Oculomotor nerve palsy is a clinical syndrome resulting from damage to the oculomotor nerve caused by various factors.
The oculomotor nerve is a motor nerve, primarily innervating the motor functions of the levator palpebrae superioris, superior rectus, medial rectus, inferior oblique, inferior rectus, and sphincter pupillae muscles.
The etiology of this disease is diverse and complex, which can be summarized into the following five types:
1. Inflammatory Infection (Yanzheng Ganran)
Clinically, it is quite common to see conditions such as viral infections, periorbital cellulitis, periostitis, rheumatism, diphtheria, nutritional deficiency neuritis, basal meningitis secondary to otitis media, thrombotic sinusitis, syphilis, and tuberculous encephalitis, which directly affect the oculomotor nerve or its nucleus in the midbrain.
2. Myasthenia gravis, Muscular dystrophy
Often causes easy fatigue and paralysis of the oculomotor nerve.
III. External Injury (Waishang)
Such as in traumatic brain injury, primarily fractures near the orbit or a hematoma compressing or irritating the oculomotor nerve, leading to paralysis.
4. Pressure
Intracranial, brainstem, cervical spinal cord, and neck tumors, as well as syringomyelia and syringobulbia, directly or indirectly affect the midbrain oculomotor nucleus.
V. Endocrine Diseases
For example, dysfunction of the thyroid gland or pituitary gland can also cause abnormal eye function, affecting the oculomotor nerve and leading to pathological changes.
【Diagnostic Criteria】
Clinically, it is often classified into two patterns.
1. Complete Paralysis Type
This type of oculomotor nerve palsy presents three characteristics: flaccid drooping of the upper eyelid (ptosis), downward and outward deviation of the eyeball, and mydriasis with loss of the light reflex. Due to the ptosis, the eyeball is almost completely covered; occasionally, compensatory contraction of the frontalis muscle allows slight opening of the eye. The unaffected eye may show compensatory over-elevation of the upper eyelid, and the head is turned to the side opposite the oculomotor nerve palsy.
2. Partial Paralysis Pattern
More common than complete paralysis, but with milder manifestations, it often presents as single muscle paralysis that is difficult to diagnose. In cases of partial oculomotor nerve palsy, involvement of the medial rectus muscle is relatively common.
【Treatment】
1. Acupoints and Needling Techniques
1. **GB14 (Yangbai) (affected side)**: Located on the forehead, 1 _cun_ above the midpoint of the eyebrow. After routine disinfection, insert a 30-gauge, 1.5 _cun_ filiform needle. Insert horizontally toward Yuyao (EX-HN4) to a depth reaching the upper third of the upper eyelid. (Note: This point lies on the forehead close to the frontal bone; needling is relatively painful, so insertion should be quick.) Needle sensation: distention and pain in the frontal and orbital region.
2. Needling from BL2 (Zanzhu) to TE23 (Sizhukong) (affected side): BL2 is located at the medial end of the eyebrow, in the supraorbital notch; TE23 is located in the depression at the lateral end of the eyebrow. Use a 30-gauge, 1.5 cun filiform needle. Perform routine local disinfection. Insert the needle at BL2, advance it to the bone, and then penetrate through to TE23. Needling sensation: distension and pain in the orbital region.
3. Shangming (EX-HN, ipsilateral): Located at the midpoint of the eyebrow, between the upper orbital border and the eyeball. Use a 30-gauge, 1.5-cun filiform needle. After routine local disinfection, gently press the eyeball slightly downward, then insert the needle perpendicularly to a depth of approximately 1.4 cun. Needle sensation: distension and heaviness within the orbit.
4. Taiyang (EX-HN5) (affected side): Located in the depression about 1 cun posterior to the midpoint between the lateral end of the eyebrow and the outer canthus. Use a gauge 30, 1.5 cun filiform needle. After routine local disinfection, insert at an angle of 25 degrees to…
Temporal bone; needling sensation: distending pain in the temporal region or radiating distending pain toward the inner upper part of the eyeball.
2. Methods
Select the affected side. The patient is seated. After inserting the aforementioned acupoints using the proper technique, apply electroacupuncture for 40 minutes. Upon needle removal, press the points with a cotton ball to prevent bleeding. Treatment is given once daily, with 6 days constituting one course. A 5-day rest is taken before the next course of needling.
[Commentary]
Oculomotor nerve palsy is relatively uncommon in clinical practice. The use of electroacupuncture is highly effective for cases not caused by cranial nerve nuclei lesions. Over the past 20+ years of clinical acupuncture work, I have treated more than 10 cases of complete palsy, most of which were cured in about 10 sessions. One case recurred 2 years after recovery, but was again cured after 10 sessions using the same method. During treatment, patients should wear glasses with the lens on the affected side covered with gauze to prevent eye discomfort or hemicrania caused by dilated pupil on the affected side. After recovery, patients should be advised to limit alcohol consumption, avoid staying up late, and engage in regular exercise to prevent recurrence. For oculomotor nerve palsy caused by brain tumors, intracranial inflammation, craniocerebral trauma, or cerebrovascular accident, after the secondary conditions are resolved, the same method can also achieve satisfactory results. If recurrence occurs, reapplication of this treatment also yields good outcomes.