Ayurvedic Approach in the Management of Keratoconus: A Single Case Study

Abstract

Keratoconus is a progressive, non-inflammatory corneal ectatic disorder characterised by paracentral thinning, conical protrusion, and irregular astigmatism, leading to gradual, painless visual impairment. It typically develops after puberty and is often associated with underlying corneal biomechanical weakness, with a higher prevalence in individuals with allergic or atopic conditions. This case report involves a 23-year-old female with a five-year history of progressive bilateral vision loss, requiring continuous spectacle correction. Corneal topography confirmed keratoconus, with central corneal thickness measuring 459 µm in the right eye and 453 µm in the left eye. At presentation, the best corrected visual acuity was 6/18 (OD) and 4/60 (OS). According to Ayurvedic principles, the condition was identified as Vatika Timira, described in the Drishtigata Roga of Prathama and Dviteeya Patala. The pathology of the disease can be described with Vata prakopa lakshanas such as Karsya (stromal thinning), Sramsa (structural loss of compaction), and Vyasa (apical protrusion). A complete pharmacological treatment protocol of Agnideepana, Vata anulomana and Brimhana was applied. Internal medications included Rajanyadi Churnam and Rasnadasamoola Ghritam, Virechana using Gandharva Eranda taila. External therapies included Nasya, Anjana, Tarpana with Jeevanthyadi Gana Ghrita, Brimhana Putapaka, Shirodhara with Ksheerabala, and Karpasasthyadi Sekam with Yashti Kashaya. The patient reported subjective visual improvement post-therapy. Acuity increased to 6/60 (OS) and remained unchanged at 6/18 (OD). Follow-up corneal topography showed stabilisation of corneal thickness without additional refractive progression during the follow-up period. It was suggested to maintain treatment with Anu Taila (2 drops in the nostrils evening for 2 weeks) as Pratimarsha Nasya. These clinical outcomes suggest that Ayurvedic interventions for restoring ocular tissue integrity and correcting Vata imbalance may be beneficial for functional stabilisation in keratoconus. There is a need for controlled clinical studies to scientifically validate the therapeutic potential of Ayurveda in corneal ectatic disorders, as reflected by this case.