examination of fundus

Findings explained in table no. 3

Table 3: Examination of fundus

On examination	Right eye
Media	Clear
Vessels	Thin
Macula	Greyish in colour
Foveal reflex	Absent
Optic disc	Pale, disc margins was blurred
Cup disc ratio	Cup disc margin was obliterated.

Investigations: Perimetry report of right eye is shown in figure no. 1

Figure 1: Perimetry report of right eye before treatment

Diagnosis: Traumatic optic atrophy

Treatment

1. Ama Pachana with Vaishwanara Churna 1 tsp at night for 3 days

2. Nasya with Jeevanthyadi Ghrutha^[9] 6 drops in each nostrils.

3. Tarpana with Jeevanthayadi Ghrutha for 5 days

4. Chakshushya Vasthi^[10] in the mode of Yoga Vasthi

5. Annalepa over eyes for 7 days

6. Shirodhara with Ksheerabala^[11] for 14 days

Internal medicines

1. Vidaryadi Kashayam^[12] 15ml BD with 60ml luke warm water before food.

2. Balarishtam and Ashwagandharishtam 25ml after food at after noon and night.

3. Sapthamrutha Louha^[13] 2 tablet at night with honey and ghee after food.

4. Ksheerabala soft gel cap 1 BD with Kashaya

5. Thriphala Ghrutha^[14] 1tsp at night

Results

Total treatment duration was 38 days, subject showed improvement both subjectively and objectively. Before and after treatment Perimetry results of right eye are shown in figure no 1 and 2 respectively. Before and after treatment Visual acuity results are shown in table no. 2 and 3 respectively.

Figure 2: Perimetry result of right eye after treatment

Table 3: Visual acuity after treatment

Visual acuity	OD	OS
Distant vision	6/12	PR (+) (subjective improvement)
Near vision	N10	_

Discussion

The present case was traumatic optic atrophy of right eye. The aim of treatment was to rejuvenate the damaged nerve fibres with Nadibalya, Brumhana and Rasayana line of treatment.

Mode of action of treatments

Amapachana was attained by giving Vaishwanara Churna. After that Brumhana Nasya was planned. Because the optic nerves got atrophic and degenerative changes due to trauma. To nourish the nerves the only way is Brumhana. Brumhana Nasya is indicated in Vataja Shoola, Nasa Shosha etc. conditions. In the present case also Shosha of optic nerves causes blurring of vision. And the medicine used for Nasya is Jeevantnyadi Ghrutha. It contains drugs like Jeevanthi, Prapoundareeka, Kakaoli, Sitha, Ksheera, Madhuka, Draksha, Ghrutha which are having Vathahara and Brumhana action. It contains Thriphala and Pippali. Both are having Rasayana karma and Triphala is considered as a Chakshushya Dravya. Thus, it helps to repair and nourish the damaged nerves.

Tarpana with Jeevantnyadi Ghrutha was adopted for 5 days. By doing Tarpana, fat soluble contents of drug absorbs through the cornea and it transports through the deeper tissues. Lipid contents of this Ghrutha helps in anaerobic oxidation which prevents from oxidative injuries and amino acids and protein contents provides strength to the nerves.^[15] Thus Balya, Rasayana and Chakshushya Karma of Ghrutha restore the blurred vision in the atrophic condition.

Chakshushya Vasthi was done in the mode of Yoga Vasthi. Anuvasana Vasthi was given with Thriphala Ghrutham and Asthapana Vasthi was given with Eranda Moola Kashayam. Thriphala Ghrutha is indicated in Thimira and it is considered as Chakshushya, Rasayana and Tridoshahara.

In Kashaya Vasthi, Yashti Kalaka and Taila are used which is Netrya, Brumhana and Vatahara. Thereby this Vasthi helps in rejuvenating the damaged nerves.

Annalepa was done only around the eyes with Shahstikashali and Ksheera. It gives strength and nourishment to the structures of eye. Shirodhara with Ksheerabala was selected. Kheerabala can act as Vatapithahara, Nadi Balya, Brumhana. Ksheerabala Dhara can cross the blood retinal Barrier and act as nerve tonic.

