Acupuncture at Tragus Apex for Treatment of Traumatic Ocular Muscle Paralysis

------------- A Report of 16 Cases

by ChenWeiping and Zeng Li(Educational College for Adults,
Nanjing University of TCM, Nanjing, 210029) and
　　Hu Zhihui (Jiangsu Provincial People's Hospital, Nanjing 210029)

Traumatic ocular muscle paralysis is not a rare condition in clinical practice. However,
complete recovery is very difficult. With acupuncture at the tragus apex, we treated 16 cases from l992 to1996, with satisfactory therapeutic results reported as follows.

Clinical Data
General data: There were 16 cases (12 males and 4 females), aged 16-52 years (mean, 32 years), with a history of 3 days-2 years (averaging 2.5 months). All the affected eyes were unilateral ones, involving superior rectus muscle in 4 cases, superior oblique muscle in 3 cases, external rectus muscle in 5 cases, internal rectus muscle in l case and combined muscle paralysis in 3 cases, (2 cases with superior orbital fissure syndrome, and l with lesion of both the inferior rectus and inferior oblique muscles and ipsilateral damage in the 2nd branch of trigeminal nerve).
Diagnostic Criteria: A history of trauma and sudden onset, with such symptoms as
diplopia and dizziness, movement of the eye toward the side of paralytic muscle limited, strabismus with a greater second squint angle than the first one. The paralyzed muscles should be determined by diplopia test.

Method of Treatment
The ipsilateral tragus apex was punctured once a day or once every other day with a filiform needle of 25 mm in length after the local skin was give sterile technique with 2% tincture of iodine. The needle was inserted 3mm in depth, lightly twirled and twisted, and then retained for 60 minutes and manipulated every 20 minutes.

Criteria for Therapeutic Effects
Cured: Position and movement of the eye turned to normal, and diplopia disappeared.
Improved: Position of the eye resumed basically normal, diplopia reduced, and the eye
movement improved.
Failed: No obvious improvement in eye position and movement, and diplopia.

Therapeutic Results
l0 of the l6 cases were cured, 5 improved, and l failed after acupuncture for l0 days to 3 months (mean 42 days). The effective rate was 93.75%. The result showed that the shorter the disease course, the better the therapeutic results. All the cases with a history shorter than 6 months were cured, and the 1 case with a history over 2 years was ineffective.

Discussion
Traumatic ocular muscle paralysis is also called traumatic strabismus, which is caused either by direct injury of the external ocular muscles after craniocerebral trauma or
indirect injury of the motor nerve or neurons that innervate the muscles. In traditional Chinese medicine, it is considered that the condition of incapability of muscle contraction is the result of the incoordination of Qi and blood, malnutrition of the tendons and vessels due to pathogenic factors damaging the meridians and collaterals. In modern medicine, there is no specific conservative treatment for it, and surgical treatment is not quite satisfactory. As puncture at the points around the eye did not give satisfactory effect, we tried to puncture the ipsilateral tragus apex and obtained very good effect.
Tragus apex is originally used for treatment of toothache and otopathy (see “Prescriptions Worth a Thousand Gold for Emergencies�?, and for treatment of strabismus as a folk remedy if punctured deeply. We presume that the specific functional regulation of external ocular muscles by acupuncture at tragus apex may be
the reason for its effectiveness.