+14 more
Present a case on prathama patalagata timira in Netra roga
Reading File
analyse_media
analyse_media
Finding Sources
analyse_media
analyse_media
Finding Sources
Finding Sources
Searching the Web
Prathama Patalagata Timira Ayurveda case presentation Netra Roga Shalakya Tantra
Reading Web Page
https://www.allmultidisciplinaryjournal.com/uploads/archives…
Searching the Web
Prathama Patalagata Timira samprapti ghataka nidana poorvaroopa roopa chikitsa Ayurveda
Here is a complete case presentation on Prathama Patalagata Timira as per the Shalakya Tantra case sheet format shown in your images:
CASE PRESENTATION
प्रथम पटलगत तिमिर (Prathama Patalagata Timira)
Netra Roga - Shalakya Tantra | IIIrd Phase
1. CASE DETAILS / रोगी परिचय
| Field | Details |
|---|---|
| Name / नाम | Mr. [Patient Name] |
| Age / आयु | 18 years |
| Sex / लिंग | Male |
| Occupation / व्यवसाय | Student |
| Address / पता | [Address] |
| Chief Complaint / मुख्य शिकायत | Blurring of distant vision (Avyakta Darshana) since 6 months |
| Duration / अवधि | 6 months |
| Associated Complaints | Headache, eyestrain, squinting to see distant objects |
2. HISTORY / इतिहास
History of Present Illness:
Patient, a student, presents with progressive blurring of distant vision for the past 6 months. He complains of difficulty reading the blackboard from the back row of the classroom, frequent headaches after prolonged reading, and squinting while trying to see distant objects. He denies any redness, discharge, or pain in the eyes.
Past History / पूर्व इतिहास:
No h/o similar complaints previously. No h/o trauma, systemic disease.
Family History / कुटुंब इतिहास:
Father uses spectacles for distance vision.
Personal History / व्यक्तिगत इतिहास:
- Diet: Mixed (Ahara - Viruddha ahara, excessive Ruksha and Katu rasa food)
- Bowel: Regular
- Sleep: Disturbed due to late night screen use (Ratrijagarana)
- Habit: Excessive mobile/screen use (Sukshma Nireekshana, Atidipta Avalokanam)
3. SYSTEMIC EXAMINATION / सर्वांग परीक्षण
- Pulse / नाडी: 72/min, regular
- Blood Pressure: 110/70 mmHg
- Temperature: Afebrile
- Respiratory Rate: 16/min
- Ashtavidha Pariksha:
- Nadi: Vatapittaja prakriti
- Mala: Samyak
- Mutra: Samyak
- Jihva: Nirama
- Shabda: Spashta
- Sparsha: Samasheetoshna
- Drik: Avyakta (diminished distant vision)
- Akriti: Madhyama
4. OCULAR EXAMINATION / नेत्र परीक्षण
| Parameter | OD (Right) | OS (Left) |
|---|---|---|
| Head Posture / शिरः स्थिती | Normal | Normal |
| Facial Symmetry / मुख द्विपार्श्व | Symmetrical / सम्मिति | Symmetrical |
| Eye Brows / भूमंडल | Normal | Normal |
| Eye Lashes / पक्ष्म मंडल | Normal | Normal |
| Eye Lids / वर्त्म मंडल | Normal, no ptosis | Normal |
| Orbit / अक्षिकूट | Normal | Normal |
| Conjunctiva / श्लेष्मावरण कला | Clear, no congestion | Clear |
| Sclera / शुक्ल मंडल | White, no icterus | White |
| Cornea / कर्णिका - Size | Normal (11mm) | Normal |
| - Shape | Round | Round |
| - Curvature | Normal | Normal |
| - Transparency | Clear / स्वच्छ | Clear |
| - Vascularization | Absent | Absent |
| - Sensation | Normal | Normal |
| Iris / तारका | ||
| - Color | Brown | Brown |
| - Pattern | Normal | Normal |
| - Synechiae | Absent | Absent |
| Pupil / दृष्टिमंडल | ||
| - Size | 3mm, equal | 3mm, equal |
| - Shape | Round, regular | Round |
| - Reflex | RAPD - ve | RAPD - ve |
| Lens / दृष्टिमणि | ||
| - Color | Clear | Clear |
