MD, PhD, FMedSci, FRSB, FRCP, FRCPEd.

Central retinal artery occlusion, nystagmus, Wallenberg syndrome, ophthalmoplegia, Horner syndrome, loss of vision,  diplopia, and ptosis are all amongst the eye-related problems that have been associated with chiropractic upper spinal manipulations. Often the damage leaves a permanent deficit – happily, not in this instance.

US ophthalmologists published the case of a 59-year-old Caucasian female who presented with the acute, painless constant appearance of three spots in her vision immediately after a chiropractor performed cervical spinal manipulation using the high-velocity, low-amplitude technique. The patient described the spots as “tadpoles” that were constantly present in her vision. She noted the first spot while driving home immediately following a chiropractor neck adjustment, and became more aware that there were two additional spots the following day.

Slit lamp examination of the right eye demonstrated multiple unilateral pre-retinal haemorrhages with three present inferiorly along with a haemorrhage over the optic nerve and a shallow, incomplete posterior vitreous detachment. Optical Coherence Tomography (OCT) demonstrated the pre-retinal location of the haemorrhage.

These haemorrhages resolved within two months.

The specialists concluded that chiropractor neck manipulation has previously been reported leading to complications related to the carotid artery and arterial plaques. This presents the first case of multiple unilateral pre-retinal haemorrhages immediately following chiropractic neck manipulation. This suggests that chiropractor spinal adjustment can not only affect the carotid artery, but also could lead to pre-retinal haemorrhages.

In the discussion section of their paper, the authors stated: Upper spinal manipulation with the HVLA technique involves high velocity, low-amplitude thrusts on the cervical spine administered posteriorly. No other aetiology of the pre-retinal haemorrhages was found on work-up (no leukemic retinopathy, hypertension, diabetes, or retinal tear). The temporal association immediately while driving home from the chiropractic procedure makes other causes less likely, although we cannot exclude Valsalva retinopathy or progressive posterior vitreous detachment. Given the lack of any retinal vessel abnormalities or plaques along with the temporal association, we postulate that the chiropractor neck manipulation itself induced vitreo-retinal traction that likely led to pre-retinal haemorrhages which were self-limited. It is also possible that the HVLA technique could have mechanically assisted with induction of a posterior vitreous detachment.

If the authors are correct, one has to wonder: how often do such problems occur in patients who simply do not bother to report them, or doctors who do not correctly diagnose them?

33 Responses to Chiropractic neck manipulations can damage your eyes

  • http://redcliffewellness.com/eye-problems-helped-chiropractic/

    More investigation to protocols of care are necessary.

    From my own empirical experience, improvement of visual fields improve under chiropractic spinal manipulation and not just under cervical manipulation under medical manipulation. http://redcliffewellness.com/eye-problems-helped-chiropractic/

  • Here is a link to the case report:
    https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6097227/

    The corresponding citation is:
    Paulus YM, Belill N. Preretinal hemorrhages following chiropractor neck manipulation. American Journal of Ophthalmology Case Reports. 2018;11:181-183. doi:10.1016/j.ajoc.2018.04.017.

  • “…but this case demonstrates that it can also lead to multiple preretinal hemorrhages.”

    Should have wrote “may”, not “can”.

    • Should have WRITTEN, DC … should have “written.”

      More to the point, no doubt you tell patients who present with neck pain, “I’m going to adjust your neck and it may NOT help” and add that “It CAN cause a stroke.”

      Right?

      Of course, cracking a neck CAN help and it may NOT cause a stroke. That’s because cracking a neck in some people, some of the time, CAN sometimes help with some presentations just as in some people, some of the time it CAN sometimes cause a stroke.

      Right?

      Well, now you should consider that cracking a neck CAN sometimes cause “multiple preretinal hemorrhages.”

      Right?

      ~TEO.

  • So neck manipulation can do all sorts of things…..it just happens that improving health or relieving pain aren’t two of them.
    “Manipulation for neck pain does not work”. Bogduk
    And having been to numerous quacks over my lifetime I will agree with the professor.

    • Actually, what Bogduk wrote is that spinal manipulation might reduce neck pain but it doesn’t eradicate neck pain.

