E-ISSN:2456-3110

Case Report

Chronic Uveitis

Journal of Ayurveda and Integrated Medical Sciences

2025 Volume 10 Number 9 September
Publisherwww.maharshicharaka.in

A Case Report on Ayurvedic management of Chronic Uveitis

Aravind V1*, VKV Balakrishnan2
DOI:10.21760/jaims.10.9.44

1* Vrinda Aravind, Third Year Post Graduate Scholar, Department of Salakya Tantra, Government Ayurveda College, Kannur, Pariyaram, Kerala, India.

2 VKV Balakrishnan, Professor and HOD, Department of Salakya Tantra, Government Ayurveda College, Kannur, Pariyaram, Kerala, India.

Chronic inflammation of anterior uveal tissue is gradual in onset and has minimal symptoms compared to acute anterior uveitis. A 14-year-old male patient presented with complaints of complete vision loss, severe pain, redness, watering, and photophobia of the right eye, associated with headache and recurrent abdominal pain for 6 months. He had a past history of retinoblastoma in the left eye and cataract surgery in the right eye. He is positive for TORCH antibodies. His condition was diagnosed as Chronic Anterior Uveitis, and Asopha Akshipaka, which has led to Hathadhimantha in Ayurvedic terms.

Intervention: The main line of treatment employed was continuous Raktamokshana with Jalouka as the diseases Ashopha Akshipaka and Athimandha are Vyadhana Sadhya Vyadhis. Along with internal medications, Panchakarma procedures with special emphasis on Lekhana Basthi and external therapies like Ksheeradhara, Shirolepanam, Netra Kriyakalpas such as Pindi, Bidalakam and Netra Pichu were advised.

Conclusion: Headache and associated inflammatory signs in the right eye reduced considerably. The patient could wean off all the allopathic anti glaucoma medication. The previously elevated liver function test and lipid profile parameters had considerably reduced.

Keywords: Asopha Akshipaka, Chronic Uveitis, Hathadhimanta, Lekhana Basthi, Raktamokshana

Corresponding Author How to Cite this Article To Browse
Vrinda Aravind, Third Year Post Graduate Scholar, Department of Salakya Tantra, Government Ayurveda College, Kannur, Pariyaram, Kerala, India.
Email: 		Aravind V, VKV Balakrishnan, A Case Report on Ayurvedic management of Chronic Uveitis. J Ayu Int Med Sci. 2025;10(9):288-293.
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Manuscript Received Review Round 1 Review Round 2 Review Round 3 Accepted
2025-07-09 2025-07-26 2025-08-06 2025-08-16 2025-08-26
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© 2025 by Aravind V, VKV Balakrishnan and 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].

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Vrinda A et al. A Case Report on Ayurvedic management of Chronic Uveitis

Introduction

Anterior uveitis refers to inflammation of uvea mainly involving areas from iris to pars plicata part of the ciliary body. When this condition last longer than 3 months, it is termed as chronic uveitis. It is gradual in onset. It has many causes and is mainly classified as infectious, non-infectious and masquerade syndromes.[1] Among the viral causes of infectious uveitis, TORCH syndromes have primary position.[1] Here a case management of a boy, who was diagnosed as Asopha Akshipaka, with Athimantha which has further progressed to Hathadhimantha is discussed. The boy had a childhood history of Retinoblastoma (Left Eye), Cataract Surgery (Right Eye) and is TORCH positive for Rubella and Cytomegalovirus. Both the conditions are Vyadhana Sadhya Rogas according to Ayurveda. Asopha Akshipaka has all clinical symptoms similar to Sasopha Akshipaka except Sopha and the treatment is mentioned in Raktaja Abhishyandha Pratishedha.[2] Hathadhimantha is a successive stage of Vataja Athimandha which occur if the Athimantha is not treated properly.[3] Even though the prognosis of Hathadhimantha is Asadhya, the severe pain and associated symptoms can be managed with treatment protocols mentioned in Sarvakshigata Roga Pratishedha. The treatment modalities include Snehapanam with Purana Ghritam, Rakta Mokshana, Sneha Virechana, Basthi, Pradeha, Parisechana, etc.