| - Transparency | Transparent | Transparent |
| - Displacement | Absent | Absent |
| Anterior Chamber / पूर्व वेश्म | ||
| - Depth | Normal | Normal |
| - Content | Clear | Clear |
| Lacrimal Apparatus / अंश्रुमार्ग | ||
| - Lacrimal Puncta | Patent | Patent |
| - Lacrimal Sac | No regurgitation | No regurgitation |
| Junctional Area / संधिपरीक्षण | ||
| - Outer canthus / अपांगगत संधि | Normal | Normal |
| - Inner canthus / कनीनिकागत संधि | Normal | Normal |
| - Eyelid margin / पक्षमवर्त्मगत संधि | Normal | Normal |
| - Fornix / वर्त्मशुक्लगत संधि | Normal | Normal |
| - Limbus / शुक्लकृष्णगत संधि | Normal, clear | Normal |
5. VISUAL ACUITY TEST / दर्शन शक्ति परीक्षण
| Vision | Right (OD) | Left (OS) | Both |
|---|---|---|---|
| Without Glasses - Distance | 6/18 | 6/12 | 6/9 |
| Without Glasses - Pin Hole | 6/6 | 6/6 | 6/6 |
| Without Glasses - Near | N6 | N6 | N6 |
| Near - Pin Hole | N6 | N6 | N6 |
| With Glasses - Distance | - | - | - |
| With Glasses - Near | - | - | - |
- Visual Field / दृष्टिक्षेत्र: Full to confrontation OU
- Color Vision / वर्ण ज्ञान-व्यवच्छेद: Normal
6. RETINAL EXAMINATION / दृष्टिपटल परीक्षण (Direct Ophthalmoscopy)
| Parameter | Right | Left |
|---|---|---|
| Media / मध्यम | Clear | Clear |
| Optic Disc / दृष्टनाडी शीर्ष | Normal, well defined margins | Normal |
| CD Ratio | 0.3 | 0.3 |
| Macula Lutea / पीत बिंदु | Normal reflex | Normal |
| Blood Vessels / रक्त वाहिन्या | Normal A:V ratio | Normal |
| General Fundus / दृष्टिपटल | Normal | Normal |
7. TONOMETRY / नेत्र दाब परीक्षण
- OD: 14 mmHg | OS: 14 mmHg (Normal)
8. OTHER SPECIFIC EXAMINATIONS
- Retinoscopy: OD: -1.00 DS / OS: -0.75 DS
- Keratometry: Normal corneal curvature
- B-Scan USG: Normal axial length (mild elongation possible)
9. LAB INVESTIGATIONS / प्रयोगशाला जांच
- CBC, Blood Glucose - Within normal limits
- Urine R/E - Normal
10. NIDANA / निदान (Etiology)
Samanya Nidana for Netra Roga (Common causative factors):
| Nidana Type | Examples in this patient |
|---|---|
| Sukshma Nireekshana | Excessive viewing of mobile screen, fine print reading in dim light |
| Dura Nireekshana | Straining to see distant objects repeatedly |
| Ratrijagarana | Late night studying/screen use |
| Pradhamsha Abhishyanda | Exposure to dust, smoke |
| Vega Dharana | Suppression of natural urges (bashpa/tears) |
| Atiushna Ahara | Excessive spicy/hot food intake |
| Viruddha Ahara | Incompatible food combinations |
| Guggulu Atiyoga | (As per Vagbhata) |
| Shoka/Krodha | Mental stress as a student |
11. POORVA ROOPA / पूर्वरूप (Prodromal Symptoms)
- Cloudiness of vision (Avyakta darshana) - mild, intermittent in the beginning
- Slight lacrimation (Ashru srava)
- Heaviness of eyes (Guruta)
- Vihanyamana rupa - slight reduction in clarity when tired
- Mild photophobia
- Eye strain (Shrama) after reading
(As per Ayurvedic classics, specific poorvaroopa for Timira are mentioned under Netra Roga Samanya Poorvaroopa)
12. ROOPA / रूप (Clinical Features)
According to Patala involvement:
Prathama Patalagata (1st Patala):
- Avyakta Darshana: All external objects appear dim and hazy to the sight
- Deranged Doshas passing through Roopavaha Siras get lodged in the 1st patala (Drishti)
- Sushruta (Su.Ut. 7): "सर्वत्र मूढदर्शनम्" - Objects appear unclear/dim without any obvious cause
- Vagbhata (A.H.Ut. 13): "अनिमित्तमव्यक्तरूपदर्शन" - Seeing objects unclearly without apparent cause
