Anterior uveitis refers to an inflammatory condition of the iris and ciliary body, while posterior uveitis refers to an inflammatory condition of the choroid.1 Both conditions cause blurred vision due to opacities in the intraocular fluid. In addition, lesions within the eye cause reduced vision and increased awareness of floaters, dark spots that drift across the field of vision.1 Children with uveitis may report pain, photophobia, lacrimation, blepharospasm, and disturbed vision – or, the patient may be asymptomatic. Several researchers report correlations between uveitis and other conditions, such as ankylosing spondylitis, sacroilitis, juvenile chronic arthritis, herpes simplex and connective tissue diseases.2 Other studies show a correlation between posterior uveitis and disorders of the central nervous system, such as toxoplasmosis. However, one third of patients with uveitis display no association with any other diseases.2,3
In a case study, a male child aged 5.75 years was diagnosed with anterior and posterior uveitis based on a thorough ophthalmological examination. Visual acuity was 20/100 in the right eye and 20/30 in the left eye; slit lamp examination showed evidence of anterior uveitis with 2+ cells and flare in each anterior chamber; and a broken synechia was identified in the right eye with mild changes of the lens consistent with inflammation.1 Ophthalmoscopic monitoring continued over a four month course of topical and systemic steroid therapy. However, no significant improvement was observed based on the Snellen eye chart and fundus examination. Therefore, steroid therapy was discontinued and chiropractic treatment was taken into consideration.1
During the chiropractic consultation, a thorough history was performed. The patient suffered from chronic bronchitis since infancy; at three years, the patient fell from the bed and lacerated his left eyelid; at five years, the patient fell from the bed again and reported leg and knee pain; the patient complained of intermittent neck and back pain and leg, knee, and ankle pain; and lastly the patient complained of pain in the proximal interphalangeal joints of all fingers.2 During spinal examination, the patient presented with a mild dextro-scoliosis in the thoracic spine and a mild levoscoliosis in the lumbar spine. Although the range of motion in the cervical spine was normal, pain at C3 to C5 was noted during neck extension.2 Furthermore, the patient reported pain at C7 during forward flexion, and pain in the area of the contralateral trapezius muscle during neck rotation.2 Lastly, static and motion palpation of the spine revealed segmental subluxations, muscle induration, fixation, and misalignments at several spinal levels.1 Therefore, a course of spinal adjustments was commenced.
Spinal adjustments were initially delivered at a frequency of three times per week and later reduced to two times per month after improvement in visual acuity was achieved. After the second visit for spinal adjustment, visual acuity was 20/80 in the right eye and 20/20 in the left eye. After the sixth visit, visual acuity was 20/50 in the right eye and 20/20 in the left eye. A year after chiropractic treatment, an ophthalmologist and optometrist verified improvement in visual acuity (20/30 for the right eye) based on Snellen chart tests.1
To understand the link between uveitis and spinal adjustment therapy, one must consider the neurological and internal anatomy of the eye. The superior cervical ganglion receives preganglionic fibers from the first thoracic nerve and supplies postganglionic fibers to the internal carotid and cavernous plexuses. In turn, the internal carotid and cavernous plexuses supply sympathetic fibers to the vasculature of the eye. Alteration of the sympathetic nerve supply may lead to tissue neovascularization and increase the possibility of rupture with trauma and histamine release.4 Therefore, correction of associated nerve irritation via spinal adjustment may reverse symptoms of uveitis.
References
1) Manuele, J and Fysh, P. “The Effects of Chiropractic Spinal Adjustments in a Case of Bilateral Anterior and Posterior Uveitis.” Journ of Clin Chiro Ped. 2004; 6:334-337.
2) Szanto E, Granfors K, Wretlind B. Acute anterior uveitis, arthritis and enteric antigens. Clin Rheumatol 1991; 4:395-400.
3) Linssen A, et al. “The lifetime cumulative incidence of acute anterior uveitis in a normal population and its relation to ankylosing spondylitis and histocompatibility antigen HLAB27.” Ophthal Vis Sci. 1991; 9:2568-78.
4) Oski, FA. Principles and Practice of Pediatrics, 2nd ed. Philadelphia; Lippincott 1994; 34:891.