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J Acupunct Res > Volume 36(2); 2019 > Article
Ku, Kang, Kong, Ryu, and Lee: A Systematic Review of Acupuncture for Oculomotor Nerve Palsy

Abstract

Acupuncture treatment for oculomotor nerve palsy has been increasing recently. This study analyzed randomized controlled trials (RCTs) and case reports, using the Cochrane risk of bias tool to investigate the efficacy of acupuncture therapy for oculomotor nerve palsy. This analysis was performed on March 7, 2019, using online databases (PubMed, Cochrane, NDSL, OASIS, CNKI) where 208 articles were retrieved. Of these, there were 18 case reports and 18 RCTs that matched the inclusion criteria, of which 32 studies used acupuncture as the primary intervention, 1 used pharmacopuncture, 1 used fire-needling, and 1 used electroacupuncture. The most commonly used acupoints were BL1, BL2, ST2, TE23, Ex-HN5, LI4, GB14, ST36, GB20 and GB1. Significant findings were reported in all RCTs. Six adverse events were reported in 3 RCTs, with no effect on the outcome. No side effects were reported in the case reports. The risk-of-bias analysis showed that the articles did not report the experimental protocol used and it was not clear whether the study was blinded. Hence, it was difficult to assess the risk of bias. Analysis of 36 studies showed that acupuncture therapy for oculomotor nerve palsy was effective in many cases. It was difficult to evaluate the potential bias.

Introduction

The oculomotor nerve (3rd cranial nerve) contains the oculomotor nerve nucleus which dominates the levator palpebrae muscle, upper rectus muscle, inferior oblique muscle, medial rectus, and inferior rectus muscles, and also contains the Edinger-Westphal nucleus which dominates the sphincter pupillae. The nucleus that dominates the levator palpebrae muscle is a mononucleus, and the other muscles have paired nuclei. The upper rectus muscle is also dominated by the contralateral nucleus, and the other outer muscles of the eye are also dominated by the collateral nucleus [1].
The anatomical structure of the nucleus can cause bilateral oculomotor nerve palsy, which is a normal function of the levator palpebrae superioris, and may also cause unilateral oculomotor nerve palsy which is accompanied by superior rectus paralysis and incomplete ptosis. Damage to the oculomotor nerve nucleus can also cause Weber syndrome, Claude syndrome, and Benedikt syndrome. Oculomotor nerve palsy may be caused by compression due to a tumor, during an aneurysm or temporal herniation. Additionally, any lesion in the neuronal nucleus, nerve bundle, subarachnoid space, cavernous sinus or the superior orbital fissure may cause oculomotor nerve palsy. Generally, it is caused by diabetes, a cerebral aneurysm, meningitis, trauma or inflammatory disease [2,3].
Oculomotor nerve palsy leads to paralysis in 4 extraocular muscles, excluding the medial rectus muscle and the superior oblique muscle. This causes obstructions for upper and lower eye movement and adduction of the eyeball. The eyeball is fixed in the exterior downward state. Significant ptosis appears sometimes accompanied by exophthalmos. If oculomotor nerve palsy is severe, paralysis of internal eye muscles, pupil and ciliary muscles, occurs. Moderate mydriasis results in the loss of direct and indirect pupillary light reflexes, and paralysis of accommodation due to ciliary muscle failure [4].
In Western medicine, with the exception of cases involving aneurysm, traumatic hemorrhage, or tumor, treatment of oculomotor nerve palsy is based on the treatment of the underlying disease; there is no special treatment for the oculomotor nerve palsy itself [5]. According to statistics from the Health Insurance Review and Assessment Service in Korea, the number of patients with nerve palsy receiving Western medical treatment increased from 1,891 in 2010 to 2,580 in 2017. Patients receiving Korean medicine treatment for nerve palsy increased from 42 in 2010 to 86 in 2017 [6]. Oculomotor nerve palsy is well documented and studied worldwide. However, in Korea, only case reports have been published; no systematic reviews have been performed. Recently, studies of acupuncture treatment for oculomotor nerve palsy have been increasing. The purpose of this study was to examine the therapeutic efficacy of acupuncture treatment for oculomotor nerve palsy, and to compare the treatment effects with those of Western medicine. Articles were analyzed to determine the type of acupuncture therapy used for oculomotor nerve palsy and the frequency of the common acupoints used in those included studies.

