Journal of Clinical and Diagnostic Research. 2019 Sep, Vol-13(9): KD01-KD04 1 1 DOI: 10.7860/JCDR/2019/42204.13175 Complementary/Alternative Medicine Section Case Report Ayurvedic Management of a Case of Central Retinal Vein Occlusion CASE REPORT A 31-year-old female with a history of blurring of vision in her left eye since August 2014. The patient was apparently well before August 2014. Her symptoms started suddenly, prompting her to seek an ophthalmic consultation. She was diagnosed with CRVO with severe macular oedema. She underwent one intravitreal injection, which gave slight relief. She consulted Sreedhareeyam Hospital in October 2014 and was advised on Inpatient (IP) management. She was neither diabetic nor hypertensive, and she does not present with dyslipidemia. Her personal history was normal. Her immediate family members do not report similar complaints. Distant Visual Acuity (DVA) was 6/6 in her right eye (OD) and 6/36 in her left eye (OS). Anterior segment examination was normal in both eyes. Posterior segment exam OS showed haemorrhages, cotton-wool spots, tortuous blood vessels, and a dull foveal reflex indicating macular oedema [Table/Fig-1a]. OCT OS along the naso- temporal plane showed an elevation at the macular region with a hyporeflective area within the elevation [Table/Fig-1b]. The patient was provisionally diagnosed with CRVO and macular oedema based on history and investigations. The disease Timira (blurring of vision), a DrshtigataRoga (disease of vision) according to Ayurveda, was explored based on the symptom of blurred vision. She underwent 2 courses of inpatient treatment. The first course was for 25 days (October 4 th , 2014 to October 28 th , 2014), and the second course was for 14 days (January 15 th , 2015 to January 28 th , 2015). Oral medicines included Guducyadi Kashaya, Sudarsanam Tablet, Amrtottaram Kashaya, Guduci Sattva, and Triphala Guggulu, Punarnavadi Kashaya, Dasamula Katutrayam Kashaya, and a Kashaya prepared from Kantakari, Tulasi, and Vasa [Table/Fig-2] were administered over the course of the treatments. External treatments comprised of Kriyakalpa (local ocular therapy), Panchakarma (purification), and therapies for the head. Virechana MANJUSREE RADHAKRISHNAN PARAPPURATHU 1 , ARAVIND KUMAR 2 , KRISHNENDU SUKUMARAN 3 Keywords: Ayurveda medicine, Kriyakalpa, Timira ABSTRACT Central Retinal Vein Occlusion (CRVO) is classified based on aetiology into ischaemic and non-ischaemic varieties. Treatment modalities of CRVO include intra-vitreal anti-Vascular Endothelial Growth Factor (anti-VEGF) injections, pan-retinal LASER photocoagulation, and pars plana vitrectomy. The case of a 31-year-old female with a two-month history of blurring and fogginess of vision in her left eye (OS) and who were diagnosed previously with CRVO is presented here. Analysis of her symptoms using Ayurvedic diagnostics showed that she suffered from Timiraor blurring of vision. She underwent inpatient treatment in October 2014 and January 2015. Oral medicines such as Kashaya (decoctions), tablets, and Sattva (starch extract) were administered. External treatment included Pancakarma therapy and local therapies for the head and eye (Kriyakalpa). The Assessment was done using Distant Visual Acuity (DVA), posterior segment examination, and Optical Coherence Tomography (OCT), which showed improvement both at discharge and 2 subsequent follow-ups. This case illustrates that prompt and timely consultation and management brought about significant improvement in both her vision and well-being. [Table/Fig-1]: a) Fundus photograph OS showing haemorrhages, tortuous blood vessels, cotton-wool spots, and dull foveal reflex; b) OCT scan OS showing marked elevation at the macular region with a hyporeflective area within the elevation. (therapeutic purgation), Pratimarsa Nasya (nasal medication), Tala (paste on a cotton gauze over the head), Talapoticchil (medicine on a plantain leaf over the head), Anjana (collyrium), Purampada (paste over the eyelids), Lepa (paste) over the forehead, and Pindi (poultice over the eyes) were administered during the first course of treatment. Pratimarsa Nasya, Tala, Talapoticchil, Sirolepa (paste over the head), Takradhara (irrigation of buttermilk over the head), Seka (irrigation), Anjana, and NetraPicu (cotton gauze with medicine over the closed eyes) were administered during the second course of treatment [Table/Fig-3]. All medicines prescribed were procured at Sreedhareeyam’s own medicinal gardens and were manufactured at Sreedhareeyam Ayurvedic Medicines, Pvt. Ltd., the hospital’s GMP-certified manufacturing unit. DVA assessed on 28 th October 2014 (25 th day of the first course) was 6/6 OD and 6/18 OS. The same reading was reported on January 28 th , 2015 (14 th day of the second course). The patient was administered Guducyadi Kashaya (15 mL with 45 mL boiled and cooled water before food), Saptamrta Lauha (1 tablet twice a day after food) [6], Pathya Punarnava Curna* (1 tablespoon of powder twice a day before food), Candraprabha Vati (1 tablet twice a day after food) [7], Triphala Guggulu (1 tablet twice a day after food), and Netramrtam* (1 drop in both eyes twice a day) at discharge and was advised regular follow-ups.