Ocular AEs

Inspired by Jiang et al 2021.[1]

Photo by Cameron Venti on Unsplash.

AEs – adverse events
EA – electroacupuncture
TPI – trigger point injection

key to acronyms

Thankfully rare, ocular injuries caused by acupuncture seem to affect me more than most other AEs. I cannot help myself grimace a little every time I think of needling points inside the obit.

When I was in my early years as an editor for Acupuncture in Medicine some 20 years ago, I particularly remember the images we published along with a student elective report.[2] They showed patients being treated with EA for optic atrophy, with long needles placed deep into the orbit and around to the back of the eye. It seemed unlikely to me that this could possibly work, but then some years later I had the opportunity to host an ophthalmologist (Edith) at the BMAS London Teaching clinic, and we often discussed the potential use of acupuncture in eye diseases. She was particularly interested in trying to influence the progression of glaucoma and educated me about the condition… the fact that it was a form of neuropathy rather than simply raised pressure in the eye.

Edith made a trip to China to visit some clinics that specialized in treating eye diseases, and before she went, we discussed the issue of needling into the orbit. It was very illuminating to hear her experiences on her return, and she was firmly of the opinion that any needling into the orbit, if it were to be used at all, should only be performed by ophthalmologists.

traumatic cataract formation

This recent case report in Acupuncture in Medicine describes a traumatic cataract formation following a penetrating eye injury with an acupuncture needle. The report includes 5 other cases, 4 of which I had not previously seen, possibly because the journals are not yet listed on PubMed.

This patient, a 28-year-old woman who was being treated with acupuncture for facial paralysis, regained full vision after standard cataract surgery.

Not all patients with ocular AEs have been so lucky, and I recall a case of infection from the literature that resulted in visual loss, although this was not through direct inoculation, but haematogenous spread from a cervical epidural abscess.[3]

endophthalmitis

Whilst we are on the subject of endophthalmitis, there is another case just out reporting an intraocular foreign body and infection following catgut embedding at periocular acupuncture points.[4] I cannot get the full details just yet, but hope to have them by the time of the Wednesday blog webinar… I didn’t as there is a problem with the page – perhaps I’ll update this when I get it.

Another recent case report involved periorbital candidal abscesses following self-administered acupuncture in a patient with undiagnosed diabetes.[5] She had used a non-disposable unsterilized needle in an attempt to treat eyelid swelling after a minor injury.

A further case report of injection out in the last few weeks involved embedded gold threads that had migrated from the back to the legs at some time over the previous 10 years since they were placed during the treatment of a lumbar disc prolapse. In the left leg some fragments were responsible for chronic inflammatory changes and subsequent recurrent cellulitis.[6]

More orthodox techniques, such as TPI, can also be the source of infection, and a recent case report from the Frank Netter MD School of Medicine describes bilateral supraclavicular abscesses diagnoses 6 days following injections to presumably upper trapezius for chronic pain.[7] The 54 year old woman had no obvious predisposition to infection, and there would arguably been even less risk if acupuncture needles had been adopted rather than hypodermic needles delivering steroid.

References

1          Jiang X, Shen M, Zhang M. Traumatic cataract caused by acupuncture: a case report and literature review. Acupunct Med Published Online First: 28 July 2021. doi:10.1177/09645284211033606

2          Sistenich V. East and West See Eye to Eye – An Elective Report. Acupunct Med 2001;19:66–8. doi:10.1136/aim.19.1.66

3          Lee S-Y, Chee S-P. Group B Streptococcus endogenous endophthalmitis: case reports and review of the literature. Ophthalmology 2002;109:1879–86. doi:10.1016/s0161-6420(02)01225-3

4          Zhou X, Chen H, Fu J, et al. Endophthalmitis with retained intraocular foreign body after catgut embedding at periocular acupoints. Clin Exp Optom 2021;:1–2. doi:10.1080/08164622.2021.1947743

5          Sung JY, Kim JM, Lee JU, et al. Multiple facial candidal abscesses after self-administered acupuncture in a patient with undiagnosed diabetes mellitus: a case report. BMC Complement Med Ther 2021;21:170. doi:10.1186/s12906-021-03343-w

6          Kang HJ, Choi IH, Park CJ, et al. Recurrent Cellulitis Associated with Acupuncture with Migratory Gold Threads. Ann Dermatol 2021;33:281–3. doi:10.5021/ad.2021.33.3.281

7          Salamone FJ, Kanamalla K, Songmen S, et al. Bilateral supraclavicular abscesses following trigger point injections. Radiol Case Rep 2021;16:2630–3. doi:10.1016/j.radcr.2021.06.032


Declaration of interests MC