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| CASE REPORT |
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| Year : 2022 | Volume
: 3
| Issue : 2 | Page : 94-98 |
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Ayurveda management of vatahata vartma - A case report
Chidanand Naganna Kalburgi1, Azizahmed Imamsab Arbar2, Kaveri N Hulyalkar2, V Geothsona2
1 Department of Kaumarbhritya, Indian Institute of Ayurvedic Medicine and Research, Bengaluru, Karnataka, India
2 Department of Kaumarbhritya, Kle Shri B.M. Kankanawadi Ayurvedic Mahavidyalaya Post Graduate and Research Center, Belagavi, Karnataka, India
| Date of Submission | 08-Feb-2022 |
| Date of Decision | 10-Nov-2022 |
| Date of Acceptance | 11-Nov-2022 |
| Date of Web Publication | 12-Dec-2022 |
Correspondence Address:
Azizahmed Imamsab Arbar
Department of Kaumarbhritya, KLE Shri B. M. Kankanawadi Ayurvedic Mahavidyalaya Post Graduate and Research Center, Belagavi - 590 003, Karnataka
India
 Source of Support: None, Conflict of Interest: None
DOI: 10.4103/ijaim.ijaim_8_22
Lagophthalmos is a condition characterized by incomplete or abnormal closure of eyelids along with the evaporation of tear film. If left untreated, it progresses to corneal ulceration, perforation, and visual loss. Conservative nonsurgical treatment includes the use of artificial tears, ointments, and therapeutic contact lenses. However, if nonsurgical approaches are not effective, surgical procedures such as tarsorrhaphy and gold/platinum implantation are used which are expensive with risks of poor cosmetic appearance. The current case was diagnosed as lagophthalmos which can be clinically correlated to Vatahata vartma described in Ayurveda. Amapachana followed by Panchakarma and Kriyakarmas along with Vata shamana chikitsa were adopted which are cost-effective, less invasive, and cosmetic friendly when compared with conventional science. This article highlights the successful reduction in core symptoms of lagophthalmos with the Ayurveda line of treatment.
Keywords: Kriyakarma, lagophthalmos, Panchakarma, Vata shamana chikitsa, Vatahata vartma
How to cite this article:
Kalburgi CN, Arbar AI, Hulyalkar KN, Geothsona V. Ayurveda management of vatahata vartma - A case report. Indian J Ayurveda lntegr Med 2022;3:94-8 |
How to cite this URL:
Kalburgi CN, Arbar AI, Hulyalkar KN, Geothsona V. Ayurveda management of vatahata vartma - A case report. Indian J Ayurveda lntegr Med [serial online] 2022 [cited 2023 Mar 23];3:94-8. Available from: http://www.ijaim.in/text.asp?2022/3/2/94/363113 |
| Introduction | |  |
Lagophthalmos is a clinical condition characterized by the inability to close the eyelids voluntarily. Physiologically, blinking of the eyes helps in maintaining the tear film and healthy ocular surface. As there is difficulty in the closure of eyelids or blinking, it increases the risk of corneal exposure, evaporation of tear film followed by exposure keratopathy, and progresses to corneal ulceration, perforation, and visual loss.[1] This condition occurs when there is paralysis of the orbicularis oculi muscle, severe ectropion, and marked proptosis following overresection of the levator muscle for ptosis. Clinical presentations are incomplete closure of the eye with palpebral aperture and excessive evaporation of tears. Classically, there are three types of lagophthalmos: congenital, acquired, and nocturnal.[2] Inability to close the eyelids since birth is congenital. And that is developed later in life is acquired. Nocturnal is inability to close the eyelids during sleep.
In conventional science, interventions such as artificial tears, ointments, and therapeutic contact lenses are used. If nonsurgical procedures fail, surgical procedures such as tarsorrhaphy and gold/platinum implantation are used.[3] In Ayurveda, lagophthalmos can be compared with Vatahata vartma by its clinical presentations. Acharya Susruta mentions Vatahata vartma in the context of Vartmagata Rogavignaneeya Adhyaya (Sushruta Samhita Uttara Tantra 3/23) where he elucidates it as a vitiation of Vartma-Shuklagata Sandhi by Vata dosha which manifests as Vimukta Sandhi Nischesta (reduced eyelid activity) and Na Milayate (unable to close the eyelids) with or without Ruja (pain).[4] Vagbhatacharya describes the Vatahata vartma in the context of Vartma roga Pratisedha (Ashtanga sangraha Uttar tantra 11/7), i.e., the eyelid drooping down getting loosened at joints, with loss of movement and found hanging is known as Vatahata vartma.[5] Although it is an Asadya Vyadhi as per Acharyas, an attempt has been made to manage this case by adopting the treatment modalities by combining Panchakarma and Kriyakarma – Abhyanga, Akshitarpana, Nasya, eyelid exercises along with Vata Shamana Ausadhis. These Ayurveda treatment modalities showed good results in reduction of core symptoms of Vatahata Vartma.
