E-ISSN:2456-3110

Case Report

Blepharospasm

Journal of Ayurveda and Integrated Medical Sciences

2025 Volume 10 Number 9 September
Publisherwww.maharshicharaka.in

Management of Nimesha (Blepharospasm) through Ayurveda - A Case Study

Gopika A1*, Pasha SM2
DOI:10.21760/jaims.10.9.52

1* Gopika A, Third Year Post Graduate Scholar, Department of Shalakya Tantra, Government Ayurvedic Medical College, Bengaluru, Karnataka, India.

2 Syed Munawar Pasha, Professor and Head, Department of Shalakya Tantra, Government Ayurvedic Medical College, Bengaluru, Karnataka, India.

Blepharospasm is defined as focal dystonia characterized by involuntary, repetitive and sustained contractions of the extraocular muscles leading to excessive blinking or persistent eyelid closure. This article explores the effective Ayurvedic management of essential blepharospasm in a 52-year-old female patient with a 2-year history of the condition. Treatments such as Nasya, Tarpana, Annalepa, Netra Pichu and internal medication with regular follow-ups were scheduled to monitor the disease progression. There was significant improvement in involuntary movement of the eyelid following the treatment, with a marked reduction in both the frequency and intensity of spasm.

Keywords: Blepharospasm, Nasya, Tarpana, Annalepa, Netra Pichu

Corresponding Author How to Cite this Article To Browse
Gopika A, Third Year Post Graduate Scholar, Department of Shalakya Tantra, Government Ayurvedic Medical College, Bengaluru, Karnataka, India.
Email: 		Gopika A, Pasha SM, Management of Nimesha (Blepharospasm) through Ayurveda - A Case Study. J Ayu Int Med Sci. 2025;10(9):327-330.
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https://jaims.in/jaims/article/view/4775/

Manuscript Received Review Round 1 Review Round 2 Review Round 3 Accepted
2025-07-11 2025-07-22 2025-08-02 2025-08-12 2025-08-26
Conflict of Interest Funding Ethical Approval Plagiarism X-checker Note
None Nil Not required 11.52

© 2025 by Gopika A, Pasha SM 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].

J Ayu Int Med Sci 2025;10(9)327
Download PDFBack To ArticleIntroductionMaterials and MethodsCase ReportDiscussionConclusionReferences
Gopika A et al. Management of Nimesha (Blepharospasm) through Ayurveda

Introduction

Blepharospasm refers to involuntary, sustained and forceful closure of the eyelids which occurs in two forms- essential and reflex blepharospasm. Essential blepharospasm is rare idiopathic affecting those between 45 and 65 years and treatment include botulinum injection and facial denervation. Reflex blepharospasm occurs due to reflex sensory stimulation through branches of 5th nerve.[1] Benign essential blepharospasm is estimated to affect approximately 20 to 133 individuals per million globally, with variation depending on geographic area.[2] It is thought that one of the contributing factors to the increased risk of blepharospasm in women is menopause.[3] Ratio of blepharospasm in women to men is 2.3:1.[4]

Nimesha is explained in classics under Vataja Asadhya Vartmagata Roga by Acharya Sushruta. The symptom explained is Chalayati Ati Vartmani (excessive movement of the lids).[5] This case study explores the effective ayurvedic treatment including Nasya, Tarpana, Annalepa, Netra Pichu and internal medications in which the intensity and spasm significantly reduced thereby improving the patient’s quality of life.

Materials and Methods

A 52-year-old female patient presented with increased involuntary blinking of eyes in the last 2 years visited Shalakya Tantra OPD of GAMC Bengaluru. The subject was thoroughly examined and diagnosed with essential blepharospasm (Nimesha). She underwent Nasya, Tarpana, Annalepa and Netrapichu for next 32 days. Patient was assessed before and after the treatment which showed marked improvement subjectively and objectively.

Case Report

Chief Complaint

A female patient aged 52 years came to Shalakya OPD of GAMC Bengaluru with chief complaints of increased blinking of eyes in the last 2 years

History of Present illness

Patient is said to be healthy 2 years ago, then gradually developed involuntary increased blinking of eyes for which she consulted a neurologist.

She was diagnosed with blepharospasm and was prescribed with Tab. Wysolone which she took for 6 months and found only symptomatic relief.

She visited another neurologist and was advised to take botulinum injection The patient declined treatment due to the high cost, expressing concern over its financial burden and approached Shalakya OPD of GAMC Bengaluru for alternative option.

History of past illness

Diabetes mellitus in the last 20 years (Under regular medication)

No history of any surgery.

Family history - Not contributory

Personal history

  • Appetite - Reduced
  • Bowel - Constipated
  • Sleep - Disturbed
  • Diet - Mixed

Ashtavidha Pareeksha

  • Nadi - Vata-Pittaja
  • Mala - Vikrutha
  • Mutra - 4-5 times/day
  • Jihva - Lipta
  • Shabda - Prakrutha
  • Sparsha - Ruksha
  • Drik - Vaikrutha
  • Akruti - Avara

General Examination

  • BP - 130/70 mmhg
  • PR - 78/min
  • R - 17/min

Systemic Examination

  • S - Normal vesicular breathing sound heard.
  • CVS - S1 S2 NORMAL
  • CNS - Conscious and oriented.

