RETINITIS PIGMENTOSA

• Retinitis pigmentosa or primary pigmentary retinal dystrophy is a progressive hereditary dystrophy of the retina or of the photoreceptors and the retinal pigment epithelium
• It is a hereditary disorder predominantly affecting the rods more than the cones
• Difficulty with night vision, slow adaptation to the dark, and gradual loss of peripheral vision (tunnel vision) which often begin in childhood, but commonly diagnosed during adolescence with a positive family history is characteristic of RP

•  Retinitis pigmentosa (RP) may occur as Sporadic disorder, isolated without family history due to mutation of multiple genes (>50%) including rhodopsin gene (40%)

• The disease is almost invariably bilateral and both eyes are equally affected
• In typical retinitis pigmentosa, rod-cone dystrophy is seen, in which rods have degenerated early and cones are involved late

Visual symptoms

• Night blindness. It is the characteristic and earliest feature
• Dark adaptation
• Tubular vision-loss of peripheral vision with preservation of central vision
• Central vision is also lost ultimately after many years.

Fundus changes

• Retinal pigmentary changes - jet black spots resembling bone corpuscles in shape.
• Retinal arterioles are attenuated (narrowed).
• The optic disc becomes pale and waxy

Visual field changes

• Annular or ring-shaped scotoma

• Visual acuity–Vision decreased associated with Night blindness
• Ophthalmoscopy - Jet black spots resembling bone corpuscles seen
• Visual field- Loss of peripheral vision with preservation of central vision

It is most unsatisfactory

• Measures to stop progression - vasodilators, placental Extracts
• Vitamin A (15000 IU, PO, qd of palmitate form) - to check its progression.
• Correct any refractive error
• Low vision aids (LVA) in the form of ‘magnifying glasses’ and ‘night vision device
• Prophylaxis- Genetic counselling for no consanguineous Marriages

Ayurvedic Treatment

• Consider as a Yapya / Krichasadya disease
• Diet- Agastyapatra ( Agatticheera) is found to be beneficial

Internal medicines

• Patoladi gritha
• Triphala gritha
• Rasna Dashamoola gritha
• Sapthamrutha lauha

External procedures

• Snehapana – Rasna dashamoola ghrita
• Virechana – Gandharva eranda
• Jaloukavacharana- eyelid and forehead
• Nasya - Agastya gritha /Agasyapatra swarasa +honey , ksheerabala
• Anjana – Maricha + Dhadi , yakrut pippali
• Tarpana - Jeevaneeya gritha
• Putapaka