| Case Report | | |
A 6-year-old male child, native of Belagavi, born to parents who are first-degree consanguineous marriage couple, presented with complaints of watering of right eye since birth and unable to close the right upper eyelid since 8 months. For the above complaints, the child was taken to the ophthalmologist and was prescribed with eye drops (name of the drops and prescription not available with patient) for 15 days and also for follow-up after 15 days. This helped the patient with reduction in symptom of watering of the eye but other complaints increased eventually, so the parents revisiting there and reported to the Outpatient Department of KLE Ayurveda Hospital, Belagavi, Karnataka, on February 16, 2021.
| Clinical Findings | | |
According to the informant (mother), the child was a vegetarian with good appetite and had sound sleep. The frequency of micturition was 6–7 times in a day and stool output was 1–2 times in a day. Family history revealed that the patient's younger brother got deceased due to cardiac illness at the age of 2 months. There were no significant findings in the birth history.
The general examination of the patient showed normal vitals with pulse rate of 86 beats/min; respiratory rate was 20 breaths/min; blood pressure of 100/70 mmHg (millimeters of mercury); weight of 26 kg; and height of 120 cm. Systemic examination of the cardiovascular system, central nervous system, respiratory system, and per abdomen examinations was normal.
On local examination, it revealed watering of the eye along with the inability to close the right upper eyelid. During the examination, the head posture of the child was maintained straight and without any tilt. In facial symmetry assessment, both eyebrows were at the same level with no deviation of the angle of the mouth. In ocular posture assessment, visual axes of both eyes were parallel to each other in primary position and were maintained in all positions of gaze. On eyelid examination, unilateral lagophthalmos was present in the right eyelid. The upper and lower eyelashes of the nonaffected eye were forward and downward. Pupils, lacrimal apparatus, eyeballs, conjunctiva, sclera, and cornea were normal.
Time line
The 6-year-old male child developed watering of the eyes since birth and later developed difficulty in closing the right upper eyelid for 8 months (since April 2020). They had consulted allopathic doctor and took medications for 15 days, but the symptoms were worsening day by day. Parents approached our hospital on February 16, 2021, for further management.
Diagnostic assessment
Clinical examination in KLE Ayurveda Hospital, Belagavi, showed epiphora from the right eyes followed by inability of the child to open the right upper eyelid. Further examination by slit-lamp examination revealed interpalpebral punctate epithelial keratopathy which confirmed the diagnosis of lagophthalmos.
As per Ayurveda, it was diagnosed as Vatahata Vartma affecting the varthma shuklagata sandhi due to the vitiation of vata dosa. Management was through Amapachana, Abhyanga, Nasya, Akshitarpana, and eye exercises.
Therapeutic intervention
During the first 3 days, Amapachana (Deepana and Pachana) was done with the help of syrup Trikatu and Vidangarista, and for bringing vitiated doshas from Sakha to Kostha and Sthanika abhyanga [Figure 1] followed by Patta Sweda [Figure 2] was done. From the 4th day, Akshitarpana [Figure 3] was started which helped in sroto Shodhana along with Nasya [Figure 4], [Figure 5], [Figure 6]which acts as Shiroroga hara. Together with panchakarma and Kriyakalpa, eye exercise with the opinion of physiotherapist was introduced. On the 10th day of the treatment, the gap between the two eyelids was improved by 80% clinically [Figure 7] and [Figure 8] (No standard scale of assessment was used).[6],[7],[8],[9],[10],[11] The treatment Schedule is mentioned in [Table 1].
| Discussion | | |
In the present case, Ayurveda treatment was found to be effective in the management of vatahata vartma (lagophthalmos). Observations showed that improvements were well sustained by adopting the vata shamana line of chikitsa. Saama Netra lakshanas were rectified with amapachana (deepana and pachana) carried out on the first 3 days with Syrup Trikatu along with Laghu bhojana (easy digestible foods). Then, snehana and swedana were done in the form of abhyanga (massage) with Murchita Tila Taila and swedana (sudation) in the form of Patta sweda (sudation with help of cloth). This aimed to bring the prakupita doshas from Sakha to kostha. The Shodhana of Prakupita dosas was achieved by Nasya (Errhine Theraphy) with Shat bindu Taila and Akshi Tarpana (the process of unctuous oily substance is kept in the eyes for a specific time) with Triphala Ghrita which also acted as Vyadhi Pratyanika Chikitsa.
