The Resolution of a Traumatic, Pupil-Involving Oculomotor Nerve Palsy (CN III) Following Comprehensive Panchakarma and Netra Kriya Kalpa

Abstract

Oculomotor nerve palsy with pupil involvement is considered a neurosurgical emergency due to the high suspicion of compressive pathology such as aneurysm or hematoma. We present the case of a 73-year-old female with pupil-involving partial CN III palsy following head trauma, presenting with persistent unilateral ptosis (5 mm), dilated non-reactive pupil, and absent Bell’s phenomenon, reflecting impaired ocular protective motor coordination. Notably, neuroimaging studies revealed no radiologically detectable compressive lesion. Despite this, the clinical risk remained significant due to the well-established diagnostic priority of the pupil sign over imaging in early trauma. The patient underwent a comprehensive Ayurvedic management protocol, including systemic purification (Takrapanam, Snehapanam, Virechana), localized neuro-rehabilitative therapies (Karna Pooranam, Nasyam, Shirodhara), and ophthalmic rejuvenation (Netra Tarpanam and Putapaka). Complete functional resolution of ptosis and restoration of pupillary reactivity was achieved with visual acuity improving from 3/60 to 6/36 in the right eye and from 6/36 to 6/12 in the left eye. This case highlights the potential of integrative Ayurvedic intervention as a rehabilitation strategy in post-traumatic cranial nerve injuries, particularly in subtle micro compressive presentation under undetected on imaging.