      • DC wrote: “Actually, what Bogduk wrote is that spinal manipulation might reduce neck pain but it doesn’t eradicate neck pain.”

        @ DC

        Yes, he did say that, before continuing with: “it is not more effective than other interventions, which do not require the same degree of allegedly necessary training and skill, which do not carry the same risks of morbidity, and which the patients can do for themselves, if and once properly instructed.”

        Ref. https://www.jpain.org/article/S1526-5900(03)00733-8/fulltext

        • is it not strange how these little bit tend to get missed!

        • Yes. But my reposnse was in regards to what Kinney wrote…which misrepresented what Bogduk wrote.

        • @BW: thank u for that more complete discussion. I’m sure “DC” will have some piffle to try to further defend his vainglorious income stream.
          Of course he/she is still left with the untenable proposition of answering the “what, where, when and how” to deliver this remarkable “big idea” to his marks? WHO taught him/her how, where and when to do “it”? AND to do it “correctly”…vs just goin’ a whackin’ wherever it hurts?
          Where is that arcane knowledge stored? At a $200,000 4 year, pretend-doctor, non-transferable diploma mill?? Who taught THEM? AND why does it take 4 years??
          Perhaps most likely it’s all a “big guess” and based on whatever entrepreneurial story-line they need to get cash from the gullible.
          Ahh science-based Chiro-quackery.

  • http://animalchiropractic.org/contact_animal_chiropractic.htm

    apparently you do not even have to be a DVM to get certified in animal chiropractic therapy. This is a great example of pseudo-medicine trying to infiltrate the veterinary profession.

  • And so many examples of so-called believers seeking verisimilitude.

  • I wonder if prosecutors ever refer to this blog for evidence the defendant participated in, and was exposed to, information that should’ve deterred use of procedures that injured the defendant’s patient?

    I do hope so.

  • the story was today (!) reported in the Daily Mail. (https://www.dailymail.co.uk/health/article-6229057/Chiropractors-neck-cracking-harm-sight-cause-bleeding-inside-eye.html)
    they quoted me thus:
    “Edzard Ernst, an expert in alternative medicine, said chiropractic treatments were too dangerous and not sufficiently effective to be recommended for any condition.”
    the quote was on their request me stating by email to their ‘science correspondent’:
    “Chiropractors frequently manipulate patients’ neck in such a way that the joints are taken beyond their physiological range of motion. This can lead to all sorts of problems, sometimes even death. This new report suggests that chiropractic neck manipulations can also damage the eyes. The ensuing problems tend to be temporary, it is likely that such eye-damage occurs often after chiropractic treatments. Chiropractic neck manipulations are not convincingly effective for any condition; as they can cause a lot of harm, their risk/benefit balance is clearly negative. In other words, we should not use or recommend them.”
    this quote was deemed too long and they asked me to agree to the following, shortened one:

    “Edzard Ernst, an expert in the study of alternative medicine and former professor at the University of Exeter, said: ‘Chiropractors frequently manipulate patients’ neck in such a way that the joints are taken beyond their physiological range of motion.
    ‘The ensuing problems tend to be temporary but it is likely that this kind of eye damage occurs often after chiropractic treatments.
    ‘Chiropractic neck manipulations are not convincingly effective for any condition as they can cause a lot of harm. Therefore we should not use or recommend them.’ ”
    WHAT HAS UK SCIENCE JOURNALISM COME TO???

  • No one is more critical of “chiropractic,” chiropractors, and chiropractism than I am. Even so, my response is that your truncated statements end up sounding a little too severe. That’s a problem with any summary statement, of course. To wit, without any nuance or explanation, comments and important criticisms may be dismissed and miss all the fundamental silliness of The Chiropractic Premise that precedes any risks attendant to cracking a neck. Damage occurring as a result of treating with an empty medical intervention only adds insult to this primary injury, which is the application of an arbitrary and fictitious medicine to manage bona fide medical diagnoses.

    That said, I will only weigh in on a part of what I see after a quick read. For example, taking joints beyond their physiologic range of motion may sound more ominous and dangerous than it really is. When you crack your knuckles, for example, you’ve taken these same synovial-type finger joints beyond their physiologic range of motion. And, cracking your knuckles or your neck does not a medicine make … except if you’re a chiropractor in the latter case of the neck.

