Cervical 2: Eyes, Sinuses

Cervical 2: Eyes, Sinuses

In my years of practice I've experienced that it's very common for patients to make completely spontaneous comments about improvements in their vision immediately following a chiropractic adjustment, even when vision was not the issue. I even notice the same thing in myself when I'm adjusted. We're going to discuss vision on this page, although C2 is also highly involved in many cases of allergy. For more on this see allergies

The positive effects of chiropractic on vision are real and have been documented. There are several theories as to how subluxation in the spine causes problems in vision such as irritation of the sympathetic nerves in the neck, alteration in proprioceptive feedback to the brain, irritation of the nerves affecting the vertebral and carotid arteries resulting in a reduced blood flow to the brain (hypoperfusion). The fact is, when your head is not on straight, interference to the nerves and blood vessels in the neck can result in decrease visual function.

In 1998 chiropractic researchers Kessinger and Boneva[1] carried out a study involving 67 subjects to investigate the relationship between upper cervical subluxation and changes in visual acuity. Their results showed an overall improvement in visual acuity in both right and left eyes in the test subjects. They noted that “considerable evidence attests an association between visual disorders and head/cervical neck trauma.” According to the authors it is also “not unreasonable to assume that ischemic changes in vasculature associated with the sympathetic and parasympathetic innervation, or pressure to the eyes per se could elicit changes in vision.”

Frank Gorman, a medical ophthalmologist, has done a considerable amount of clinical research regarding the connection between chiropractic and improvements in vision. Gorman has documented dozens of cases including a case of two girls age 13. One girl had “headaches, blurred vision, motion sickness and peripheral pains and aches” along with“concentric narrowing of the visual fields.” Also her “suboccipital joints were tender to palpation.” The other girl had “headaches, dizziness, blurred vision and peripheral pains and aches”. She also had sub-occipital pain and decreased range of motion of the cervical spine. Following chiropractic adjustment improvements in vision in both patients was immediate.

Another case by Gorman[2] is a patient with reduced visual field and retinal damage due to congenital glaucoma. The patients left eye had been removed at age 3 and glaucoma had progressed to threaten the vision in her right eye. By age 16 she was “declared legally blind”. The patient sought chiropractic care because of “long-term back pain, neck pain, headache, and frequent classic migraine.” As an aside, it's very common that people seek chiropractic care for conditions like back and neck pain for which chiropractic treatment has been pigeon-holed. Then they are amazed to find that as they are adjusted other symptoms and deficits seem to improve. Ophthalmic examination of this patient found“total area of vision …. assessed as 2% of a normal field.” The patient herself indicated that her visual capacity was “shadows only.” A high velocity, low amplitude chiropractic adjustment was applied and immediately after her first adjustment the patient reported that she “can now see a hand, not just a shadow”. Ophthalmic examination showed a visual field increase from 2% to 11%. After the 2nd chiropractic session the field increased further. Several months after her treatment her visual field increased to 20% where it has remained. The patient's migraines also stopped completely. The discussion section of the paper notes that, “cervical pathology may irritate the sympathetic nerve fibres (vertebral nerve), which accompany the vertebral arteries which may lead to constriction of the vertebral-basilar arterial system.”

We can only imagine what the results might have been for the previous patient had she gotten chiropractic care earlier in life before so much irreversible damage had been done.

Another paper by Gorman[3] was of a woman who lost vision in her left eye following a fracture of the left zygomatic arch. The left eye had reduced light perception and both optic nerves were diminished. Following chiropractic adjustment over several sessions a significant improvement occurred in vision.

Other important findings by Gorman include in a paper discuss a patient who presented with neck pain, and a history of incidents of acute spastic torticollis[4]. Following chiropractic adjustment the patient's eyes were re-examined and found “immediate improvement in visual field sensitivities and a decrease in defect levels measured after spinal adjustment.” A 62-year-old male with presumptive optic nerve ischemia, presented with a one week history of monocular visual defect, headaches and neck strain[5]. Vision improved immediately following spinal manipulation as measured using static perimetry. A 9 year-old with spinal injuries and cortical and ocular vision loss which was corrected following spinal adjustment[6]. Gorman refers to his personal experience with cases of 6,000 chiropractic case that support his theories that “spinal manipulation, by repositioning vertebrae, defuses the irritative focus, leading to relaxation of the cerebral vasculature.” Because the carotid artery supplies micro-circulation to the optic nerve, Gorman believes that chiropractic adjustment can reduce irritation to the arteries and restore normal blood flow.