Materials and Methods

Subjects and search methods

Domestic (Korean) and foreign electronic databases were used to collect literature that related to this research topic. PubMed, the Cochran library, the China National Knowledge Infrastructure (CNKI), the Korean databases Oriental Medicine Advanced Searching Integrated System (OASIS) and the National Digital Science Library (NDSL) were used. “Medical Subject Heading” (MeSH) search terms included “oculomotor nerve paralysis,” “oculomotor nerve palsy,” “third nerve palsy,” “acupuncture,” “electroacupuncture”, “pharmacopuncture,” and “dry needling.” The search was conducted on March 7, 2019 (Appendix 1).
Clinical articles that used acupuncture, electroacupuncture, pharmacopuncture, and acupotomy as the main treatment intervention were included in the analysis. There were no restrictions placed on the language of the publication, and there were no limits on the format of the published studies. Articles that were excluded included literature reviews, cases of paralysis not due to oculomotor nerve paralysis, and treatment intervention that did not include acupuncture, electroacupuncture, pharmacopuncture, or acupotomy. Two or more independent Korean medical doctors reviewed the 208 retrieved article titles and abstracts according to the selection criteria and excluded duplicate studies. In cases of inconsistency, third parties participated and decided whether to include articles by consensus. Finally, 36 articles, 18 case reports and 18 randomized controlled trials (RCTs), were selected. (Figs. 1 and 2).

Results

Research design and number of cases

Of the 36 clinical studies, 14 were conducted in Korea and 22 were conducted in other countries. The 18 case reports consisted of 17 studies with less than 10 cases and 1 study with 30 or more cases (Table 1). Of the 18 RCTs, there was 1 study with less than 30 patients, 6 studies with 30 or more but less than 60 patients, 7 studies with 60 or more but less than 90 patients, and 4 studies with more than 90 patients. The 18 case reports included 50 cases (24 males and 26 females). The 18 RCTs included 1,441 participants (803 males and 638 females). This data is shown in Table 2.

Intervention analysis

There were 33 studies that used acupuncture as the main intervention [7-39], 1 used fire-needling [40], 1 used pharmacopuncture [41], and 1 used electroacupuncture [42] (Fig. 3).

Acupuncture

Among the 33 studies that used acupuncture as the main intervention, there were 18 case reports [7-24] and 15 RCTs [25-39]. Of the case reports, 13 used Korean herbal medication as a supplementary intervention [10,12-14,16-24], 10 used electroacupuncture [12-15,17-21,23,24], 4 used pharmacopuncture [13,18,19,24], 3 used rehabilitation [12,13,24], 2 used moxibustion [12,19], 2 used Western medication [10,20] and 1 used chuna [7]. Two of the RCTs used Korean herbal medication as a supplementary intervention [27,30] and 9 used Western medication [25,27,29,30,32,34-36,38] (Fig. 4). Frequently used acupoints included BL1, BL2, ST2, Ex-HN5, LI4, GB4, ST36, GB20, GB1 SP6, GV20, and LR3. Seven studies examined the effectiveness of new acupoints for acupuncture treatment of oculomotor nerve palsy compared with traditional acupoints. In studies that used the same intervention, there were significant differences in acupuncture techniques and acupoints used (p < 0.05).

Pharmacopuncture

There was 1 RCT that used pharmacopuncture as the main intervention. Of the 456 patients, 237 were men and 219 were women. The experimental group of 228 patients was divided into 4 groups according to Traditional Chinese Medicine (TCM) syndromes such as the syndrome of attack of collaterals by pathogenic wind, the syndrome of deficiency of spleen qi, the syndrome of liver-yang transforming to wind, or the syndrome of stagnation of qi and blood. The efficacy of pharmacopuncture was compared with that of Western intravenous fluid administration. Acupoints included BL1, GB14, ST2, GB1, and BL18. Additional acupoints were added according to the syndrome. GB20 and medical Chinese thorowax root injection were used for the syndrome of attack of collaterals by pathogenic wind, BL20 and medicinal astragalus membranaceus injection were used for the syndrome of deficiency of spleen qi, EX-HN5 and medicinal gastrodin injection were used for the syndrome of liver-yang transforming to wind, and BL17 and medicinal compound red-rooted salvia injection were used for the syndrome of staging of qi and blood. The results were statistically significant in the pharmacopuncture group (p < 0.05).

Fire-needling

There was 1 RCT with fire-needling as the main intervention. The study reported the effects of dry needling and fire-needling on the acupoints. Of the 48 included patients, 40 were male and 8 were female. In the experimental group, 24 patients underwent fire-needle acupuncture at GB14, BL2, EX-HN4, TE23, EX-HN5, ST2, and ST36. Dry needling was performed at BL23, ST36, GB37, GB20, GB14, BL2, TE23, EX-HN5, and ST2. The results were statistically significantly different in the fire-needling group compared to the control group (p < 0.05).

Electroacupuncture

There was 1 RCT that used electroacupuncture as the main intervention. Electroacupuncture, rehabilitation, electroacupuncture and rehabilitation were used to study the significance of each treatment. Of the 72 included patients, 38 were men and 34 were women. Electroacupuncture, rehabilitation treatment, and combination therapy were conducted on individuals in an experimental group and a control group. Combination therapy was shown to be significantly more effective than electroacupuncture or rehabilitation alone (p < 0.05).