    Of course, damage to ligaments and joint surfaces can and does occur when that narrow paraphysiologic joint range — apparently a relatively “safe zone” — is exceeded by anything more than in a controlled fashion … let’s say if your neck is injured in an auto accident in the extreme or with more force than needed to get the desired “POP” at the hands of a chiropractor in Chiroville, a barber in New Delhi, a filipino collecting a buck in a bar to crack your neck, or a Turkish masseur finishing his massage in an Istanbul bathhouse with bilateral cervical fireworks. A poke in the eye with a burning stick, after all, is likely to be unpleasant and do tissue damage, no matter. Defended chiropractors who argue complete safety without telling about all the potential damage they can do are simply FOS. Totally.

    Part of being a chiropractic student is that you get to be a chiropractic patient while you’re learning the trade. So, not to go-on too much at this point, I’ll leave you with a quick anecdote. While learning one particular chirodigm (The Thompson Technic) in chiropractic school, I volunteered to be the “adjusting dummy” for the teacher to demonstrate how a “drop table” works. The drop table has segmented sections that are first “cocked” so that when the chiropractor applies their manual “adjustment” to the prone patient, the table segment releases and drops a short distance amidst a noisy mechanical clatter. This teacher was a brute and maintained his hand position and pressure to the back of my neck until the neck segment bottomed-out.

    I saw stars. Lots of them.

    The surrounding students and class were asking me if I was OK because, apparently, I just lay there for I don’t know for how long, non-responsive. At some point, I indicated that I thought I was OK, rose from the table, finished the class and left school to go home. After dropping a classmate off in front of his house in Oakland, I proceeded less than half a short block and drove directly into the back of car that was double parked … without braking. I can’t say with confidence that one thing had to do with another … but hey. Could have happened to anyone at anytime, too.

    Right? 🙂

    ~TEO.

    • “Funny” anecdote. I too was ‘adjusted’ in a similar fashion by the Cadillac-of-Chiroquacks, one Vern Pierce DC PhC! (C-is for Chiropractic….they made up a fake-doctor-degree and a fake professor-degree).
      The C5-slam as it was affectionately known left me in pain, and ‘distress’ for more than a month. It also seemed to be correlated to a bout of vertigo (I never had previously) and that has plagued me intermittently ever since.
      This reprobate was a really BIG deal in the profession for decades….until he died at 61 from septicemia from refusing antibiotics for a non-healing wound. Preferring instead that “innate cures everything as long as there are no subluxations”. This “technique” (and variations) still perpetuates today. There is no underpinnings of truth or reason to chiropractic….irrespective of whether PTs or DOs also buy into its erroneous-nonsense.
      “IT” can’t be reformed, no more than Islam can be. It’s history IS it’s future.

  • There are four five “professions” that practice “Spinal Manual Therapy”. Chiropractors, Osteopaths, Physiotherapists, Medical Practitioners and untrained manipulators.
    To attribute this type of incident only to chiropractors negates that this could have happened to a patient receiving care from any of the above five professions. This is a fundamental flaw with these types of articles.

    • it’s a case report!
      and the case happened with a chiro
      NOT ROCKET SCIENCE, IS IT?

      • Causality cannot be inferred from an uncontrolled observation. An association does not imply a cause-effect relationship. The observation or event in question could be a mere coincidence. This is a limitation shared by all the descriptive studies [47]. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4001358/

        • absolutely right!
          but with adverse effects, it is wise to consider the possibility of causality. it is in the interest of patient safety and it is what we do with adverse effects of drugs.

          • We should consider possiblity as well as probability..

          • exactly!
            and the authors of the case report – the people who might best be able to judge the probability in this case – thought causality is very probable.

          • Well, they postulated.

          • @DC
            You said:

            Well, they postulated

            It would be very interesting to hear your thoughts as to what explains the findings described in this case. What do you think caused them, if not what the chiropractor did?
            Do you have a more plausible explanation than the authors?

          • “…although we cannot exclude Valsalva retinopathy or progressive posterior vitreous detachment.”

