Retinal periphlebitis is associated with tuberculosis-related hypersensitivity, leading to retinal vein inflammation, thrombosis, and vitreous hemorrhage. It commonly affects young men, causing floaters and sudden vision loss. Fundus examination reveals venous sheathing, tortuosity, and hemorrhages. Severe cases may develop proliferative retinopathy or retinal detachment.
Acupuncture treatment targets specific points including Xinming 1 and 2, Jingming, and Yiming, using precise needling techniques. Needles are retained for one hour per session, with treatment given daily in ten-session courses. Clinical experience with fifteen cases reported satisfactory outcomes.
Retinal periphlebitis, also known as juvenile recurrent retinal vitreous hemorrhage.
This disease is generally believed to be associated with tuberculosis infection or lesion transmission. The delayed-type hypersensitivity reaction occurs because the retinal vein wall tissues are sensitized by tubercle bacillus proteins; however, systemic examination often reveals no active tuberculous lesions. It may also be related to other infectious foci or endocrine disorders. Inflammatory damage to the retinal vein wall and its surrounding tissues leads to venous thrombosis or rupture of the vessel wall, resulting in retinal vitreous hemorrhage.
【Diagnostic Key Points】
This condition commonly occurs in young men and often involves both eyes. In the early stage, patients may notice floaters and vision loss, which result from hemorrhage into the vitreous body. If bleeding is massive, vision can suddenly and severely decline, sometimes leaving only light perception. Fundus examination reveals exudative lesions or white sheathing along the affected retinal veins. The involved veins become tortuous and deformed, with scattered hemorrhagic spots in the adjacent retina. Severe bleeding may extend into the vitreous. If the hemorrhage is absorbed, vision may improve. In serious cases, proliferative retinopathy and secondary retinal detachment may develop.
【Treatment】
I. Acupoints and Needling Techniques
1. **Xinming 1** (affected side): Located 0.5 cun anterior and superior to TE17 (Yifeng), at the midpoint of the crease behind the earlobe. A gauge-30, 2.5 cun filiform needle is used. After routine local disinfection, insert obliquely along the posterior aspect of the earlobe, passing beneath the zygomatic arch toward GB1 (Tongziliao) at the lateral canthus. Note: needling this point requires precise control of the insertion angle, as it is technically demanding. Needle sensation: radiates toward the interior of the eyeball.
2. Xinming 2 (affected side): Located 1 cun above the lateral end of the eyebrow, at a depression 0.5 cun lateral to that point. Use a 30-gauge, 1.5 cun filiform needle. Perform routine local disinfection. Insert the needle parallel to the bone, directed toward the frontal bone, to a depth of approximately 1 cun (note: needling close to the bone is painful, so the insertion should be quick and accurate). Needle sensation: radiates toward the eye.
3. BL1 (Jingming) (affected side): Located on the face, in the depression slightly superior to the inner canthus. Use a gauge-30 filiform needle of 1.5 cun. After routine local disinfection, gently press the eyeball outward, then insert perpendicularly to a depth of about 1.4 cun. (This point is prone to bleeding; take care to apply pressure during needling.) Needle sensation: distension and heaviness throughout the periorbital region and the eyeball.
4. **Yiming (EX-HN14)** (affected side): Located 1 cun posterior and parallel to TE17 (Yifeng). Use a 30-gauge 2-cun filiform needle. After routine disinfection of the local area, insert perpendicularly about 1.8 cun. Needling sensation: local distension and pain.
2. Methods
Acupoints on the affected side are selected. The patient is seated. The above points are inserted according to the standard method, with needles retained for 1 hour before removal. The needles are twisted once during the retention period. Treatment is given once daily, with 10 sessions constituting one course. A 5-day rest is taken before the next course.
**Commentary**
Over the past two decades, acupuncture treatment for retinal periphlebitis has accumulated considerable clinical experience, making significant contributions to restoring vision in patients with this condition. We have treated 15 cases using the above methods and achieved satisfactory results. However, it is essential to ensure accurate positioning, angle, and direction of acupoints during treatment to achieve satisfactory outcomes.