Analysis of causes

In 17 studies, stroke, diabetes, trauma, infection, and idiopathic causes were recorded, but 19 studies did not document the cause of oculomotor nerve palsy. There were 223 stroke patients [9,10,18,20,21,29,30,33,36], 221 diabetic patients [24,25,34-36], 12 infections reported [9,36], and 44 idiopathic cases [13,14,32] (Fig. 5).

Analysis of evaluation tools

Twenty studies used the palpebral fissure width (PFW) to analyze efficacy, 12 used clinical scores, 17 used 3rds level evaluations, 5 used 4th level evaluations, 7 used eye movement, 4 used clinical results, 3 used the position distance of the muscle, 9 used the size of the pupil, 1 used changes of oculi rimae, 1 used muscle power grade, 1 used the Korean version of the Scale for the Assessment and Rating of Ataxia (K-sara), 1 used motor grade, 1 used the visual acuity test, 1 used the angle of view, 1 used the quality of life score, 2 used diopters, 1 used the light reflex, and 1 used efficiency (Fig. 6).

Adverse reactions and side effects

Three RCTs reported side effects. All 6 adverse events did not affect the results. In the study by Li [27], 2 of the experimental groups complained of nausea, and the defect rate was 2.47%. After treatment, side effects disappeared. In the experimental group in Yu and Zeng’s study [29], 1 patient had a hematoma, and the defect rate was 6.98%. Dong’s study [39] reported bleeding in 1 patient in the treatment group and 1 patient in the control group, but these adverse events did not affect the results. There were no adverse effects reported in the case reports.

Risk of bias

The risk of bias was assessed for 18 RCTs according to the Cochrane handbook (Fig. 7).

Random sequence generation

Low risk was observed in 5 studies (28%). Three studies (17%) used random numbers, and 2 studies (11%) used computers to generate random sequences. Three studies (17%) showed high risk. One study (6%) was categorized without random assignment, and 1 study (6%) was assigned according to treatment time. One study (6%) was assigned using odd and even numbers. The remaining 10 studies (56%) did not clearly specify the randomization method.

Allocation concealment

Low risk was observed in 1 study (6%). One study (6%) used a serial numbered envelope [34]. Four studies (14%) had high risk. Four studies (14%) used a random number table [35,36,41,42], and the remaining 13 studies (72%) were classified as unclear hazards with no record of concealment methods.

Blinding of participants and personnel

Blinding was not performed in any of the 18 studies (100%). However, it was classified as an unclear risk as it was difficult to judge the effect of blinding on the evaluation of the result, because it was evaluated together with objective items such as PFW and efficiency rate.

Blinding of outcome assessment

Low risk was categorized using a single-blind method to avoid observer bias in 1 study (6%) [34]. Seventeen studies (94%) were classified as unclear risk.

Incomplete outcome data

Low risk was observed in 18 studies (100%). In 1 study (6%), 19 participants dropped out, but a sufficiently large number of participants were included in the study to prepare for dropouts [34]. 17 studies (83%) had no dropouts.

Selective reporting

There were no reports on protocols and predefined plans therefore, all 18 studies (100%) were classified as unclear hazards.

Other bias

Five studies (28%) were considered to have a high risk of bias. In 2 studies (11%), there were differences in the number of participants in the experimental and control groups at the experimental design stage, so there was a concern that the design of the study and the derivation of the results may not have been processed properly because there was no mention of the experimental design [35,37]. There was no mention of the number of treatments or the duration of treatment in 1 study (6%) [30], there was no mention of treatment in the control group in 1 study (6%) [26], and there was no mention of treatment in the experimental or control groups in 1 study (6%) [25]. In 13 studies (72%), there was no possibility of additional prejudice; these were classified as low risk (Fig. 8).

Summary of research trends

There were 36 studies that satisfied the inclusion criteria of this study. There were 14 South Korean studies and 22 studies from other countries. Of the foreign studies, 21 were in Chinese and 1 was in Israeli. All of the studies from Korea were case reports; there were no RCTs using acupuncture treatment for oculomotor nerve palsy. Of all the case reports, 8 (44.44%) were published after 2010, and 10 (55.56%) were published before 2010. Among all the RCTs, 17 (94.44%) were published after 2010, and 1 (5.56%) was published before 2010. All the studies that related to electroacupuncture, pharmacopuncture, and fire-needling were published in China after 2010 (Fig. 9). RCTs have been published relatively recently in China, but in Korea, only case reports have been recently published.
Acupoints were used in all 36 articles selected for this study. Acupoints around the eye such as BL1, BL2, ST2, TE23, Ex-HN5, LI4, GB14, ST36, GB20, and GB1 were mainly used. The frequency of each acupoint’s use is shown in Table 3. There was 1 study that used scalp acupuncture [34] and 1 used acupoints around the eyelids [39].