Case Report

14-year-old male of moderate built, first child of non-consanguineous parents, presented to the Out Patient Department of Ayurvedic Hospital on 09-09-24 with complaints of complete loss of vision, severe pain, redness, watering and photophobia in right eye for the past 6 months. He also reported associated symptoms of headache and recurrent abdominal pain during the same time. Prior evaluation by an ophthalmologist, revealed intraocular inflammation and elevated Intra Ocular Pressure in the affected eye. The doctor prescribed an injection and 4 types of anti-glaucoma eyedrops. After the injection, he experienced sudden and complete loss of vision in right eye. Other symptoms of eye pain, watering, redness and photophobia persisted. Headache was constant, aggravated during night time, also with exposure to light and sound.

There was no nausea or vomiting associated. Then, he got admitted at Ayurveda Hospital, for further treatment.

Past illness

  • H/o Retinoblastoma (left eye) was found at 8th month of age.
  • H/o Cataract (right eye) was found at 10th month of age.

Treatment History

  • Surgery for removal of Retinoblastoma tumour
  • Chemotherapy
  • Radiation therapy
  • Cataract surgery in right eye
  • Continuous monitoring - every 6 month till 6 years of age

Birth History

  • Full Term, LSCS
  • Birth weight -3kg
  • NICU Admission - 4 days - due to physiological jaundice
  • Milestones were attained at normal age
  • Fully vaccinated

Personal History

  • Diet - mixed
  • Appetite - good
  • Bowel - regular
  • Sleep - disturbed
  • Micturition - WNL
  • Allergy - to dust

Allopathic Treatment

  • Dorzolamide + timolol - 1 drop twice daily right eye instillation
  • Bimatoprost - 1 drop at night, right eye instillation
  • Ripasudil - 1 drop twice daily right eye instillation
  • Brimonidine - 1 drop twice daily right eye instillation

Vital Status

  • Temperature - 97°F
  • BP - 110/70mmHg

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  • HR - 70/min
  • Pulse Rate - 62/min
  • Respiratory rate - 14/min
  • Body Weight - 65kg
  • Height - 162 cm
  • BMI - 24.7

Table 1: Examination of eye

ExaminationRight EyeLeft Eye
EyeballSunkenProsthetic eye
EyelidMargin – normal
Movements – normal		Margin - normal,
Movements - normal
Conjunctiva-
Palpebral conjunctiva
Bulbar conjunctiva		Congested ++
Ciliary congestion ++
ScleraWhitish-
CorneaMacular opacity-
Anterior chamberDeep-
Iris
Pupil
Lens		Brownish
Irregular
Pseudophakia		-
Visual acuityPL negativePL negative
IOP - digital TonometryHard-
Non-contact tonometryError-
Paranasal sinuses
{Frontal, Ethmoidal, Maxillary}		No tendernessNo tenderness
NoseNormalInferior turbinate hypertrophy
Throat - anterior & posterior pillars
Tonsils		Congested
Grade 2 enlargement		Congested
Grade 4 enlargement

Table 2: Symptom Score

SNSymptom ScoreBefore treatment
25-9-24		After Treatment
4-11-24
1.PainSevereNil
2.RednessModerateMild
3.WateringModerateNil
4.PhotophobiaSevereNil
5.HeadacheModerate to severeNil
6.Pain AbdomenModerateNil

Ashtasthana Pareeksha

  • Nadi - Hamsam Gathi
  • Mootram - Avilam, Ishat Peeta Varnam

  • Malam - Agrathitham
  • Jihwa - Upaliptam
  • Shabdham - Voice - Ksheenam, Borborygmus (Abdomen)
  • Sparsham - Anushnasheetam, Mridu Sparsham
  • Aakriti - Madyamam

Drik Pareeksha

  • Dhumra Varnam - Smoky eyes (corneal opacity)
  • Aruna Varna - Shukla Mandalam
  • Chanchalam - Nystagmus
  • Antapravishta - Sunken eyes

