Optic neuritis is an acute or chronic vision loss condition with complex causes, including systemic factors like infections, poisoning, demyelinating diseases, and local factors such as sinusitis or ocular inflammation. It presents as either optic papillitis or retrobulbar optic neuritis, each with distinct symptoms and fundus changes.
Acupuncture treatment targets specific points around the eye and neck, using gentle insertion techniques to restore vision. The treatment is typically combined with medication during the acute phase, with precautions to avoid hematoma and a course of ten sessions.
Optic neuritis is a common clinical ophthalmic condition, a type of acute or chronic blindness caused by various factors.
The pathogenesis of optic neuritis is complex and can be summarized into two aspects: systemic and local.
I. Systemic Factors
Acute infectious diseases (e.g., epidemic meningitis, encephalitis, influenza, mumps, measles, typhoid fever); chronic infectious diseases (e.g., tuberculosis, syphilis); poisoning (e.g., from tobacco, alcohol, methanol, lead, arsenic); demyelinating diseases (e.g., neuromyelitis optica, multiple sclerosis); nutritional and metabolic diseases (e.g., vitamin deficiency, pregnancy, lactation, anemia, diabetes mellitus).
II. Local Factors
Sinusitis, tonsillitis, dental caries, and ocular inflammations (such as orbital cellulitis, uveitis, retinochoroiditis).
Diagnostic Points
Clinically, it can be divided into two types: optic papillitis and retrobulbar optic neuritis.
1. Optic Papillitis
The clinical onset involves one or both eyes, with a rapid decline in vision. When the eyeball moves or is compressed, a traction-type pain behind the globe is felt. There is pain around the eye, and the visual field reveals a central scotoma with concentric contraction.
Small, the pupillary light reflex appears easily fatigued, meaning it can maintain a constricted state for only a very short time. In cases of complete vision loss, the pupil is dilated and the direct light reflex is absent.
Fundus changes: In the early stage, the optic disc shows congestion, blurred margins, swelling, and a reddish color, with mild elevation generally not exceeding 3 diopters. The retinal veins are mildly dilated and tortuous. There is mild edema, flame-shaped hemorrhages, and a few exudates in the retina adjacent to the optic disc. In advanced stages, secondary optic atrophy may occur.
2. Retrobulbar Optic Neuritis (Qiuhou Shishen Yanyan)
Vision significantly declined, with visual field constriction presenting as central scotoma or dumbbell-shaped scotoma, and tractional pain upon eye movement. The duration of persistent miosis was very brief. In the early stage, the fundus was mostly normal, or there was mild congestion of the optic disc; in the advanced stage, the optic disc became partially or completely pale.
This condition can be classified into acute and chronic types. The acute type has a sudden onset, while the chronic type develops gradually with progressive vision loss, a longer disease duration, and a poorer prognosis.
Treatment
1. Acupoints and Needling Techniques
1. **BL1 (Jingming)** (affected side): Located on the face, in the depression slightly superior to the inner canthus of the eye. Use a 30-gauge filiform needle of 1.5 cun in length. After routine local disinfection, gently press the eyeball outward, then insert the needle perpendicularly to a depth of approximately 1.4 cun. *Note: Insertion technique should be gentle without rotation; withdrawal should be slow, with mild pressure after removal to avoid lower eyelid hematoma.* Needling sensation: Local distension and pain.
2. **Shangming (Extra point)** (affected side): Located directly below EX-HN4 (Yuyao), between the upper orbital margin and the eyeball. Use a 30-gauge, 1.5 cun filiform needle. After routine local disinfection, gently press the eyeball downward and insert the needle perpendicularly to a depth of approximately 1.4 cun (note: insertion and removal precautions are the same as for BL1 [Jingming]). Needling sensation: local distension and soreness.
3. **Qiuhou** (Extra point, affected side): Located at the junction of the lateral 1/4 and medial 3/4 of the infraorbital margin. Use a 30-gauge, 1.5 cun filiform needle. Perform routine local disinfection. Gently press the eyeball upward and insert the needle perpendicularly to a depth of approximately 1.4 cun (precautions are the same as for BL1 *Jingming*). Needling sensation: local distension and pain.
4. GB20 (Fengchi) on the affected side: Located in the depression between the upper ends of the sternocleidomastoid and trapezius muscles on the posterior neck, level with GV16 (Fengfu). Use a gauge-30 filiform needle of 2 cun. After routine local disinfection, insert obliquely toward the spine to a depth of about 1.8 cun. (The skin at this point is relatively tough; insertion should be swift through the skin and slower afterward.)
Sensation: local distending pain or radiation to the ipsilateral occipital region.
2. Methods
For unilateral lesions, needle the affected side; for bilateral lesions, needle both sides. The patient should be in a sitting position. Insert the above points as per the method and retain the needles for 1 hour. During the retention, perform a gentle twirling manipulation once. Remove the needles. Treat once daily or every other day, with 10 sessions constituting one course of treatment. Rest for 5 days before starting the next course.
**Commentary**
Acupuncture treatment has a favorable effect on restoring vision for this condition. During the acute phase, it is best to combine with symptomatic medication for more ideal results. During the acupuncture procedure, subcutaneous hematoma in the lower eyelid area can easily occur. If this happens, the practitioner should not panic; suspend needling for about 5 days before resuming. Apply cold compresses to stop bleeding within the first 24 hours, and switch to hot compresses after 24 hours. Bruising (cyanosis) appearing on the upper or lower eyelid after hematoma absorption is considered within normal range.