- Unable to see distant objects clearly
- Near vision well preserved
- Pin hole test improves distant vision
According to Dosha involvement:
| Dosha | Features in this patient |
|---|---|
| Vata | Objects appear scattered/multiple images |
| Pitta | Coloured halos, photophobia |
| Kapha | Heaviness, watering |
| Tridoshaja | Avyakta darshana (all objects appear hazy) |
13. SAMPRAPTI / सम्प्राप्ति (Pathogenesis)
Due to excessive Nidana sevana (Sukshma/Dipta nireekshana, Ratrijagarana, Viruddha ahara):
Doshas vitiated (primarily Tridosha with Vata predominance)
↓
Vitiated Doshas travel through Roopavaha Siras (visual channels)
↓
Get lodged in the Prathama Patala (1st layer of Drishti / innermost coat of pupil)
↓
Obstruction of the channels (Srotas - Rupavaha Siras) = Sanga type Srotodushti
↓
Disruption of nutritional supply to the Drishti (Dhatuposhana is impaired)
↓
Impaired visual processing at the 1st Patala level
↓
Avyakta Darshana - Blurring/hazy distant vision
14. SAMPRAPTI GHATAKA / सम्प्राप्ति घटक
| Ghataka | Component |
|---|---|
| Dosha | Tridosha (primarily Vata + Pitta vitiation) |
| Dushya | Rasa, Rakta, Mamsa dhatu |
| Agni | Jatharagni Mandya (leads to Ama formation) |
| Srotas | Roopavaha Siras (visual channels) |
| Srotodushti | Sanga (obstruction) and Vimarga Gamana |
| Rogamarga | Madhyama Rogamarga (Shiras is Pradhana Marma) |
| Adhishthana | Drishti (Prathama Patala specifically) |
| Vyakta Sthana | Netra (Eye) |
| Roga | Prathama Patalagata Timira |
15. DIFFERENTIAL DIAGNOSIS
| Differential | Distinguishing Feature |
|---|---|
| Dviteeya Patalagata Timira / द्वितीय पटलगत तिमिर | Visual acuity more reduced, inability to thread a needle (Suchipashyam na pashyati), may correlate to Presbyopia/higher refractive error |
| Kacha / काच | Lens opacity visible, gradual vision loss, correlates to Cataract |
| Linganasha / लिंगनाश | Complete blindness, loss of light perception, correlates to mature cataract/amaurosis |
| Refractive errors (Myopia) | Pin hole improves vision - confirms refractive nature |
| Glaucoma (Adhimantha) | Raised IOP, optic disc changes, visual field defects |
(Handwritten note on case sheet confirms: Differential Diagnosis - Dviteeya Patalagata Timira, Kacha, Linganasha, Refractive errors/Myopia)
16. COMPLICATIONS / उपद्रव
- Progression to Dviteeya/Triteeya Patalagata Timira
- Kacha (cataractous changes)
- Linganasha (total loss of vision) if untreated and Doshas progress deeper
- Amblyopia (Lazy eye) if untreated in young age
- Anisometropia
17. DIAGNOSIS / व्याधि निर्धारण
Ayurvedic Diagnosis: प्रथम पटलगत तिमिर (Prathama Patalagata Timira)
- Drishtigata Roga, Tridoshaja predominance
- Madhyama Rogamarga
- Sadhya (Curable) - 1st Patala involvement
Modern Correlation: Simple Myopia (Shortsightedness / Refractive Error)
18. PROGNOSIS / साध्य-असाध्यता
Sadhya (Curable) - as it is Prathama Patalagata Timira.
| Stage | Prognosis |
|---|---|
| 1st Patala (Prathama) | Sadhya - completely curable |
| 2nd Patala (Dviteeya) | Krichchra Sadhya - difficult to cure, eye becomes reddish |
| 3rd Patala (Triteeya) | Yapya - only manageable |
| 4th Patala (Chaturtha) | Asadhya - incurable (except Kaphaja Linganasha) |
19. TREATMENT / चिकित्सा
Treatment Principle / चिकित्सा सूत्र:
Nidana Parivarjana + Dosha Shamana + Drishti Prasadana
Based on dominance of Dosha - Snehapana, Virechana, Nasya, Anjana, Tarpana, Lepa, Seka are advised.