Blood Investigation

  • HbA1c - 6%
  • FBS - 120mg/dL
  • PPBS - 190mg/dL

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Gopika A et al. Management of Nimesha (Blepharospasm) through Ayurveda

Examination of Eye

Slit Lamp Examination

Ocular ExaminationRight EyeLeft Eye
LidNormalNormal
ConjunctivaNormalNormal
ScleraNormalNormal
CorneaClearClear
Anterior chamberNormal depthNormal depth
PupilRound, Regular, ReactiveRound, Regular, Reactive
LensSIMCSIMC
VisionBCVA 6/6, N6BCVA 6/6. N8

Blinking rate- 30-35/min

Diagnostic Assessment

Jankovic Rating Scale (JRS)[6]

JRS Severity

0No symptoms
1Increased blinking produced only by the action of external stimuli (eg; bright light, wind, reading etc)
2Mild, spontaneous blinking (without spasms), clearly visible, sometimes troublesome, but with no functional impairment
3Moderate, clearly visible spasms of the eyelids, moderate impairment
4Severe, impairing spasms of the eyelids, probably with involvement of other facial muscles

JRS Frequency

0No symptoms
1Slightly increasing blinking frequency
2Flickering of eyes with individual blink duration of less than one second
3Spasms of the eyelids lasting more than one second; eyes open more than 50% of waking time
4Functional blindness is caused by prolonged closure of the eyes for more than 50% of waking time

Treatment

TreatmentMedicinesDurationDose
NasyaKarpasastyadi Taila[7]7 days10 drops
TarpanaTriphala Ghrita[8]7 daysQ.S
Annalepa[9]Shashtikashali +Balamoola ksheerapaka7 daysQ.S
Netra PichuMahatriphala Ghrita[10]14 daysQ.S

Discharge Medicines: Saptamrita Loha 0-0-2 A/F for 15 days

Eye exercise for 1 month

Follow-Up and Result

Total treatment duration was 35 days. Subject showed improvement both subjectively and objectively.

ParameterBefore TreatmentAfter 35 Days of Treatment
Blinking rate30-35/min12-16/min
SymptomsFrequent, involuntary eyelid spasmsReduced frequency and severity
Jankovic Rating Scale (JRS)Severity: 3 (moderate) Frequency: 3Severity: 1 (mild) Frequency: 1
Blepharospasm Disability Index (BSDI)[11]Difficulty with reading, driving, watching TVImproved ability to perform daily activities
Functional ImpactSignificant interference with vision and daily tasksMinimal interference
Associated FeaturesPhotophobia, facial tensionPhotophobia improved, facial tension reduced
Quality of Life (QoL)Impaired; frustration, social withdrawalImproved QoL; more confidence, less stress
Patient SatisfactionLowHigh

Discussion

The present study evaluated the efficacy of a combined Ayurvedic treatment approach - including Nasya, Tarpana, Annalepa, and Netrapichu - in the management of blepharospasm, a focal dystonia characterized by involuntary, forceful eyelid contractions. This condition, though primarily neurological in origin, has been increasingly correlated with ocular surface disturbances and stress-induced factors, which is mainly due to Vata Dosha. The patient's symptoms were classic, including progressive eyelid closure, photophobia, and social withdrawal. These features are consistent with previous descriptions of benign essential blepharospasm, which typically affects individuals in mid-to-late adulthood and is more common in females. Notably, no structural brain abnormalities or secondary causes were identified, supporting a diagnosis of primary blepharospasm.

Karpasastyadi Taila - Karpasastyadi Taila has Ushna, Snigdha, Brumhana, Rasayana and Vatahara properties. It contains drugs like Ashwagandha and Bala which are neuro restoratives. Triphala Ghrita has Chakshushya, Rasayana and Tridoshahara properties. Annalepa with Shashtikashali acts as localized Snehana and Swedana which helps to control vitiated Vata Dosha. Netra Pichu with Mahatriphala Ghrita delivers lipophilic, Vata-pacifying agents directly over these tissues, providing a calming, nourishing effect on hyperactive neuromuscular junctions involved in spasms.


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Gopika A et al. Management of Nimesha (Blepharospasm) through Ayurveda

Because of the above-mentioned properties of the drug, the treatment was planned and patient showed marked improvement by 35th day of treatment.

Conclusion

The combined effect of Nasya, Tarpana, Annalepa, and Netra Pichu demonstrated encouraging outcomes in the management of blepharospasm, a challenging focal dystonia with both neurological and ocular components. These treatments, rooted in classical Ayurvedic principles, collectively addressed the underlying vitiation of Vata Dosha, nourished the ocular and neuromuscular tissues, and provided local symptomatic relief without invasive intervention or adverse effects. This holistic, non-invasive approach underscores the relevance of Ayurvedic therapeutics in neuro-ophthalmic care and highlights their potential as complementary or alternative interventions for conditions like blepharospasm.

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