Discussion

The oculomotor nerve is the third cranial nerve that divides into motor and parasympathetic fibers. Starting from the third cranial nerve nucleus, located in front of the middle cerebral cortex, the motor fibers dominate the levator muscles and the extraocular muscles, including the upper rectus muscle, inferior oblique muscle, medial rectus muscle, and lower rectus muscle. Parasympathetic nerve fibers dominate the circular fiber of the pupillary sphincter and the ciliary muscle. The nerve fibers pass through the cavernous sinus and enter the orbit through the superior orbital fissure, where they are divided into upper and lower branches. The upper branch dominates the upper rectus muscle and levator muscle, and the lower branch dominates the medial rectus muscle, lower rectus muscle, inferior oblique muscle, pupillary sphincter, and ciliary muscle [43].
Oculomotor nerve palsy causes unilateral ptosis, impairment of upper, lower, and medial oculomotor movement, and visual impairment. The eyeballs are displaced downward at rest. The sphincter pupillae muscle can also cause problems with the pupil size and reactivity [44].
The most common cause of oculomotor nerve palsy is ischemic damage to the oculomotor nerve. Other causes include head trauma, vascular disease, aneurysms, tumors, diabetes, and inflammatory diseases [45]. In Rush’s retrospective study, causes of oculomotor nerve palsy included unknown origin in 26.3% of cases, trauma in 19.7%, vascular disease in 17.2%, neoplasms in 14.3%, aneurysms in 7.1%, and other in 15.4% [46].
In Western medicine, oculomotor nerve palsy is examined using brain magnetic resonance imaging, magnetic resonance angiography, and lumbar puncture. Clipping is performed for aneurysms, and resection is performed for tumors. If there is no abnormality upon examination, the individual is diagnosed with ischemic oculomotor nerve palsy. Follow-up examination is performed to determine the prognosis of the oculomotor nerve palsy. If there is no improvement within 1 year of observation, surgical treatment of the extraocular muscle and levator muscle is usually performed [47,48]. Covering the affected eye to avoid diplopia is recommended in the early stage of paralysis. When deviation is within 10Δ, use of prism glasses is recommended [49]. In other cases, corticosteroids, vitamins, and botulinum toxin can be injected.
According to a study by Lee et al on the recovery of oculomotor nerve palsy, 46.8% of patients had complete or partial recovery from oculomotor nerve palsy, while Rush and Young reported 48% and 57.3%, respectively. In a study by Park et al, the recovery rate was 44.8% [50].
In the diagnosis of differential TCM symptoms, the causes of oculomotor nerve paralysis are classified into attack of wind to the collaterals, wet phlegm obstruction, wind heat affection, wind of liver moving inside, stagnation of qi and blood, deficiency of endowment, and unilateral properties [51]. Conservative Korean medical treatment, such as herbal medicine, acupuncture, pharmacopuncture, electroacupuncture or moxibustion, is performed according to the cause of oculomotor nerve paralysis.
In the case reports, clinical symptoms were improved with the use of additional interventions such as chiropractic treatments, herbal medicine, Western medicine, moxibustion, rehabilitation, pharmacopuncture or electroacupuncture.
Eight of the RCTs reported acupuncture therapy to be significantly more effective than Western medication alone [7,9,14,16-18,20]. Six of the RCTs reported efficacy by comparing experimental acupoints with traditional acupoints [26,28,29,33,37,39]. Sun et al conducted acupuncture treatment according to diagnosis of TCM syndrome in the control group. The experimental group showed significant improvement with acupoint treatment around the eyes [28]. Two studies have reported that Xingnao Kaiqiao acupuncture therapy is more effective than traditional acupuncture therapy in cerebrovascular patients [29,33]. Yang et al reported that the efficacy of acupoints around the eyes was improved using a multi-needle shallow puncture technique rather than conventional methods [37]. Wang’s study compared effects in 3 groups using rehabilitation. There was significant improvement in the group that combined acupuncture and rehabilitation treatment [31]. There were 2 RCTs using nontraditional acupoints. Yang performed scalp acupuncture [34], and Dong used upper eye point 1, upper eye point 2, upper eye point 3, lower eye point 1, and lower eye point 2 [39]. Both studies reported significant improvement when compared with traditional acupoints.
In a systematic review of the therapeutic acupoints for oculomotor nerve palsy using 23 previously reported studies, the frequency of use for each acupoint was as follows: BL2 7.2%, BL1 6.8%, TE23 6.5%, LR3 6.5%, Ex-HN4 5.8%, GB14 5.4%, ST36 5.0% 4.7%, GB20 4.3%, Ex-HN10 4.0%, SP6 4.0%, and LI4 4.0%. By body part, the face was used in 60.8% of studies, upper limb in 23.0%, lower limb in 7.5%, nuchal in 6.2% and the back in 2.2%. In summary, acupuncture treatment for oculomotor nerve palsy was considered to be effective at giving a strong and sustained stimulation to the acupoint around the eyes with multi-needle. Acupoints around the eye seem to be effective when chosen according to TCM syndrome.