ORAL MEDICATIONS / अभ्यन्तरयोग:
| Medicine | Dose | Anupana | Indication |
|---|---|---|---|
| Triphala Ghrita | 10 ml | Warm water | Chakshushya, Tridoshahara |
| Saptamrita Lauh | 250 mg BD | Honey + Ghrita | Chakshushya, vision improvement |
| Amalaki Rasayana | 5g BD | Milk | Rasayana, Chakshushya |
| Triphala Churna | 3g at bedtime | Lukewarm water | Deepana, Pachana, Anulomana |
| Mahatriphala Ghrita | 10 ml | Milk | Specifically indicated in Timira |
"The patient should be made to lick a compound of powdered Triphala with copious quantity of Ghrita in cases of Pittaja Timira, with oil in Vataja Timira, and with honey in Kaphaja Timira." (Su. Ut. 7)
"The use of old and matured Ghrita kept in an iron vessel proves beneficial in Timira of any type." (Su. Ut. 7)
KRIYA KALPA / ANUSHASTRA KARMA:
Name of procedure: नेत्र तर्पण (Netra Tarpana)
| Step | Procedure |
|---|---|
| Purva Karma | Sarvanga snehana (Abhyanga with Tila taila), Sarvanga Swedana (Bashpa sweda), face Snehana + Nasya (Anu taila 2 drops each nostril) |
| Pradhana Karma | Netra Tarpana with Triphala Ghrita or Mahatriphala Ghrita - Construct well/dam (Kupa) around eye with black gram paste (Masha), fill with lukewarm medicated ghrita, patient asked to blink repeatedly; retain for 100-200 matras (approx. 7-10 minutes) |
| Pashchat Karma | Drain ghrita, clean eye gently, apply protective Anjana (Kajal), advise rest in semi-dark room; avoid bright light, dust, and wind; Pindi application over closed eyes if needed |
Other Kriya Kalpas:
- Aschyotana (Netra Parisheka): Triphala kashaya or Rose water eye drops
- Nasya: Anu Taila 6 drops each nostril - for Urdhvajatrugata Vikaras
- Anjana: Saikataanjana or Rasanjana - for Chakshusya effect
- Shirobasti / Shirodhara: With Ksheerabala taila - for associated headache, Vata Shamana
20. SUITABLE-UNSUITABLE DIET & LIFESTYLE / पथ्य-अपथ्य आहार-विहार
Pathya (Suitable / पथ्य):
Ahara:
- Cow's ghee (Go-Ghrita), milk (Dugdha), butter (Navanita)
- Triphala in diet
- Green leafy vegetables, Draksha (grapes), Amalaki (amla)
- Shatavari, Yashti madhu (liquorice)
- Light, easily digestible food
- Madhura (sweet), Tikta (bitter) and Kashaya rasa foods
Vihara:
- Adequate sleep and rest
- Eye exercise (Trataka - lamp gazing at moderate distance)
- Mild walking in natural light (early morning)
- Regular Netra Prakshalana (washing eyes with cool water)
- Adequate reading distance and lighting
- Taking breaks from screen (20-20-20 rule)
Apathya (Unsuitable / अपथ्य):
Ahara:
- Excessive Katu (pungent), Amla (sour), Lavana (salty) food
- Viruddha Ahara (incompatible food combinations)
- Excessive alcohol, fermented food
- Atisheetala ahara (extremely cold food)
- Junk food, excessive oily/fried food
Vihara:
- Excessive screen time / mobile use (Sukshma-Atidipta Nireekshana)
- Reading in dim light or bright sunlight without protection
- Ratrijagarana (staying awake at night)
- Diva Swapna (day sleep - increases Kapha, clouds vision)
- Exposure to dust, smoke, and bright light
- Suppression of tears (Bashpa-Vega Dharana)
- Excessive weeping, straining eyes
21. FOLLOW-UP
| Date | Clinical Features | Treatment |
|---|---|---|
| Day 0 | BCVA OD 6/18, OS 6/12; complains of headache + distant blur | Tab Saptamrita Lauh + Triphala Ghrita; Netra Tarpana course initiated |
| Day 7 | Reduced headache, slightly improved subjective vision | Continue same; Nasya with Anu Taila added |
| Day 14 | BCVA OD 6/12, OS 6/9 improved; less eyestrain | Continue + lifestyle counselling |
22. REFERENCES
- Sushruta Samhita, Uttara Tantra, Chapter 7 (Timira Pratishedha)
- Ashtanga Hridayam, Uttara Tantra, Chapter 13
- Charaka Samhita, Indriya Sthana
- Review on Prathama Patalagata Timira (Simple Myopia), International Journal of Multidisciplinary Research, 2024
- Clinical efficacy of Madhu Aschyotana in management of Prathama Patalagata Timira, JAIMS
Summary Note: The case sheet images show this is a Shalakya Tantra IIIrd Phase case format (pages A-3 through A-11). The handwritten notes visible on the sheet indicate the differential diagnosis includes Dviteeya Patalagata Timira, Kacha, Linganasha, and Refractive errors (Myopia), which is consistent with the above presentation. The Media noted as "Clear" and Normal findings with visual acuity of 0.3 are visible in the upper portion of some pages - consistent with the mild myopic presentation described.
This is a shared conversation. Sign in to Orris to start your own chat.