Effect of Seka in the Management of Seborrhoeic blepharitis – A case study

INTRODUCTION

3Seborrhoeic blepharitis is primarily anterior blepharitis with some spill over posteriorly. The overallprevalence in India is more than 1millon cases per year. It is usually associated with seborrhoea of scalp (dandruff). In it, glands of Zeis secrete abnormal excessive neutral lipids which are split by Corynebacterium acne into irritating free fatty acids. It causes to deposition of whitish material (soft scales) at the lid margin associated with mild discomfort, irritation, occasional watering and a history of falling of eyelashes. SignsincludeAccumulation of white dandruff-like scales is seen on the lid margin, among the lashes. On removing these scales underlying surface is found to be hyperaemic and greasy. The lashes fall out easily but are usually replaced quickly. Lid marginis thickened and the sharp posterior border tends to be rounded leading to epiphora, in long standing cases. Treatment includes improvement of general health and balanced diet. Associated seborrhoea of the scalpshould be adequately treated. Local measures include removal of scales from the lid margin with the help of lukewarm solution of 3% soda bicarb or baby shampoo and frequent application of combined antibiotic and steroid eye ointment at the lid margin.

The similar clinical manifestation can be observed in a disease called as krimigranthi. 1It is a kaphaja bhedana sadhya vyadhi having the symptoms like 1 kandu kuryuhu (produces itching), krimayaha sandhi jatah(germination of krimis in netra sandhi)¹ , 2 usha (burnig sensation), pakshmapotavan (clubbing of lashes), pooyasrava (pus discharge), krimiyutoartiman (pain due to krimi)² . The specific treatment has been mentioned for krimigranthi such as 1 swedana, bhedana, pratisarana with manashiladi lepa, Rasakriyapariseka with triphala kwatha 1 and 2 lekhana.

In this study, a case of seborrhoeic blepharitis was treated with seka of triphala and yasthimadhu kashaya, Ophthacare eye drops (tid) and capsule Netramruta (tid) orally for 15days. Patient got marked relief.

MATERIALS AND METHOD:

CASE HISTORY: A 19 year old female patient came to our OPD with chief complaints of itching over lid margin, associated with falling of lashes and scales over lid margin with the H/O dandruff since 2 months. She was diagnosed as a case of seborrhoeic blepharitis.

CLINICAL FINDINGS: The pulse rate was 76/ minute. Respiratory rate was 18/minute and blood pressure was 110/70mmhg. Systemic examination was within normal limits.

OCULAR EXAMINATION: Eye ball, eye brows were normal in both eyes. White scale deposition and medarosis on lid margin was seen.

VISUAL EXAMINATION: In both eyes distant visual acuity was 6/6; N-6 (B/L).

DASHAVIDA PAREEKSHA: She is vatapitta prakruti. Vikruti ,Dosha-kapha and Dhaturasa,raktha,meda. Her Saara, samhanana ,pramana satmya, satva, aharashakti and vyayamashakthi were madyama. She was in yuvavasta.

ASHTVIDHA PAREEKSHA: Her nadi, mutra, shabda were prakruta. Mala was abadha. Jihva was alipta. sprsha was anushnasheetha. Akruti was madyama and Drik was 6/6.

SROTOPAREEKSHA: Rasa, Rakta, and Meda vaha srotas were involved.

DIAGNOSTIC ASSESSMENT: By observing the signs and symptoms diagnosis can be done.

THERAPEUTIC INTERVENTION: Seka was done with Triphala and Yastimadhu kashaya for 7 days followed by aschotana of ophthacare eye drops for 7 days. Capsule NETRAMRITA (TID) was given orally for 15 days.

RESULTS:

There was marked improvement in signs and symptoms. Itching, medarosis, scales were reduced.

DISCUSSION:

Line of management of krimigranthi include svedana, bhedana, pratisarana with manashiladi lepa and rasakriya-pariseka with triphala kashaya. Seka was done with triphala and yasthimadhu kashaya followed by Aschotana with ophthacare eye drops and Capsule NETRAMRIT(TID) was given orally. Sukhoshna seka reaches to the deeper tissues through Siramukha &Swedavahi Srotas, clears the obstruction in Swedavahi Srotas thus clearing out the micro channels. Whichhelps to removing the scales andincreasing the blood flow which enhances absorption of drugs and new metabolites formation. Thriphala is tridoshahara and yashtimadhu is vatapittahara and capsule Netramrit acts as a Raktashodhaka.The above said medicine having the antimicrobial, antiinflammatory, antioxidant action so pacifying the doshas involved in the krimigranthi.

CONCLUSION:

• Nidana parivarjana by treating the sebohhoea of scalp.

• Seka (Triphala, Yasthimadhu), Cap.Netramrit, Opthacare Eye drops played a vital role in reduction of signs and symptoms.

• Seka Karma can be advised for successful treatment in patients of krimigranti (Seborrhoeic Blepharitis) as it is cost effective and given better efficacy in treatment.

• By this method of treatment Steroid can be avoided.