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Keratoconus |
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Keratoconus is type of corneal ectasia, which is bilateral and progressive in nature in which the cornea assumes an irregular conical shape. The onset is at around puberty with slow progression thereafter. It is a relatively rare condition. The prevalence ranges from 4 per 100,000 people to 600 per 100,000. Many early studies on keratoconus reported that the prevalence of the disease was much higher in women than in men. However, more recent studies have found that the prevalence is higher in men or that there is no significant difference. The cause of keratoconus is unknown. There have been many theories related with Heredity,
Association with Systemic Conditions, Eye Rubbing, Hormonal Change s, Rigid Contact Lens Wear etc. Morphologically it can be classified as Round or Nipple, Oval or Sagging, Ill-defined or Globus types. It is also associated with systemic diseases like Downs's syndrome, Turners syndrome, Marfans syndrome, Osteogenesis imperfecta and Mitral valve prolapse. Ocular conditions like myopia, aniridia, keratoconjunctivitis, laber congenital amaurosis and retinitis pigmentosa are also found involved with this disease |
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Approaching a patient with keratoconus |
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Sreedhareeyam has developed a unique protocol in the management of this disease. We here adopt a mixed approach consisting of both ayurveda and modern medicine. Modern investigations are confined to the diagnosis as well as prognostic assessment part, while the treatment is solely based on ayurveda. We here get patients within the age group of 10 to 45 ,in varying stages of the disease, with even history of surgical procedures. |
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As soon as the patients are admitted a detailed history is recorded, including onset, duration, causative factor, severity of the disease and presence of any coexisting systemic or ocular diseases. They are also enquired upon family history and a detailed treatment history. |
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The diagnosis and staging of the diseases is done considering the factors of age, duration, clinical condition at the time of presentation, presence of coexisting disorders and the corresponding dosha dooshyas. |
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The main investigations that are done here are. |
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Refraction analysis |
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Direct ophthalmoscopy, which shows an oil droplet reflex. Vessels of the fundus appear distorted and broken and the optic disc seems to be elongated |
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Retinoscopy shows an irregular scissor reflex |
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Slit lamp biomicroscopy shows very fine vertical deep stromal striae (Vogt lines) and prominent corneal nerves |
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Often we insist the patients, especially in the early stages, to get done corneal topography studies and the keratometry studies from elsewhere, which are very sensitive tests both in the diagnosis and prognostic assessment. |
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Ayurvedic Management |
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It's difficult to find out an exact reference about this disease condition from the classical textbooks of ayurveda. |
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According to different stages of samprapthi, this can be clinically classified into. |
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Stage 1 - Early |
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Stage 2 - Middle |
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Stage 3 - Late |
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Stage 4 - Complications |
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Stage 1 - Early |
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This manifest as the primary symptoms of keratoconus as distorted vision, sudden variation of visual acuity, ghost images and some times monocular diplopia difficult to be corrected with glasses – a condition referred to as difficult astigmatism. The disease can be easily diagnosed by direct ophthalmoscopy, retinoscopy and slit lamp examination which reveal deep stromal striae-(Vogt lines)-and prominent corneal nerves. Corneal topography, if done, is the most sensitive test to determine early stromal and structural changes. |
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Stage 2 - Middle |
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Very poor visual acuity, photophobia and FB sensation and eye pain are the symptoms. |
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Stage 3 - Late |
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In this stage, high degree of vitiation leads to functional defect. As per the latest research of the modern science, link between keratoconus cornea and high degree of free radical production is found which directly means the progressive degenerative process leading to corneal thinning. Detailed examination may reveal more progressive corneal thinning up to 1/3 rd and obvious conical shape of cornea. |
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Stage 4 - Complications |
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At this stage, extensive corneal thinning and scarring leads to rupture of the descemet's membrane and herniation of aqueous humour. States of acute hydrops and corneal ulcers are common. Stromal scarring is also not uncommon. |
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Treatment |
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We at Sreedhareeyam, usually treat patients belonging to the first three stages. This will yield the maximum prognosis. As the disease enters the terminal stages, therapeutic outcome also decreases. The approach of treatment in this disease does not go away from the classical lines in any stages. In some cases prodromal symptoms are noted, such as heaviness of head etc. So, the presence of indigestion is well established. Thus main aim of the treatment is to correct the digestive machanism. In this disease panchakarmas have a comparatively lesser role, but the upakarmas(treatments) have the main role. |
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We at sreedhareeyam, usually administer a treatment schedule that lasts for 3 weeks which completes a course. The patients are periodically assessed during their inpatient stay and are discharged with medicines to be taken at home. They are usually reassessed after 4 weeks in the OPD, and decided whether to under go another course or not. The improvement of vision starts gradually with in one year. Three courses of inpatient treatment are usually needed with an interval of four months. |
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The medicines given to treat this disease act through 2 routes. |
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1. Internal medicines [systemic] |
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2. External medicines [local] |
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For all the three stages the line of treatment is the same but the choice of medicine can be decided according to the severity of the stage. |
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Snehapanam |
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Virechanam - After snehapanam |
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Marsanasyam |
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Anjanam |
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Aschodanam |
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Nethradhara |
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Moordhwathailam |
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Tharpanam |
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Nethrabandhanam |
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Stage of Complications |
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Snehapanam and followed by Virechanam |
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In this stage, the vitiation is more, so Marsanasyam can be done. |
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Lekhana-anjana prayogam |
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Nethradhara |
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Moordhwathailam - sirodhara can be done, depending on the severity,oil used should be changed. |
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Tharpanam and Putapakam |
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