Ayurvedic management of Non-Sjögren's Dry Eye (Shushkakshipaka) as a preparation for cataract surgery—a case report

Abstract

This case report describes Shushkakshipaka (Non-Sjögren's Aqueous Deficient Dry Eye – Non-Sjögren's ADDE) in a patient unfit for cataract surgery due to compromised ocular surface integrity. A 73-year-old woman presented with ocular irritation, foreign body sensation, and blurred distant vision for three months. She had a six-year history of type II diabetes mellitus and hypertension, controlled. Evaluation revealed Grade 2 Nuclear Sclerotic cataract (NS) and Posterior Subcapsular cataract (PSC) (Left > Right) with Punctate Keratopathy, making immediate bilateral cataract surgery unsuitable. Schirmer's test I showed right eye <1 mm and left eye <1 mm, and tear break-up time (TBUT) was right eye (4 s) and left eye (6 s). She was diagnosed with moderate-to-severe non-Sjögren's ADDE and cataract. During ophthalmic evaluation, the patient was diagnosed with punctate keratopathy and dry eye symptoms. She was prescribed artificial tears and omega-3 fatty acid supplements. Cataract surgery was deferred, as the patient was unfit for surgery. Owing to inconsistent treatment adherence, conditions showed minimal improvement at the time of presentation to the Ayurveda hospital. She was diagnosed as Vata-Pitta Pradhana Shushkakshipaka (predominance of Vata and Pitta Doshas; in Ayurveda, Vata, Pitta and Kapha are collectively called Tridosha, the three regulatory functional factors of the body). Treatment had three phases. The first focused on systemic intervention, with Deepana (metabolism-enhancing) and Pachana (digesting), followed by Mrdu Shodhana (mild therapeutic bio-cleansing) and Marsha Nasya (high-dose errhine therapy). Following systemic cleansing and attainment of Niramavastha (a state free from accumulated metabolites achieved by either therapeutic measures or the effect of time), the second phase focused on local ocular management through Netra Kriyakalpa (localised ocular therapeutic procedures). The third involved follow-up and maintenance therapy for long-term ocular stability. Oral Ayurvedic polyherbal formulations, dietary modifications, and lifestyle changes were administered throughout the two-month Ayurveda treatment period. After two months, parameters improved, with Schirmer's values of right eye 5 mm and left eye 7 mm and TBUT of right eye 8 s and left eye 14 s, making her fit for cataract surgery. Within the Ayurvedic framework, these changes may be viewed as consistent with improved Agni (digestive/metabolic factors) and supportive of subsequent Kriyakalpa; links with ocular surface integrity or the gut-eye connection remain hypothetical. This case warrants further investigation in selected cataract surgery candidates with severe, non-responsive dry eye.