Role of Netra Tarpana with Triphala Ghrita in Dry Eye: A Clinico-Pathological Evaluation

Abstract

Dry eye syndrome is a very common condition that is characterized by a disturbance of the tear film. There is not a single entity which can be compared as dry eye but a group of diseases or stages of diseases which are more or less similar to dry eye like Sushkaksipaka, Pothaki, Suktika. Preservative-free tear substitutes are the first step in medical management of DED which increases humidity and improves lubrication at the ocular surface. The preservative present in these formulations also causes dry eye. Thus, temporary symptomatic relief can be obtained by these modalities of modern treatment, but there is no satisfactory treatment of dry eye at present. Once dry eye syndrome developed it cannot be prevented, only its effects may be reduced with the help of medicine, surgery and self-care suggestions. Recent works on Triphalaghrita have shown its beneficial effect on dry eye. It can be used as good local lubricating agent and more over it is easily available, cheap and free from side effects. Considering these factors it was essential to evaluate its efficacy on dry eye. So Triphalaghrita Tarpan for 15 min was given to the patients of treated group in the interval of 7 days twice in therapy. Study was conducted on 120 eyes of 60 patients. The patients were divided into two groups, Group I (Control) and Group II (Treated). Subjective as well as objective findings were recorded in each group for a comparative assessment on first date of initial visit, response on the various clinical manifestations after 7 days (1st seating) of treatment (1st follow up-F1), after 21 days (2nd seating) with an interval of 7 days (2nd follow up-F2). The relapse rate was recorded after 15 days of stopping the treatment (AT1) and after 30 days of stopping the treatment (AT2). The accessing symptom of subjective criteria are feeling of dryness, foreign body sensation, discomfort, burning sensation, blurring of vision watering, heaviness of lids, hyperaemia, itching, ocular pain and for objective criteria Schirmer I test, tear film break up time (tbut), rose begal staining. Scoring pattern was developed for assessment for each symptom and examination. After statistical analysis it was observed; eyes receiving tarpana therapy slowly relieved in feeling of dryness and foreign body sensation but had less relapse rate as compared to control group. Though eight eyes did not respond to the treatment of tarpan, but the relief rate of discomfort is statistically significant with less relapse rate. Both groups showed statistically significant effect on burning sensation, blurring of vision, watering and heaviness of lids and watering. Eyes receiving tarpana therapy effectively cures hyperaemia and itching and ocular pain than control group. Effect of therapy was also observed in grades of Schirmer’s test, tear film break up time, rose begal staining. As is evident from data, both the groups reduced the grades after the completion of therapy. Thus conclusion shows that Triphalaghrita tarpan was able to cure dry eye disease slowly but more effectively and with less relapsing rate than control group.