In the Guo study, Western medication and pharmacopuncture were used differently according to TCM syndrome. The therapeutic effect, degree of movement of the affected eyeball, and changes in the oculi rimae and pupil, were analyzed. The therapeutic effect was 92.2% in the attack of wind to the collaterals, 91.0% in the deficiency of spleen qi, 91.6% in the hyperactivity of liver-yang transforming to wind, and 91.7% in the stagnation of qi and blood (p < 0.05). There was a significant difference in the degree of movement of the muscle rectus medialis, superior rectus muscle, muscle rectus inferior and inferior oblique muscle in both experimental and control groups (p < 0.05). However, when comparing the experimental and control groups, the difference in the degree of movement was only apparent in musculus rectus medialis. When comparing changes in the pupil, there were significant differences among all groups after treatment (p < 0.05), but when comparing changes in the oculi rimae, significant differences were only noted when the experimental group and control group were compared (p < 0.05) [16].
According to Song’s study, the efficacy in the experimental group using fire-needling at BL2, BL20, BL18, BL23, GB14, GB37, GB20, ST2, ST36, TE23, Ex-HN4, and Ex-HN10 was superior to the acupuncture treatment group (p < 0.05) [41].
Zhan et al’s study [42] compared electroacupuncture, rehabilitation, and combined electroacupuncture and rehabilitation treatments. Efficiency and diopters were effective in the electroacupuncture group, but significantly more effective in the combination group (p < 0.05). The efficacy rate of rehabilitation, which accounted for a large proportion of nonsurgical treatments in Western medicine was 52.17%, the effective rate of electroacupuncture was 83.30%, and the efficacy rate of combination treatment was 96.0%. Significance was reported in all studies compared with conservative Western medical therapy. It is therefore effective to use a combination of various treatments when using acupuncture in clinical practice.
PFW was the most common method used to evaluate efficacy. It measures the distance from the midpoint of the upper eyelid to the midpoint of the lower eyelid. Clinical scores, clinical results, and evaluation level, which are qualitative evaluations, differ in detailed symptom evaluation. They do not evaluate objective measures and it is not enough to evaluate specific treatment effects. The visual analogue scale score and the quality of life score are subjective evaluations and are considered to be supplementary evaluation items. The K-sara and motor grade were used to assess stroke sequelae. The evaluation methods should utilize objective measurement values such as PFW, size of the pupil, angle of view, diopters, light reflex and movement of the eyeball.
Three RCTs reported side effects, but none of them directly affected the study results. In the study by Li [27], 2 participants in the experimental groups complained of nausea and improved after treatment. The side-effect rate was 2.47% [27]. In Yu and Zeng’s study [29], 1 patient in the experimental group had a hematoma, nausea, and vertigo. The side-effect rate was 6.98%. In the control group, 1 patient had hematoma, erythema and nausea. There was not a significant difference between side-effect rates between control and experimental groups. Dong’s study [39] reported bleeding in 1 patient in the treatment group and 1 in the control group. However, there were no effects on the study results. There were no reports of adverse events in the case reports included in this study. Reports of side effects should be reported quantitatively and in detail. In the future, evaluation of the consistency of acupuncture treatment is warranted.
The 18 RCTs included in this study were analyzed according to the Cochrane Handbook’s Risk of Bias Assessment. It is impossible to apply the blinding method to both the therapist and the patient because of the nature of the study comparing acupuncture with other treatment interventions. Treatment without blinding may result in reduced expectations of controls, and differences in behavior between groups. Overall, the quality of the studies assessed was low. In subsequent studies, as it is difficult to blind the subjects and the practitioner, the evaluators should clearly indicate how the study has been blinded.
Most articles in this study reported the effectiveness of acupuncture-based treatment of oculomotor nerve palsy. Case reports were reported before 2010, but RCTs have been actively reported since 2010. In all studies, acupuncture alone or in combination showed improvement and statistical significance in the experimental group compared with the control group. Many frequent acupoints used in the experimental groups were around the eyes. Strong stimulation therapy showed a tendency to be more effective. PFW, clinical score, and level evaluation were used as evaluation methods, but there were no unified criteria between studies. It has been shown that acupuncture therapy studies of oculomotor nerve palsy are increasing and that acupoints around the eyes are effective.
This study had some limitations. In the study-selection process, the main word and intervention was selected, regardless of the quality. A systematic review of the literature was conducted, including all studies satisfying inclusion criteria. Additionally, this study searched 5 databases but did not include other non-English language studies or ongoing clinical trials, and gray texts not listed in the database that were missing. Moreover, the classification of acupuncture therapy had various limitations, such as order and depth, which made it difficult to analyze.

