PTOSIS (NETRA PATANA)

PTOSIS (NETRA PATANA)

Ptosis is defined as the drooping of the upper eyelid due to dysfunction of the muscles that elevate the eyelid. In Ayurveda, it is correlated with "Vartma Patana" or "Akshi Vartma Vikara" based on symptom similarity.

ETYMOLOGY AND DEFINITION

• Ptosis comes from the Greek word “πτῶσις” meaning “falling.”

• It refers to a drooping of the upper eyelid, which may be unilateral or bilateral.

• Ptosis can be congenital or acquired.

ETIOLOGY (NIDANA)

A. ACCORDING TO AYURVEDA

• Vata Vyadhi: Ptosis is often considered a Vata-dominant disorder.

• Excessive ruksha (dry), sheeta (cold), and laghu (light) ahara-vihara lead to vata prakopa.

• Abhighata (trauma) to the eye or eyelid region.

• Shira abhighata (head injury) can cause cranial nerve palsy affecting eyelid movement.

• Dhatukshaya, especially of mamsa dhatu (muscle tissue) and majja dhatu (nervous tissue).

• Avarana (obstruction) of vata by kapha or pitta.

Sanskrit Reference:
“वायुर्विदारणात् कुर्यात् नेत्रस्य चलनं तथा ।
वर्तनं पतति भ्रान्तं संकुचत्यथवा स्थिरम् ॥”
– Ashtanga Hridaya Uttara Tantra, 13/8
(Explains vata involvement leading to abnormal eye movements and eyelid dysfunction)

B. ACCORDING TO MODERN MEDICINE

Congenital Causes:

• Congenital myogenic ptosis (levator muscle dystrophy)

• Congenital neurogenic (third nerve palsy, Horner’s syndrome)

Acquired Causes:

• Neurogenic: Third nerve palsy, Horner’s syndrome, Myasthenia gravis

• Myogenic: Myopathy, muscular dystrophy

• Aponeurotic: Senile or involutional ptosis due to disinsertion or dehiscence of levator aponeurosis

• Mechanical: Tumor, edema, or scarring pulling down eyelid

• Traumatic: Injury to nerve or muscle involved in eyelid elevation

CLINICAL FEATURES (LAKSHANA)

A. AYURVEDIC FEATURES

• Vartma patana (eyelid drooping)

• Aakunchana (inability to lift eyelid properly)

• Sthirata (stiffness or immobility of eyelid)

• Netra daurbalya (eye fatigue or weakness)

• Associated features may include shiro ruk (headache), akshi ruk (eye pain) due to vata prakopa.

B. MODERN FEATURES

• Drooping of upper eyelid (partial or complete)

• Visual field obstruction

• Chin elevation (compensatory head posture)

• Eyebrow elevation (frontalis overaction)

• Fatigability (seen in myasthenia gravis)

• Unequal palpebral fissure height

• Anisocoria (unequal pupil size) in Horner’s syndrome

• Diplopia (double vision) in neurogenic causes

PRINCIPLE OF TREATMENT (CHIKITSA SIDDHANTA)

A. AYURVEDIC MANAGEMENT

Chikitsa Sutra: Vata Anulomana, Balya, Brimhana, Snehana, and Nadi Sweda

1. SNEHANA (OLEATION)

   • Abhyanga with medicated oils like Mahamasha taila, Ksheerabala taila

   • Helps in reducing vata and improving muscle tone

2. SWEDANA (SUDATION)

   • Nadi sweda over eye and periocular muscles

   • Improves local circulation and neuromuscular response

3. NASYA KARMA

   • Use of anu taila, shadbindu taila as nasal drops

   • Especially beneficial in urdhwajatrugata vata rogas

4. SHIROBASTI / SHIRODHARA

   • With Bala taila, Brahmi taila

   • Strengthens cranial nerves and improves neurological function

5. NETRA TARPANA / PUTAPAKA

   • Using ghee preparations to nourish eye muscles

   • Triphaladi ghrita, Jeevantyadi ghrita used

6. ORAL MEDICINES

   • Ashwagandha, Brahmi, Vacha, Rasna, Shankhapushpi, Suvarna bhasma, Mahayogaraj Guggulu

   • For vata shamanam and nervine strengthening

Sanskrit Reference:
"तत्र स्नेहस्वेदनाभ्यङ्गनस्यादीनि च कारयेत्।
नस्यं नेत्रतरं चैव, स्वेदादीनि प्रयोजयेत्॥"
– Ashtanga Hridaya Uttara Tantra, 13/17

B. MODERN TREATMENT

1. IDENTIFICATION AND TREATMENT OF UNDERLYING CAUSE

• Myasthenia gravis: anticholinesterase drugs (e.g. pyridostigmine), corticosteroids

• Third nerve palsy: investigation for aneurysm, diabetes control

• Horner’s syndrome: treat underlying pathology

2. SURGICAL MANAGEMENT

• Frontalis sling surgery – for severe ptosis with poor levator function

• Levator resection – for moderate ptosis with fair levator function

• Müller’s muscle-conjunctival resection – for mild ptosis with good levator function

3. NON-SURGICAL OPTIONS

• Ptosis crutch – mechanical support in spectacle frames

• Physiotherapy – in neurogenic or traumatic ptosis (limited role)

PROGNOSIS (SADHYASADHYATA)

• Ayurveda: Prognosis depends on dosha predominance, chronicity, and dhatu involvement. Early stages with vatika predominance respond well.

• Modern medicine:

  • Congenital ptosis: surgical correction often needed

  • Myasthenia gravis-related: variable prognosis depending on systemic control

  • Third nerve palsy: may recover partially or fully over time