Inspired by Davidson et al, Tsai et al, and Yao et al 2025.[1–3]
AEs – adverse events
BCVA – best corrected visual acuity
RCT – randomised controlled trial– key to acronyms
AEs related to needling close to the eyes occur from time to time, and I have mentioned them here a couple of times previously – see Ocular AEs from 2021 and Hearts lungs and eyes 2022.
I am highlighting the subject here again because I have collected 3 reports in the last month from Auckland, Singapore, and Nanjing.
Two involved periorbital bruising and the third involved an injury to the globe of the eye itself.
The case from Auckland was of bilateral orbital haemorrhages, which I assumed from the title was simply a pair of black eyes, but the images in the paper are quite shocking. The acupuncture treatment was attempting to treat cataracts by needling from the medial canthus (presumably BL1) towards the optic nerve in both eyes. The patient noticed periorbital swelling and some protrusion of the eyes whilst in the acupuncture clinic and an ambulance was called. When in the specialist centre, her eyes were measured to be protruding by 23mm bilaterally, yet thankfully there was no compromise of the optic nerve in this case. The haemorrhages resolved over 2 weeks with conservative management, and she was advised to avoid further acupuncture treatment. The patient in this case was a 56-year-old woman with high myopia but who was otherwise fit and well and not taking any regular medications.
The cases from Singapore were less dramatic, involving bruising around a single eye in each case. Both women (ages 61 and 86) were undergoing treatment for dry eyes. The younger of the 2 patients was taking 100mg of aspirin daily, along with a statin. She had had 20 sessions of acupuncture and already suffered a previous minor bruising around her other (left) eye. Whilst both cases were much less dramatic than the case from Auckland, the bruising was bad enough to result in a consultation with an ophthalmologist for assessment. Both patients had normal vision (BCVA 20/20) and did not require any treatment.
The final case was published as a clinical image in the journal Eye (IF 2.8) – the official journal of the Royal College of Ophthalmologists. This case, from Nanjing, also involves treatment for dry eyes. The patient, a 53-year-old woman, experienced a sudden onset of floaters in her right eye during needling of the point BL1. The needle had clearly penetrated the globe of the eye and caused some bleeding into the vitreous. The 3 images of fundus photographs nicely tell the story of both the adverse event and subsequent treatment. I will show you the images at the Wednesday webinar.
Interestingly, this short report in Eye includes the statement that BL1 acupuncture is effective and safe for dry eye. Sure enough they use the reference I highlighted in 2022 – follow this link and scroll down to the last few paragraphs for details of the RCT of needling at BL1.[4]
References
1 Davidson AE, Al-Ani H, Hart R. A case of bilateral orbital haemorrhages following periocular acupuncture. Orbit. 2025;1–5. doi: 10.1080/01676830.2025.2479745
2 Tsai JHJ, Au Eong JTW, Au Eong K-G. Severe periocular ecchymosis following acupuncture therapy for dry eye: a report of two cases. J Surg Case Rep. 2025;2025:rjae783. doi: 10.1093/jscr/rjae783
3 Yao B, Yu H, Liu G, et al. Vitreous haemorrhage and retinal detachment secondary to acupoint BL1 acupuncture. Eye. Published Online First: 13 February 2025. doi: 10.1038/s41433-025-03689-2
4 Zhang X, Zhang B, Peng S, et al. Effectiveness of acupuncture at acupoint BL1 (Jingming) in comparison with artificial tears for moderate to severe dry eye disease: a randomized controlled trial. Trials. 2022;23:605. doi: 10.1186/s13063-022-06486-4
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