Conclusion

This study analyzed 36 articles according to the inclusion criteria of the study design. Eighteen case reports and 18 RCTs were included in the analysis. Acupuncture treatment for oculomotor nerve palsy was significantly more effective than Western medicine monotherapy. Dry needling, pharmacopuncture, electroacupuncture, and fire-needle therapy can be used alone or in combination for treatment of oculomotor nerve palsy.

Conflict of Interest

The authors have no conflicts of interest to declare.

Fig. 1.
Flow diagram of selection process.
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Fig. 2.
Analysis of acupuncture treatment of Oculomotor nerve palsy design. RCT, randomized controlled trial.
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Fig. 3.
The number of articles for main intervention.
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Fig. 4.
The number of articles for supplementary intervention.
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Fig. 5.
The number of causes for oculomotor nerve palsy in articles.
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Fig. 6.
The number of evaluation tools in articles.
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Fig. 7.
Risk of bias graph.
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Fig. 8.
Risk of bias summary.
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Fig. 9.
The year articles were published. RCT, randomized controlled trial.
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Table 1.
Summary of 18 Case Reports.
Author (y) Sample (size/ gender) Main Treatment Other Treatments Outcome Measure Results
Luo (2018) [8] Female (n =1) Acupuncture (BL1, BL2, GB14, Ex-HN4, GB1, Ex- HN10, Ex-HN7, ST2, GB20, TE5, SI6, LI4, ST36, Ashi) Chiropractic Muscle power grade Grade 1→Grade 5
Lei (2018) [7] Female (n =1) Acupuncture (BL1, BL2, GB14, Ex-HN4, GB1, ST2, GB20, TE5, LI4, ST3, GB4, TE23, LI11, LI6, TE3) Palpebral fissure width size of pupil position distance of the muscle palpebral fissure: 6 mm→12 mm size of pupil:5 mm/4 mm→3 mm/3 mm position distance of the muscle innervated by the oculomotor nerve: 0.4 cm→Normal
Yin (2009) [9] Acupuncture (BL2, Ex-HN10, TE5, LI4, TE23, Ex-HN14, ST8) Palpebral fissure width size of pupil position distance of the muscle 3rd level: cure/effective/ failed palpebral fissure 2.43 ± 0.56→6.78 ± 0.436 p < 0.01 size of pupil 4.67 ± 0.39→3.45 ± 0.65 p < 0.05 measurement of the position distance of the muscles:
30 The medial rectus muscle (n = 20) 8.25 ± 1.36→2.84 ± 1.10 p < 0.01
Male (n =16) The superior rectus muscle (n = 12) 4.56 ± 0.44→2.32 ± 0.34 p < 0.05
Female (n = 14) The inferior rectus muscle (n = 10) 4.64 ± 0.42→2.40 ± 0.41 p < 0.05
The inferior oblique muscle (n = 6) 4.80 ± 0.72→3.97 ± 0.66 p > 0.05 cure 10 (33.33%) effective 12 (40.00%) failed 8 (26.67%)
Kim (2017) [10] Male (n = 1) Acupuncture (BL2, GB14, Ex-HN4, GB1, ST36, TE23, Ex-HN1, GV26, LI10, SP6, GB39, ST1) Herb medication, Western medication K-SARA Palpebral fissure width K-SARA Subscores
1. Walking: 8→3
2. Standing: 6→2
3. Sitting: 3→1
4. Finger to nose: 20→7
Total score: 20→7
Palpebral fissure: 0 → 9 mm (seat position)/5 mm (lying position)
Frenkel (2002) [11] Female (n = 1) Acupucture (GB14, GB1, GB20, LI4, GV26, GB19, LR3, Ashi) Clinical results 1 wk: pain disappeared
4 wk: ptosisalmost disappeared
9 wk: symptom free
Jeung (2015) [12] Female (n = 1) Acupucture (BL2, GB14, Ex-HN4, GB1, Ex-HN10, ST2, LI4, ST36, TE23, ST1, TE17) Herb medication, Electroacupuncture, Moxibustion, Rehabilitation treatment Palpebral fissure width (PFW, MRD1, MRD2) 3rd level (ptosis): Mild, Moderate, Severe movement of eyelid: Excellent, Good, Fair, Poor VAS: eye pain PFW (0→5 mm) MRD1 (0→1 mm), MRD2 (0→4 mm)
Ptosis: Severe → Mild