Dasha Vidha Pareeksha

  • Dooshyam

Dosha - Tridosham

Dhatu -

Rasam - (Agni Nasham, Srotorodham)
Rakta - (Rakta Netradha, Gulma, Kamala)
Mamsa - (Arbudham, Galashundika)
Meda - (Shithilatwam Ange, Aasya - Swapna Sukham)
Asthi - (Danta Shoolam, Dental Caries)
Majja - (Tamaso Darsham)

  • Desham -

Bhumi Desham - Anupa Desham
Deha Desham - Netram

  • Balam -

Roga Bala - Pravara
Rogi Bala - Vyayama Shakti (physical and mental) - Heena
Vyadhi Kshamatwam - Heena

  • Kalam -

Kshanadi Kalam - Sarva Ritu (Sarat, Grishma more)
Vyadi Avastha Kalam - Puranam

  • Analam - Mandagni
  • Prakriti - Pitta - Kapha
  • Vaya - Balyam
  • Satwam - Heena
  • Satmyam - Sarva Rasam
  • Aharam -

Abhyavarana Shakti - Madhyama
Jarana Shakti – Heena


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Table 3: Blood Investigations

SNBlood TestBefore Treatment
(25-9-2024)		After Treatment
(04-11-2025)
1.Hb14.4 Gm%14.7 Gm%
2.ESR12mm/hr8mm/hr
3.T. Bilirubin0.3 mg%0.2 mg%
4.D. Bilirubin0.1 mg%0.1 mg%
5.SGPT129 IU/L78 IU/L
6.SGOT78 IU/L39 IU/L
7.T. Cholesterol154 mg%187 mg%
8.Triglyceride252 mg%94 mg%
9.HDL35 mg%44 mg%
10.LDL69 mg%125 mg%
11.VLDL50 mg%18 mg%
12.RA Factor29 IU/ML--
13.ASO Titre< 50 IU/ML--
14.CRPNegative--
15.HBsAGNegative--
16.IgE15 IU/ml--

Previous Reports

USG Abdomen - 13/9/24

Grade 1 – 2 (mild to moderate) Fatty liver.

Torch IgG IgM Screening - 19-10-2024

Rubella IgG - 131.200 - Reactive
CMV IgG - 144.30 - Reactive

Nidanam

1. Viprakrishta Nidanam - Janmabala Pravritta Vyadi → Jatyandhyam

  • Genetic mutation - deletion of RB 1 gene → Retinoblastoma (left eye)
  • Congenital cataract (right eye)

2. Sannikrishta Nidanam - habits - Swapna Vip-aryayam - falling sleep late night, day sleep, (dis-turbing circadian rhythm), until then hearing mobile using air pods, (no control over sound volume or listening time) - Shravanendriya Atiyogam

  • Diet habits -

Consumption of heavy food - almost daily basis,
Biriyani, ice cream - Viruddha Aharam

  • Mental stress - cortisol
  • Lack of exercises
  • TORCH positive

Poorvaroopam - Aavila, Samrambham, Ashru, Toda, Raga, Soolam Vartma Kosham

Roopam - Ragam, Ashrupata, Severe Eye pain, Headache, Increased IOP, Loss of vision, Nystagmus, Sunken eyes

Upashaya - Sheeta

Anupashaya - Ushna

Samprapti

Dietary Nidanas like having heavy and Virudha Aharas, Nidanas like Swapna Viparyaya - having day sleep and late-night sleep, Shrotrendriya Athiyoga, mental tension, presence of TORCH antibodies in blood etc causes Jataragni Mandya, which leads to accumulation of Ama and Kledamsha in body (Sarva Deha Syandhana). Urdhwa Vahi Siras carry Ama & Kleda into Shiras causing Shiro Netra Abhishyandha (Prayena Sarve Netramayasthu Bhavanthi Abhish-yandha Nimittamoola).[4] Thus, leading to succe-ssive stages of Abhishyandham - Asopha Akshipa-kam - Athimandam (increased IOP) & finally vitiated Vata Dosha causing Drishtinasha (loss of vision) and severe eye pain leading to stage of Hathadimantha.