A study by Zhang [7] found improvement of visual disturbance in 83% of 111 cases treated over a period of seven years, including 9 cases out of 12 blind eyes which regained vision. The authors also indicate a finding of a correlation between poor posture of the cervical spine and head and visual disturbances.

Briggs and Boone[8] show a relationship between upper cervical chiropractic adjustments and changes in nervous system response, sympathetic and parasympathetic.

Schutte et al[9] a study of 12 children with esophoria, which is a muscle co-ordination problem in which an eye or eyes have a tendency to turn inward. The findings suggest that esophoria may respond well to chiropractic cervical adjustment.

Terrett and Gorman[10] report on a 4 year-old girl, blind since age 9 months who recovers sight after adjustment of her upper cervical spine (C1-atlas). They discuss research with rabbits in which removing the superior cervical ganglion (sympathetic nerve fibers) in the neck resulted in a disappearance of fluorescent fibers of the iris indicating that the nerve supply to the iris originated in the nerves of the neck!

A study by Brown[11] suggests that accommodative disturbance (ability to adjust and focus the eyes to changing distance) is one of the causes of visual disturbance following whiplash injury. In their study with a whiplash group of 19 subjects and a control group of 43 non-whiplash subjects they found that the amplitude of accommodation of the right and left eyes of the whiplash group was defective compared to the non-whiplash subjects.

The role of neck proprioception (movement control) affecting vision is seen in a study by Dichgans[12] where they find that “compensatory eye movement is critically influenced by vestibular and neck afferents and is not initiated centrally.” In other words, the control of eye movement arises directly from the neck and not directly the brain as one might suppose. The study examines patients with labyrinthectomy (removal of balancing mechanism in the inner ear) or rhizotomy (severing of spinal nerve roots) or both and finds a compensatory mechanism between the two and not a central compensation. The author says, “These findings extend our previous conclusion that for the range of movements we tested, ocular stabilization is entirely achieved by afferents from the labyrinth and neck proprioceptors.” After labyrinthectomy was performed a recovery of ocular stabilization was returned to 90% one month after the procedure. This was attributed to “an increase in gain of the neck-to-eye loop.” In other words, the alignment of the neck is a huge influence on eye movement and balance.

How can this be?

One theory as to the cause of the vision loss suggests that cerebral hypoperfusion (reduced blood flow to the brain) may be the cause. A clue may be found in a study by Bogduk[13] which showed that irritating the cervical sympathetic nerves results “in pronounced decrease in carotid artery flow (30% of control group).” The study also found that this stimulation resulted in“reduced blood supply to the retina in human subjects.”

A study by Otte found that 85% of patients with non-traumatic cervical pain had “parieto-occipital hypoperfusion” and “in 24 patients confirmed by independent observers to be suffering from cognitive disturbances after whiplash ALL had parieto-occipital hypoperfusion compared to control subjects.” Parieto-occipital hypoperfusion means reduced flow of blood to the cerebral cortex in the brain. And when the brain isn't getting proper blood flow it simply cannot function properly. Murphy[14] says that it is reasonable to conclude that the posture control system is affected in whiplash subjects due to misleading information from the cervical (neck) proprioceptors which causes vertigo and disturbance in eye function.

It's been suggested by Ernst, Seidl and Todt[15] that“manual medicine [chiropractic] should be an integrated part of modern clinical otolaryngology” and that “joint disorders” in the neck are “characterized by a variety of symptoms.” In other words, chiropractic problems in the neck can cause a lot of the problems that people tend to go to the Ear, Nose and Throat doctor for such as headache, vertigo, dizziness and blurred vision. The evidence is clear that visual problems can be caused by irritation of the cervical sympathetic chain in the neck which can be corrected by cervical chiropractic adjustment to restore proper vertebral alignment.

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