Movement of eyelid: Poor → Good
Pain: 10 → 0
Jeung (2009) [13] Male (n = 3) Acupucture (BL1, BL2, GB14, Ex- HN4, GB1, ST2, GB20, TE23, TE17) Herb medication, Electroacupuncture, Rehabilitation treatment Pharmacopuncture VAS: Ptosis, Ocular deviation Clinical results Case 1 (11 times) Look ahead MRD (1→9) Eye open MRD (3→9) ptosis, Ocular deviation (1→9), diplopia, vertigo, headache - severe→disappearance
Case 2 (8 times) Look ahead MRD (1→9), Eye open MRD (4→9), ptosis, Ocular deviation (1→8), diplopia, vertigo - severe→disappearance
Case 3 (14 times) Look ahead MRD (2→9), Eye open MRD (3→9), ptosis, Ocular deviation (2→8), diplopia, vertigo - severe→disappearance
Lee (2010) [14] Female (n = 1) Acupucture (BL1, BL2, GB1, ST2, TE5, TE23, LI11, LR3, LR2, GB43, GB43, TE3, KI10, TE2) Herb medication Palpebral fissure width Clinical photograph VAS: Ocular deviation 3rd level: ptosis: mild/moderate/severe Movement of eyelid: excellent/good/fair/poor PFW (0→8 mm), MRD1 (0→3 mm), MRD2 (0→5 mm)
Ocular deviation 0→9
Ptosis: Severe → Good
Movement of eyelid: Poor → Normal
Kim (2006) [15] Female (n = 1) Acupucture (Ashi) Electroacupuncture Clinical results Cure
Kim (2009) [16] Male (n = 1) Acupucture (BL1, BL2, Ex-HN4, GB1, LI4, ST36, TE23, LR3, GV20, SI18, ST37, SP9, LR4) Herb medication VAS: Eye pain, Nuchal pain Palpebral fissure width (PFW, MRD1) Eye Movement First treatment
Eye pain: VAS10 → 0
Nuchal pain: VAS10 → 1
Ptosis & Abduction exercise: No change
Second treatment
Eye pain: VAS10 → 0
Nuchal pain: VAS10 → 0
PFW (0 mm→11 mm), MRD1 (0→4 mm)
Eye movement: Adduction exercise → Upward exercise
Kim (2004) [17] Female (n = 1) Acupucture (BL1, BL2, GB14, GB20, TE23, ST1, KI10, GV20, SP2, HT8, LR1, SP1, LR4, LU8, LR8) Herb medication, Electroacupuncture Clinical results Cure
Eom (2015) [18] Male (n = 1) Acupucture (BL1, BL2, GB14, Ex-HN4, Ex-HN10, ST2, LI4, TE23, ST1, TE17, GV20, SI18, LR1, GV24, ST7, LI1, GB15) Herb medication, Electroacupuncture, Pharmacopuncture Palpebral fissure width Clinical photograph Corneal reflex VAS: Diplopia Corneal reflex: 45˚→15˚
PFW: 5.5 mm→9 mm
Diplopia: 10→10
Son (2017) [19] Female (n = 1) Acupucture (BL2, Ex-HN4, Ex-HN10, ST2, TE5, LI4, ST36, TE23, LI11, LI10, LR3, ST37, CV12, SP10, CV6, CV4) Herb medication, Electroacupuncture, Moxibustion, Pharmacopuncture Length from medial canthus to lateral iris VAS: Diplopsia Length: 14 mm→10.5 mm
NRS: 10→1
Jeung (2005) [20] Male (n = 1) Acupucture (GB14, LI4, ST36, SP6, ST1, GV20) Herb medication, Electroacupuncture, Western medication Eye movement Motor grade Eye movement:
Upward 1→3 Downward 2→4 Adduction 1→5 Abduction 8→10
Motor grade: Upper limb IV→Sl Lower limb IV→Sl
Jeung (2000) [21] Female (n = 1) Acupucture (BL1, BL2, Ex-HN4, GB1, Ex-HN10, ST2, GB20, TE5, LI4, ST36, TE23, ST1, LR3, TE17, GB43, GV20) Herb medication, Electroacupuncture Palpebral fissure width Eye movement PFW: 0 mm→8 mm
Eye movement: Adduction 0→1/2
Lee (2003) [22] Female (n = 1) Acupucture (BL1, BL2, Ex-HN4, Ex-HN10, GB20, TE5, LI4, ST36,TE23, ST1, LR3, GV20) Herb medication Clinical results Cure
Eom (2004) [23] Male (n = 1) Acupucture (BL1, BL2, GB14, Ex-HN4, ST2, TE23, ST1) Herb medication, Electroacupuncture Palpebral fissure width Ocular deviation PFW: 5 mm→5.5 mm
Ocular deviation: Adduction 0˚→45˚
Jo (2014) [24] Female (n = 1) Acupucture (BL2, GB14, Ex-HN10, ST2, LI4, ST36, TE23) Herb medication, Rehabilitation treatment, Pharmacopuncture, Electroacupuncture Palpebal fissure width (PFW, MRD1, MRD2) Eye movement Visual acuity test PFW 5.5→10 MRD1 3→5 MRD2 4→5
Eye movement
Ocular deviation 17.0→10.3 Horizontal adduction 2→9
Horizontal abduction 9→10 Elevation 2→9 Depression 3→9
Visual acuity test 0.63/0.36 → 0.63/0.80

CT, computed tomography; MRI, magnetic resonance imaging.