Intervention

Asopha Akshipakam & Adhimantham are Vyadhana Sadhya Vyadhis. Hathadimantha is later stage, which is Asadhya. The Dosha predominance of Ashopha Akshipaka is Tridosha & Rakta. Dosha predominance of Hatadhimantha is Vata Dosha. The treatment protocol in this case is formulated considering systemic condition & comorbidities of patient. The patient suffered from recurrent pain abdomen, and ultrasound scan revealed patient to have grade 1- 2 fatty liver, it was evident with elevated values of Triglyceride, SGPT & SGOT levels. As all disease arise from Jataragni Mandya & Ama, his treatment began at base level - correcting Agni. Other comorbidities like tonsilitis, toothache was also managed during course of hospital stay.

Table 4: List of Medicines Given

SNInternal MedicationDose
1.Guluchyadi Kashaya90 ml Bid B/F
2.Punnarnavadi Kashaya90 ml Bid B/F
3.Vaishwanara Choorna5 gm Bid B/F
4.Gokshura Choorna5 gm Bid A/F
5.Tab. Chandraprabha1-0-1 A/F
6.Manibadra Gulam5gm Hs
7.Kanchanara Guggulu1-0-1 B/F
8.Trikatu Choorna2gm Bid A/F with Anar Juice

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Table 5: List of Treatment Procedures given to the Patient

SNProcedureMedicineDays
1.UdwartanamKolakulathadi Choornam3 Days
2.KashayadharaVaranadi Kashayam + Guluchyadhi Kashaya3 Days
3.TakrapanamVaishwanara Choornam2 Days
4.SnehapanamPurana Sarpis processed with shigru leaves + vilva leaves3 Days
5.Abhyanga + Oshma SwedaLakshadi Taila1 Day
6.VirechanaGandharva Erandam + Milk + Triphala Kashaya1 Day
7.Ksheeradhooma NasyaRasnadashamoola Grita3 Days
8.Lekhana BasthiTriphala Kashaya, Kalka- (Shatapushpa + Mustha+ Pippali), Madhu, Saindhavam, Panchamla Taila15 Days
9.KsheeradharaManjisthadi Ksheeradhara7 Days
10.ShirolepamNalavanchuladi Choornam7 Days
11.Netra PindiTriphala Choorna+ Yashti Choornam + Madhu +Murivenna +Saindhavam7 Days
12.Netra PichuDurva Gritam + Murivenna7 Days
13.Raktamokshanam - Over Outer Canthus of Right EyeJaloukaEvery Day
14.SekamYashti KashayaInitial 10 days
15.AschyotanamShigru - Punnarnavadi ArkamInitial 10 days
16.BidalakamMukkadi BidalakamInitial 10 days

Discussion

Guluchyadi Kashaya has Agni Deepana property, pacifies Pitta and Kapha Dosha, reduces Daha, Trishna, has Jwarahara (anti-inflammatory) action. This helps to regulate liver functions and proper secretion of bile. Punnarnavadi Kashaya[5] has Deepana, Pachana, Medohara, Srotorodhahara action, reduces Sotha, Gulma, Udaram, and has Lekhana action. Vaishwanara Choorna has Agni Deepana action, Vatanulomana action, helps in Uttarothara Dhatu Parinama. Improves bile secretion and fat emulsification. Gokshura Choorna is Vata-Kaphahara, is Mutralam and Sothahara. It has Rasayana action. Tab. Chandraprabha[6] contains 37 ingredients with Shilajathu and Guggulu as main drugs, it is Katu, Thikta in Rasa and Laghu Rooksha in Guna, Ushna Veerya and Katu Vipaka, it is Tridosha Shamaka and Vata Kapha Shamaka,

reduces Medoroga, Kamala, Netraroga, and Dantaroga.Manibadra Gulam is given for Nithya Virechanam. When Malas are properly expelled through the urinary route and through the stools, the macro and microchannels of the body clears of the toxins and lead to Srotoshodhana. Kanchanara Guggulu has Chedhana, Medohara action, it is useful in Galaganda, Gulma, Sotha, Medoroga. Trikatu Choornam[7] with pomegranate juice has excellent hepato-protective effects. It reduces the triglyceride deposition in the liver. It aces the secretion of liver enzymes. Thus, all the internal medications are selected to reduce inflammation in body and in eye.

