AYURVEDIC MANAGEMENT OF POST-FEBRILE MACULAR HEMORRHAGE WITH SPECIAL REFERENCE TO URDHVAGA RAKTAPITTA: AN OCT-DOCUMENTED CASE REPORT

Abstract

Background: Macular hemorrhage is a potentially sight-threatening retinal disorder characterized by bleeding within the macular region, leading to sudden impairment of central vision. The condition may develop secondary to retinal vascular disorders, trauma, inflammatory conditions, or post-febrile vascular alterations. Management in conventional ophthalmology is largely directed toward the underlying cause, and spontaneous recovery is often awaited in selected patients. However, no universally accepted pharmacological treatment exists for uncomplicated post-febrile macular hemorrhage. From an Ayurvedic perspective, hemorrhagic manifestations involving structures above the clavicle may be conceptually correlated with Urdhvaga Raktapitta, resulting from vitiation of Pitta Dosha and Rakta Dhatu. Objective: To evaluate the functional and anatomical outcomes of Ayurvedic management based on Raktapitta Chikitsa Siddhanta in a patient with post -febrile macular hemorrhage using best-corrected visual acuity (BCVA), fundus examination, and spectral-domain Optical Coherence Tomography (OCT). Case Presentation: A 28-year-old male presented with sudden painless diminution of vision in the right eye for five days following a recent febrile illness. Best-corrected visual acuity was 3/60 in the affected eye. Fundus examination revealed localized macular hemorrhage associated with retinal thickening, while OCT demonstrated a hyper-reflective lesion involving the macular region with increased central macular thickness (358 µm). The patient underwent a comprehensive Ayurvedic treatment protocol comprising Deepana–Pachana, Pratimarsha Nasya, Raktachandanadi Bidalaka, Shamana Aushadhi, and Pathya–Apathya for 30 days. Results: Following completion of therapy, BCVA improved from 3/60 to 6/6 (partial). Fundus examination demonstrated marked resolution of the macular hemorrhage with restoration of the normal foveal appearance. OCT showed substantial reduction of the hyper-reflective lesion and normalization of retinal architecture, while central macular thickness decreased from 358 µm to 261 µm, indicating objective anatomical recovery. No recurrence or deterioration was observed during the subsequent four-week follow-up. Conclusion: The present case demonstrated encouraging functional and structural recovery following Ayurvedic management based on Pitta-Shamana and Rakta-Stambhana principles. Integration of classical Ayurvedic therapeutics with modern retinal imaging enabled objective monitoring of treatment response. Although spontaneous resolution cannot be completely excluded in isolated post-febrile retinal hemorrhage, the favorable clinical outcome observed in this patient suggests that Ayurvedic intervention may have a supportive role in selected cases. Further prospective studies involving larger patient populations are required to establish efficacy and reproducibility.