Vidaraydi Kashayam contains Vidari, Jeevathi, Jeevaka, Rishabhaka, Bruhati, Sariva, Gokshura etc. drugs which are having Vatapithahara and Brumhana in Karma. Ashwagandharishta and Balarishta relieves Vata and gives strength to nerves. Sapthamrutha Loha contains Ghrutha, Thriphala and Madhuka. They are Netrya, Pithanilahara and Bhrumhana. Since, it is indicated for Timira, it helps to reduce the blurring of vision present in the optic atrophy.

Conclusion

In the present study of traumatic optic atrophy the blurriness occurs according to the damage or degeneration of nerves. So, in this condition there is a need of Nadibalya, Brumhana and Rasayana Chikitsa. The mentioned three line of treatments are adopted in the different modalities for improving the vision by repairing the atrophied nerves.

Reference

1. Khurana A K. Comprehensive Ophthalmology, Jaypee Brothers Medical Publishers (P) ltd. New Delhi, Edition 7. 2019. pp 338.

2. P S Girija Devi, Ophthalmology for undergraduates. Jaypee Brothers Medical Publishers (P) Ltd. New Delhi, Edition 1, 2015, pp 498.

3. L C Dutta. Modern Ophthalmology. Jaypee Brothers Medical Publishers (P) Ltd. Newdelhi. Edition 2. 2000. pp 961.

4. L C Dutta. Modern Ophthalmology. Jaypee Brothers Medical Publishers (P) Ltd. Newdelhi. Edition 2. 2000. pp 962.

5. https://eyewiki.aao.org/Traumatic_Optic_Neuropathy

6. Stephen J. H. Miller. Parsons’ Diseases of the Eye. Oxford Boston Johannesburg Melbourne. New Delhi. Singapore. Edition 18.1990. pp 263.

7. Khurana A K. Comprehensive Ophthalmology. Jaypee Brothers Medical Publishers (P) ltd, New Delhi, Edition 7, 2019. pp 340.

8. Stephen J. H. Miller. Parsons’ Diseases of the Eye. Oxford Boston Johannesburg Melbourne. New Delhi. Singapore. Edition 18.1990. pp 263.

9. K.V.Krishnan Vaidyan, S.Gopala Pillai. Sahasrayogam. Vidyarambham Publishers. Alappuzha, 2006. Edition 26, Ghruthayogam 45, pp332.

10. Vagbata. Ashtanga Hrudayam. Commentary by P.M Govindan Vaidyan. Cheppattu Achyutha Warrier. Published by Devi book stall. Kodungallur. 14 Reprint 2010. Kalpa Sthanam. Chapter 4.27-28. pp267.

11. K.V.Krishnan Vaidyan, S. Gopala Pillai. Sahasrayogam. Vidyarambham Publishers. Alappuzha. 2006. Edition 26. Tailayogam 96. pp315.

12. Vagbata. Ashtanga Hrudayam. Commentary by P.M Govindan Vaidyan. Published by Devi book stall. Kodungallur. 16 Reprint 2010. Sutra Sthanam. Chapter 15.9-10.pp385.

13. Brahmashankar Mishra, Govinda Das. English Translation by Kanjiv Lochan. Bhaishajyaratnavali. Chaukhambha Sanskrit Sansthan.Varanasi. 2009; Netrarogadhikara 181-186.

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

15. Arun Kumar Gupta. Anticipated Mode of Action Netra Tarpana. World Journal of Pharmaceutical and Life Sciences. Volume 6. Issue 7. 2020 (January) pp 1-9.

Manuscript Received	Review Round 1	Review Round 2	Review Round 3	Accepted
2022-06-01	2022-06-02	2022-06-09	2022-06-16	2022-06-23
Conflict of Interest	Funding	Ethical Approval	Plagiarism X-checker	Note
Nil	Nil	Yes	19%

Case Report

Traumatic optic atrophy

Journal of Ayurveda and Integrated Medical Sciences