Triphala ghrta is a Vyadhi Pratyanika Dravya by its nature and acts as Sarva Netra Roga hara and given in Tarpana shows tremendous effect by reducing the symptoms. Tarpana forms an occlusive film over the surface of the eyeball and improves the composition of tear film by enhancing the mucin and aqueous layers. It prevents frictional damage to the ocular surfaces secondary to lid movement or extraocular movements. It helps by retaining fluid and maintaining hydration of the ocular surface. It prevents desiccation from corneal tear film and reduces burning sensation in patients with lagophthalmos. It also reduces reflex tearing and the need for artificial tears and warm compressors.[12] By these procedures, clinical manifestations of lagophthalmos were reduced significantly. Then, vatahara line of treatment was adopted with mukha abhyanga with Murchita Tila Taila and eye exercises during the course of the follow-up period. In conventional science, Lagophthalmos to a great extent, is being managed surgically; but in this study, there was a reduction in core symptoms of Vatahata vartma (lagophthalmos) through Ayurveda medical management.
| Conclusion | | |
Vatahata vartma has an effective treatment in Ayurveda with Panchakarma treatment. Based on the clinical signs and symptoms, the disease Vatahata vartma can be correlated to lagophthalmos. In this study, Akshitarpana and eye exercises were found to be safe and effective in the management of Vatahata vartma.
Declaration of patient consent
The authors certify that they have obtained all appropriate patient consent forms. In the form, the guardian has given his consent for the child's images and other clinical information to be reported in the journal. The guardian understands that the child's name and initials will not be published and due efforts will be made to conceal the identity, but anonymity cannot be guaranteed.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
| References | | |
| 1. | Fu L, Patel BC. Lagophthalmos. 2022 July, 25. In: StatPearls. Treasure Island (FL): StatPearls Publishing; 2022.  |
| 2. | Mrudulatha Mourya, Dinesh Kumar Mourya. Shalakya tantra. Revised ed., Varanasi. Chaukambha Orientalia; 2018. p. 86. |
| 3. | Oh TS, Min K, Song SY, Choi JW, Koh KS. Upper eyelid platinum weight placement for the treatment of paralytic lagophthalmos: A new plane between the inner septum and the levator aponeurosis. Arch Plast Surg 2018;45:222-8. |
| 4. | Sharma P. Sushruta Samhita, Dalhana's Commentary. Uttara Tantra. Vartmagata Roga Vijnaniya. 1 sted., Ch. 3., Ver. 23. Varanasi: Chaukhambha Visvabharati; 2001. p. 122. |
| 5. | Murthy S. Ashtanga Sangraha of Vagbhata. Uttar Tantra.Vartma Roga Vijnaniya. Reprint ed., Ch. 11., Ver. 7. Varanasi: Chaukambha Orientalia; 2016. p. 104. |
| 6. | Lochan K. Bhaisajya Ratanavali of Shri Govinda Dasji, Commented by Shastri Ambikadatta Shastri. Jwara Chikitsa Prakaranam. Reprint ed., Vol. 1., Ch. 5., Ver. 1286-1287. Varanasi: Chaukhambha Sanskrit Sansthan; 2019. p. 367. |
| 7. | Prabakar R. Sharangadhara Samhita of Sarandharacharya. Madhyama Khanda. Sneha Kalpana. 1 st ed., Ch. 9., Ver. 66-71. New Delhi: Chaukhambha Publications; 2013. p. 169. |
| 8. | Prabakar R. Sharangadhara Samhita of Sarandharacharya. Madhyama Khanda. Sneha Kalpana. 1 st ed. Ch. 10., Ver. 47-52. New Delhi: Chaukhambha Publications; 2013. p. 201. |
| 9. | Lochan K. Bhaisajya Ratanavali of Shri Govinda Dasji, Commented by Shastri Ambikadatta Shastri. Netra Roga. Reprint ed., Vol 3. Ch. 64., Ver. 248-63. Varanasi: Chaukhambha Sanskrit Sansthan; 2019. p. 303-6. |
| 10. | Lochan K. Bhaisajya Ratanavali of Shri Govinda Dasji, Commented by Shastri Ambikadatta Shastri. Shiro Roga. Reprint ed., Vol. 3 Ch. 65., Ver. 81-3. Varanasi: Chaukhambha Sanskrit Sansthan; 2019. p. 323-4. |
| 11. | Mishra S. Bhavprakash of Bhava Mishra. Haritakyadi Varga. 8 th ed. Ver 42-3. Varanasi: Chaukhambha Sanskrit Sansthan; 2003. p. 136. |
| 12. | Timmapur GM, Fiaz S. Efficacy of Triphala Ghrita and Goghrita Manda Tarpana in the management of Shushkakshipaka w.s.r. to dry eye syndrome: An open labelled randomized comparative clinical trial. Ayu 2020;41:52-7. |
[Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6], [Figure 7], [Figure 8]
[Table 1]
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