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Category: Case Studies

Date	30-nov-1998
Case Title	Bilateral Simultaneous Optic Nerve Dysfunction After Pariorbital Trauma: Recovery of Vision with SMT
Author	Danny Stephens, DC, DO, Henry Pollard, Don Bilton, DC, Peter Thomson, DC, DO and Frank Gorman, DO
Main Condition/ Disease	Visual Disturbance
Source	Journal of Manipulative and Physiological Therapeutics (JMPT); Volume 22, No9, 615-21;(Nov/Dec 1999)
Abstract	This paper discusses recovery of optic nerve function following chiropractic spinal therapy. A woman reported loss of vision in her left eye following a fracture of the left zygomatic arch. The left eye had reduced light perception and both optic nerves were diminished. Following chiropractic treatment over several sessions a significant improvement occurred in vision immediately following spinal manipulation.
Summary	The authors initially discuss the literature which has previously indicated visual recovery following spinal manipulation and propose some theories for the involvement of cervical spine derangement as a causal factor in visual disturbances. One theory is that “flow in the vertebral arterial system is reduced by entrapment of the arteries in an area of spinal derangement.” This, it is suggested affects the basilar system by vasoconstriction (constriction of blood flow), thus producing neuronal ischemia which affects the occipital lobes and “this vascular vasospasm can occur anywhere in the cerebrovascular circulation as a result of irritation of the cerebral arteries in the neck.” The case discusses a 53 year old woman with a lifelong history of migraines who suffered a fall while visiting a physiotherapist and fractured her right zygomatic arch. Some 2 weeks after surgery “she noted loss of vision in the left eye” and her ophthalmologist “noted a minor degree of macular edema in the left eye.” Further examination by one of the authors revealed “severe loss of vision in the left eye and visual evoked responses (no response) were consistent with recent optic nerve damage in both eyes - severe on the left and asymmetrical on the right.” The c-spine was placed in traction and manipulated and additionally the thoracic and lumbar spines were manipulated. Visual field was measured pre and post manipulation with recovery of vision occurring over a 44 day period. Table 1 on page 618 indicates a left eye improvement from 3.2 mean visual sensitivity to 27.2, an improvement of 750% with the right eye improving from 27.6 to 30 (8.7%). The patient was still well and vision “excellent” 12 months after the treatment. Stephens et al in the discussion state “in our opinion, the critical feature in the examination of the cervical spine was the presence of suboccipital tenderness, manifested by exerting pressure on the transverse processes of the atlas vertebra.” This tenderness is consistent with upper cervical subluxation, usually C0 to C1, and also c1 to C2. This is further proof of involvement of the upper cervical spine. I suggest that it is the upper cervical manipulation which is responsible for the changes in vision and not anything to do with manipulating the thoracic or lumbar spine. The authors also point out the delay in onset of symptoms following the fall indicating that this is well know in “cervical syndrome”. In fact, this is very consistent with my findings particularly in cases of whiplash. Another good paper and more evidence supporting the need for research funds being spent on chiropractic research.
References
Keywords	chiropractic manipulation, visual loss, optic nerve, ischemia

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