Chiropractic as Part of an Interdisciplinary Team for the Care of a Patient with Diplopia: A Case Report

Introduction

A 59-year-old male began to experience intermittent diplopia 50% of the time, which after three-days became constant. Over the previous 30 years it was not uncommon for him to initial awaken with “double vision” but after a few minutes it would go away. When his condition became constant he consulted with an ophthalmologist who diagnosed him with a fourth cranial nerve palsy causing a vertical displacement of his eye. He was given prism glasses to correct the displacement. He presented on February 17, 2015 for an assessment and treatment at this clinic.

Methods

A 56-year-old female patient presented for chiropractic and dental care with persistent symptoms of sleep apnea, excessive daytime sleepiness, short-term memory loss, foggy-headedness, TMJ pain, chronic myofascial neck and shoulder pain, fatigue, and vertigo.

Cranial palpatory pain was noted at the right zygomaticomaxillary joint, upper medial orbit, sphenoid wing, coronal and squamosal sutures, and an occipital extension cranial distortion pattern. Pelvic torsion with sacroiliac joint hypermobility was noted on the left (category two). Palpatory pain and hypertonicity of right sub occipital muscles was noted along with palpatory pain from C-1-6. He had cervical spine antalgia with decreased rotation range of motion to 25°.

The patient was treated for a total of six visits between February and April that was directed at stabilizing the sacroiliac instability SOT blocks and sacroiliac support belt. Spheno-maxillary cranial adjustments were administered to the maxilla and zygomatic bones along with intraoral cranial therapy for the occipital extension cranial distortion. Cranial dental co-treatment consisted of a lower occlusal splint, which involved one-visit per week three-weeks in a row, with the splint equilibrated immediately after cranial treatment.

Results

The patient was making consistent progress with reduced neck pain, antalgia, and significantly improved cervical ranges of motion so at that time was referred to have the splint dentally equilibrated after the third visit and noted at that time a 70% reduction in diplopia. By the fifth dental visit on April 2, 2015 he stopped needing prism glasses. Follow-up ophthalmology exam in May of 2015 found no evidence of diplopia.

Discussion

There is not much in the literature regarding chiropractic and optometric or ophthalmological co-treatment of patients. One study by Tymms discussed a 13-year-old male with intermittent diplopia referred for chiropractic care by his optometrist. In this case only one treatment achieved a full resolution of the patients symptoms with the optometrist finding on re-examination a correction of the overconvergence ¹.

With cases that do not have a discrete relationship it is difficult to explain what were the specific mechanisms that affected improved ocular function following a chiropractic intervention. Many types of possibilities relating to chiropractic manipulative therapy and its affect on visual fields, vision, and optic nerve function have been discussed by Gorman et al in the literature ^2-6.

Conclusion

It is difficult to generalize from case reports however the ongoing nature of the patient’s condition and the temporal relationship between the care received and his significant response warrants further study. Determining if there might be a subset of patients with visual or ocular disorders that might be helped with chiropractic and/or interdisciplinary care also deserved greater exploration.

References

1. Tymms G. Visual recovery from diplopia in a 13-year-old following chiropractic intervention. J Clin Chiropr Pediatr. 2011 Jun;12(1): 876-878.
2. Wingfield BR, Gorman RF. Treatment of severe glaucomatous visual field deficit by chiropractic spinal manipulative therapy: a prospective case study and discussion. J Manipulative Physiol Ther. 2000 Jul-Aug;23(6):428-34.
3. Stephens D, Gorman RF. Does ‘normal’ vision improve with spinal manipulation? J Manipulative Physiol Ther. 1996 Jul-Aug;19(6): 415-8.
4. Gorman RF. Monocular scotomata and spinal manipulation: the step phenomenon. J Manipulative Physiol Ther. 1996 Jun;19(5): 344-9.
5. Gorman RF. Monocular visual loss after closed head trauma: immediate resolution associated with spinal manipulation. J Manipulative Physiol Ther. 1995 Jun;18(5):308-14.
6. Gorman RF. The treatment of presumptive optic nerve ischemia by spinal manipulation. J Manipulative Physiol Ther. 1995 Mar- Apr;18(3):172-7.

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