How to Treat Punctate Inner Choroidopathy with Ayurveda?

ABSTRACT

If any organism can feel nature, the reason behind it is his ability to sense. As a human we are gifted with 5 senses that introduces us to life. Of all the senses the sense to see is the most beautiful yet vulnerable creation of the god. Human eye is often praised for its beauty, remarkable expression, accommodation and distinctive vision but indeed can be a victim to so many pathologies too. Eyes play such a vital role, it becomes very necessary to understand the nature of the diseases that dysfunctions it.The concept of senses is very beautifully mentioned in Ayurveda by the name Indira. Ayurvedic texts name eyes “Chakshu Indriya” that is made up of “Tejo mahabhoot” (Fire element). Ayurvedic concepts describe vitiation of doshas to cause various pathologies. One such pathology that requires a detailed description, interpretation and elaboration is Punctate Inner Choroidopathy(PIC). This article discusses the nature,etiology,sign- symptoms and management of this pathology.

INTRODUCTION

Human eye is made up of various layers, each specialized with some different function.  It is made up on the outer side by Sclera (the white fibrous layer of an eye), the middle layer Choroid (Vascular layer of an eye) and the inner layer Retina (the photosensitive nervous layer). Choroid is the part of the Uvea of the eye. This vascular layer is made up of four layers which are

• Bruch ‘s membrane (found in the innermost part of the choroid)
• Choriocapillaris ( layer made up of capillaries)
• Sattler’s layer (layer made up  of medium size blood vessels)
• Haller’s layer (Outermost layer made up of  large size  blood vessels)

Punctate inner choroidopathy (PIC) is a pathology of choroid. It is considered an inflammatory disease that affects the choroid and retina causing vision loss, however its actual cause is not identified yet. It has been found that young women are most affected by this ailment.

ETIOLOGY

1. The actual cause is considered idiopathic (no known cause identified yet). However many theories have been made on the causative factor of the same.
2. Many consider it to be a viral (Epstein Barr) pathology.
3. Some compare it with Multifocal choroiditis and Panuveitis (MFCPU), Myopic degeneration or Multifocal Choroiditis (MFC) or may be a variant of one of these.
4. Infectious thrombosis of “Choriocapillaris layer”
5. Hereditary factors (some studies linked it with HLA- DR2)

VULNERABLE GROUP- Middle age (18 to 40 year old myopic females)

PATHOLOGICAL FINDINGS

Findings show bilateral white-yellow lesions that are approximately 100 to 200 microns in diameter. These lesions are seen in between choroid (inner) and retina (Retinal Pigment Epithelium). These lesions are bilateral but asymmetrical .They gradually turn into atrophic scars (deeper, depigmented halo). Neovascular sub retinal membranes too are identified in the findings. The findings of Punctate inner choroidopathy does not involve iritis or vitritis (unlike in MFCPU).

SIGN AND SYMPTOMS

The above condition shows the following sign and symptoms-

• Photopsia (floaters in eyes)
• Blurred vision
• Scotomata (appearance of blind spots in the vision)
• Photophobia
• Inflammation in the posterior part of eye
• Distorted vision

INVESTIGATIONS

Inorder to rule out the nature of lesions various diagnostic procedures are used such as-

• Fluorescein angiography (shows staining in cystoid macular edema (CME), acute lesions, Choroidal neovascular membrane (CNVM) etc that are associated with Punctate Inner Choroidopathy.
• Indocyanine green (ICG) (This has better diagnostic potential as it indicates PIC even in sub clinical stages via its hyperfluorescent spot in good number of patients)
• Electrophysiology (amplitude of waves are examined for abnormality)
• Electrooculogram (EOG) (This can diagnose very mild abnormalities of the Arden ratio due to the presence of the retinal pigment epithelial layer).
• Visual field-( this diagnose for the enlarged blind spot;Central or paracentral scotomata Scotoma)
• Spectral domain-Ocular coherence tomography (SD-OCT) (not a specific diagnostic test as such but helps showing the associated thickenings)
• Fundus autofluorescence (shows hyper autofluorescence halo around the lesion, an indication of uncontrolled inflammation)

MANAGEMENT

Usually for the patients that have no evidence of CNV (Choroidal neovascularization) no treatment is given.

