Tear secretion provides continuous moisture and lubrication on the ocular surface to maintain comfort, corneal, and conjunctival health and vision. The lacrymal gland, globlet cells, and meibomian glands produce different secretions, which compositely form a layer on the eye termed as a tear film. Abnormalities of any of the components of the secretion (quantitatively or qualitatively) lead to the instability of the tear film, resulting in drying of the ocular surface and the syndrome.
Ayurveda describes a similar condition called Shushkakshipaka
, which matches etymological[1
] derivation and clinical picture[2
is mentioned in the classical literature of Ayurveda under Sarvagata Netraroga
(diseases affecting all parts of the eye). Based on our current knowledge of dry eye syndrome, it is more appropriate to consider[3
] it as an ocular surface inflammatory syndrome rather than simply a tear film insufficiency. Indeed the term keratoconjunctivitis sicca, used for decades to describe the ocular surface disease that develops in dry eye, by definition, acknowledges an inflammatory aetiology.
Tear substitutes are the only treatment modality with modern medical science. The duration of action of these tear substitutes is variable and are advised as per the need, only providing symptomatic relief. The preservatives present in these formulations are also a cause of dry eye, whereas those available without preservatives (e.g., are not cost-effective.
As per Ayurveda, each patient of dry eye needs a different approach as the etiology and pathology are variable. Vata-Pitta/Rakta
] vitation in shushkaksipaka
is the basic pathology due to disturbed system biology which needs a holistic approach to deal with the problem.
We describe a patient with dry eye who was regularly taking medicines and seeking consultation for the problem for a period of 5 years, which included antibiotics orally and topically, artificial tear supplements, and lubricating eye ointment. However, even after that patient had slight symptomatic relief and turned to Ayurvedic medicines for relief.
The patient, a 39-year-old woman, Hindu by religion, housewife, living presently in Jamnagar presented at the OPD of Netraroga (Shalakya department) I.P.G.T. and R.A. Hospital, Gujarat Ayurveda University, Jamnagar, on December 04, 2008. She complained of pain in both eyes, foreign body sensation, and dryness in eyes for the past 5 years. She was a pre diagnosed case of dry eye since November 2003 at Command Hospital (SC), Pune. Her problem started in Pune when she was 33 years old after she suffered from malaria fever in October 2002 for which she took treatment, following which she had an attack of asthma; she was given medicine for inhalation (name and record of the inhaled medicine not available with the patient).
On the very first day of using inhaler, she developed white ulcerative patches in oral cavity in November 2002, but she continued using the inhaler for 1 month, as doctor advised her to use that till her asthma problem persisted. Since then, she was under treatment in Command Hospital in Pune with regular follow-ups. She was treated on the line of oral candidiasis with mild symptomatic relief but oral ulcers persisted thereafter. Along with the patches, she had excessive salivary secretion. After 9 months in August 2003 along with her oral complaint, her ocular complaints started. She had mild blurred vision in 2003, although on examination she had distant visual acuity 6/6 in both eyes. She later complained of foreign body sensation, and burning and whitish discharge in both eyes, more in left eye. At that time her eye examination revealed greasy lid margins in both eyes (L>R),locked meibomian orifices foamy discharge on outer surface, and Schirmer's readings of 10 mm in 05 min (Rt. eye) and 02 mm in 05 min (Lt. Eye). A diagnosis of evaporative dry eye due to chronic meibomitis was made and treatment was given with doxycycline, hot compression over lids, and hypotear plus eye drops.
Later a diagnosis of oral Lichen planus was made and treatment with Triamcidone acetonice paste initiated. Later a further diagnosis of generalized Xerosis was made for which local application of liquid paraffin, glycerine, and water (1:1:2) was prescribed.
In December 2008, the distant visual acuity had become 6/12p in the right eye and Lt. eye 6/9p in the left eye. There was no tear meniscus present and a lot of mucous debris was seen. On fluoresceine staining corneal and conjunctival epithelial defects were seen. The tear film break up time was 3–5 sec in both eyes, and the Schirmer's test was 0 mm in both eyes after 5 min.