          • @DC
            Not good enough. Valsalva retinopathy is a phenomenon which does not occur without a triggering forceful Valsalva action. Maybe you should look up what that is. Wikipedia has a good article on it. There is no history of any forceful Valsalva-causing activity such as heavy lifting, forceful coughing, straining on the toilet, or vomiting. The authors are trying to be thorough but they can actually exclude Valsalva retinopathy as there was no such history , which is the only way to set such a diagnosis.
            The only forceful activity or action in the history is the neck wringing, which immediately preceded the symptoms.
            As to the second phenomenon the authors present, that is partly incorrect as the symptoms resolved so the pathology was obviously not progressive and the vitreous detachment may have been caused byt forceful jerking of the head as well, so this is not a differential diagnosis.

            Are you still certain the trauma of HVLA neck manipulation had nothing to do with the hemorrhage and retinal detachment found as cause of the symptoms that immediately followed? If so, how do you explain (away?) this obvious relationship and the quite credible hypothesis of causality?

          • “…which is the only way to set such a diagnosis.”

            If that’s true, we all better make sure that our heavy lifting & coughing diaries are up to date. Alas, even when I was younger I couldn’t have given you an accurate coughing and heavy lifting history. I would have kept better notes if I’d known it was so important.

            “What do you think caused them, if not what the chiropractor did?”

            If a patient presents, without having seen a chiro and reports no heavy lifting, forceful coughing, etc on their history…how do explain that away?

          • “Are you still certain the trauma of HVLA neck manipulation had nothing to do with the hemorrhage and retinal detachment…”

            You seemed confused, I never said that.

          • Did I say you ‘said’ that? 😀

            (But our little lurker “jm” is certainly confused 😉 )

    • There are four five “professions” that practice “Spinal Manual Therapy”. Chiropractors, Osteopaths, Physiotherapists, Medical Practitioners and untrained manipulators. To attribute this type of incident only to chiropractors negates that this could have happened to a patient receiving care from any of the above five professions. This is a fundamental flaw with these types of articles.

      Oh, PUH-LEAZE, GibleyGibley.

      Cracking the joints of the Chiropractic Spine has been the bread and butter of The Chiropractic Enterprise since its inception in 1985. It remains so today. Chiropractors crack joints. What does that mean here? It means that when you go to a chiropractor, the likelihood that you’re going to get cracked is almost certain. In case you hadn’t noticed, that’s what chiropractors do. Take a look.

      Yes, in some chiropractic offices you might also get some ultrasound, let’s say, if this sort of “adjunct” therapy is allowed under their license; but, odds are you aren’t going to escape the office without getting cracked. Typically, even if a patient complains of low back pain, they’re going to get a low-back crack as well as a thoracic spine and neck cracking. You can’t be too careful, after all. Similarly, if you complain of a headache, you’re not getting out of the office without a side-posture maneuver and mid-back crunching. That’s simply what most every chiropractor does, unless they are purely an Activator Methods, SOT, or NUCCA practitioner, for example. And, even then. Chiropractors are quite enthusiastic about these bone-cracking “Adjustments,” in case you hadn’t noticed.

      Now, consider the other practitioners who, for some reason, you pretend routinely crack necks. They don’t. Physical therapists typically _mobilize_ with a range of gentle passive motion all the way up to a grade five mobilization (rarely, never mind routinely done) in which they “pop” joints. Osteopaths in the United States practice biomedicine, prescribing labelled drugs and doing surgery. Manual therapy is an elective for the D.O. and you’d have to actually look for one who corrects “Spinal Lesions” or who does Cranial “work,” or Bloodless Surgery. As for getting your neck cracked by an MD … well, you’ve got to be kidding.

      You seem bothered by the very idea that chiropractors who crack necks might cause any unintended and undesirable effects. It doesn’t appear that post-neck cracking retinal hemorrhages or other eye problems are all that common, although the numbers aren’t known. Moreover, if chiropractors have anything to do with it, the statistics never will be known. Chiropractors don’t take criticism very well. So, when things go south at the hands of a chiropractor, the denials that “chiropractic” had anything to do with it are reflexive, defended, and predictable. It seems that most every chiropractor was at home watching TV when the accident happened and didn’t see or hear anything. Pretty stupid for so many reasons. But who’s counting.

      You’re not a chiropractor, are you?

      ~TEO.

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