• Modern medicine makes use of corticosteroids such as dexamethasone etc (in the form of implants,injections, etc) to numb the associated pain and inflammation.
• Antibiotic and immunosuppressives (Sirolimus,Mycophenolate mofetil)
• Photodynamic therapy
• Surgery

All these are either invasive procedures or involved with a lot of side effects. The use of these medications over this disease in longer runs can do enormous harm to the body. Ayurveda has a number of herbs that are naturally capable of reliving the ocular pressure and other pathologies of the eye. These herbs balance the vitiated doshas,and cures pathology.

Herbal Remedies For Punctate Inner Choroidopathy By Planet Ayurveda

Planet ayurveda  is a herbal manufacturing unit offering herbal formulations across all over the world. These formulations are 100% natural and prepared from standardized extract of herbs with strict adherence of ancient ayurvedic principles.They are very effective in alleviating lots of diseases as the planet ayurveda products are devoid of any kind of chemical, binder, preservative and additive. Planet Ayurveda offers a herbal remedies for Punctate Inner Cheroidopathy which includes the following

1. Angel Eye Vitale
2. Kaishore Guggul
3. Bilberry Capsules
4. Triphala Ghrit
5. Saptamrit Loha
6. Curcumin Capsules

PRODUCTS DESCRIPTION

1. Angel Eye Vitale

This is a very effective supplementation required for the betterment of eyes. It is composed of pure extracts of Vit C, Zinc, Bilberry, Carrot Seed, Marigold, Corn, Astaxanthin, Vit E etc. This makes it an amazing tonic for eye nourishment.

Dose: One capsule twice a day with plain water after meals

2. Kaishore Guggul

This formulation is made up of Amalaki (Emblica officinale), Bibhitaki (Terminalia bellirica), Haritaki (Terminalia chebula), Guggul (Comiphora mukul),Giloy (Tinospora cordifolia), Ginger ( Zingiber officinale), Black pepper ( Piper nigrum) etc, which makes it very efficient in combating inflammations,pain and associated symptoms of Punctate Inner Choroidopathy.

Dose: 2 tablets twice a day with plain water after meals

3. Bilberry Capsules

This formulation is made up of standardized extract of Vaccinium myrtillus which is rich in anthocyanosides that dilate the blood vessels and lower the blood pressure. This formulation is also a potent immunomodulator that can fight the pathogenic infestations.

Dose: 1 Capsule twice a day with plain water after meals

4. Triphala Ghrit

This formulation is made up Amalaki (Emblica officinale), Bibhitaki (Terminalia bellirica), Haritaki (Terminalia chebula), madhuka (Glycyrrhiza glabra), Katukarohini (Picrorhiza kurroa), etc. This formulation relieves itching, discharge, strain or pains of eyes. This ayurvedic formulation is tridoshghan and is loaded with rasaynik properties of triphala for eyes.

Dose: 1 tsp with warm water twice a day

5. Saptamrit Loha

This formulation is made of Triphala, Iron calx (Bhasma) and Licorice which boosts immunity by increasing the blood cells. This makes it an efficient anti pathogenic formulation and improves the systemic wellbeing.

Dose: one tablet twice a day with plain water after meals

6. Curcumin Capsules

This formulation has pure extracts of Curcuma longa which is an excellent anti-inflammatory, antibiotic and immunomodulation. It also helps in relieving pain and kills most of the microbes by detoxifying and antimicrobial action of the curcumin.

Dose: 1 capsule twice a day with plain water after meals.

CONCLUSION

Ayurveda has a huge potential in infectious pathologies too. This is because it has ancient methods for boosting up immunity and making the body fight with the same. The herbal formulations mentioned above are natural formulations that can relieve Punctate Inner Choroidopathy without causing any side effects.