“Tathra Shaaka Raktadayo Dhathavastwak Cha Bahyaroga Margah[8]”: since the Bahyaroga Marga include all the Saptha Dhatus, all the external treatments applied on the body will get absorbed and will bring about therapeutic effects in the patient. Udwartanam is the procedure which help in reducing Kapha and dissolving Medas, it provides firmness to body parts and clarifies the skin. Kolakulathadi Churna is the most commonly used medicine for Udwartana purpose. It helps in reducing Vata Kapha Dosha and Medoroga. Kashayadhara improves blood circulation in the body, improves strength, helps in detoxification. Local treatments like Yashti Kashaya Sekam, Aschyotanam with Shigru - Punnarnavadi Arkam and Bidalakam was done in the initial 10 days of the treatment. Yashti Kashaya has Pitta - Raktahara action, is soothing to the eyes. Aschyotanam and Bidalakam has the properties to reduce Daha, Upadeha, Raga and Sopha. Mukkadi Purampada is used as Bidalaka. The Yoga is mentioned in Sahasrayoga. It reduces elevated IOP, redness and other inflammatory signs in the eye. Takrapana is done by adding Vaishwanara Churna for the purpose of getting Agni Deepthi before introducing Ghrita. Vicharana Snehapana was done with Purana Ghrita processed with Shigru and Vilva leaves and was given to the patient for 3 days. Abhyanga with Lakshadi Taila, followed by Swedana was given for one day prior to Virechana. Snigdha Virechana was done with Gandharva Erandam + milk + Triphala Kashaya and it resulted in 4 Vegas. Lekhana Basthi Dravyas have Tridoshahara property, Deepana, Rochana, Lekhana, Chedhana, Chakshushya and Vatanulomana property. Panchamla Taila is mentioned in Sahasrayoga, has Vata-Kaphahara property, has some of the Amla Rasa Pradhana drugs, Gomutra and Tila Taila.


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It helps for Vatanulomana, is useful in Udara. Triphala Kashaya is rich in anti-oxidants, has Anulomana, Chakshushya and Vranaropana action. Kalka Dravya used is a combination of Shatapushpa, Pippali and Musta. It has Agni Deepana and digestive action. Madhu has Chedhana and Lekhana properties and Saindhava are Yogavahi and helps to remove the doshas from the body. Manjishtadi yoga mentioned in Sarvakshi Pratishedham in Ashtanga Hridaya is used for Ksheeradhara. Ingredients are Manjishta, Rajani, Laksha, Draksha, Ridhi, Madhuka, Utpala. It is specifically mentioned to do Sechana in Rakta and Pitta predominant Avastha. Nalavanjuladi Choornam is described for Shirolepa in the context of Pitta Rakta Shiroroga in Susruta Samhita Shiroroga Pratishedha, ingredients are Nalavanchula, Kalhara, Chandhana, Utpala, Padmaka, Vamsha, Durva, Yashtiadhu and Musta. The drugs have Sheeta property, Rooksha Guna and thus reduces inflammatory signs and intra ocular pressure. Netra Pindi is specifically mentioned Abhishyadha diseases, it is effective in reducing inflammatory conditions. Netra Pichu is also very useful to reduce inflammatory condition.

Raktha Mokshana with Jalooka Avacharana was done on every day during the hospital stay. One jalooka can suck about 5 - 15ml of blood at a stretch. Its saliva contains anticoagulant and anti-inflammatory substance. All toxins carried by Rakta is removed. The continuous Rakta Avasechana will reduce Srotorodha and improves aqueous secretion and its microcirculation, thus reduce intra ocular pressure. Accordingly reduces pain and other inflammatory signs in eye.

Conclusion

Stealing gift of vision from person is sorrowful, but much worser is when he has to suffer physical pain in addition to loss. Considerable & sustainable reduction in pain & other inflammatory signs were obtained; patient could stop using all allopathic anti-glaucoma eyedrops. The elevated blood parameters like Lipid Profile & Liver Function Test were almost normal by end of treatment.

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