Table 2.
Summary of 18 RCTs.
Author (Y) Sample size/ gender Main treatment Outcome Measure Results
Yan (2017) [25] Experimental (n = 13) Acupuncture (BL2, Ex-HN10 etc.) Palpebal fissure width Angle of view 4th level: Excellent, Good, fair, poor Palpebal fissure width: 3.11 ± 1.23→8.33 ± 1.31 Palpebal fissure width p < 0.05
Angle of view: 68.92 ± 22.31→16.23 ± 13.21
Control (n = 13) 4th level: Excellent (n = 10), Good (n = 3), Fair (n = 0), Poor (n = 0) Angle of view p < 0.05
Male (n = 15) Insulin, Vitamin B SC injection. Palpebal fissure width 3.20 ± 1.20→5.21 ± 1.22 Total efficiency: 100% p < 0.01
Female (n = 11) Angle of view 67.82 ± 23.73→38.21 ± 14.33
4th level: Excellent (n = 4), Good (n = 7), Fair (n = 2), Poor (n = 11)
Zou (2018) [26] Experimental (n = 25) Acupuncture (BL1, GB14, GB1, Ex-HN10, ST2, TE23, ST1) Palpebal fissure width Eye Movement 3rd level: Excellent, Good, Poor Palpebal fissure width: 6.05 ± 0.43 Palpebal fissure width p < 0.05
Male (n = 11) Eye Movement: 4.54 ± 0.41
Female (n = 14) 3rd level: Excellent (n = 13), Good (n = 11), Poor (n = 1) Eye movement p < 0.05
Control (n = 25) Acupuncture (Traditional acupoints) Palpebal fissure width:4.33 ± 0.30 Total efficiency: 96% p < 0.05
Male (n = 13) Eye Movement: 3.54 ± 0.32
Female (n = 12) 3rd level: Excellent (n = 8), Good (n = 10), Poor (n = 7)
Li (2017) [27] Experimental (n = 30) Acupuncture (BL1, Ex-HN4, Ex-HN10, Ex-HN7, GB20, LI4, ST36, TE23, ST1, GV20), Herb medication 3rd level: Excellent, Good, Poor Quality of life score 3rd level: Excellent (n = 20), Good (n = 8), Poor (n = 2) Total efficiency: 93.3% p =0.016
Male (n = 20) Quality of life score 55.70 ± 4.52→76.88 ± 8.65
Female (n = 10)
Control (n = 30) Western Medication 3rd level: Excellent (n = 15), Good (n = 5), Poor (n = 10) Quality of life score p =0.000
Male (n = 18) Quality of life score 55.63 ± 4.81→67.29 ± 8.30
Female (n = 12)
Sun (2015) [28] Experimental (n = 32) Acupuncture (BL1, ST1, GB1, LI20, BL2, ST2, GV20, GB20, KI3, SP3, LR3, SP6, GB20) Palpebral fissure width Size of pupil VAS: Diplopsia 3rd level: Excellent, Good, Poor Palpebral fissure width 4.82 ± 1.03→3.27 ± 0.51 Palpebral fissure width p < 0.05
Male (n = 16) Size of pupil 2.79 ± 0.64→7.26 ± 0.43
Female (n = 13) VAS: Diplopsia 4.55 ± 1.33→2.35 ± 0.98
3rd level: Excellent (n = 20), Good (n = 8), Poor (n = 2) Size of pupil p < 0.05
Control (n = 29) Acupuncture (Group 1 BL20, BL23, ST36, SP6, GB14 / Gruop2 BL20, CV6, ST36, GB14 / Group 3 ST36, LR3, SP6, GB20, GB14 / Group 4 GB14, BL2, GB20, BL17) Palpebral fissure width 4.66 ± 0.92→3.96 ± 0.58 VAS: Diplopsia p < 0.05
Male (n = 18) Size of pupil 2.70 ± 0.62→5.09 ± 0.41 Total efficiency: 93.75% p > 0.05
Female (n = 14) VAS: Diplopsia 4.51 ± 1.27→3.68 ± 1.07
3rd level: Excellent (n = 20), Good (n = 8), Poor (n = 2)
Yu (2015) [29] Experimental (n = 43) Acupuncture (GV26, PC6, SP6, GV23, Ex-HN3, GB12, LI4, GB20, BL10, Ex-HN5, BL1, Ex-HN7, ST3, ST2 etc.), Western medication 3rd level: Excellent, Good, Poor 3rd level: Excellent (n = 19), Good (n = 10), Poor (n = 11) Total efficiency: 93.02% p < 0.05
Male (n = 24)
Female (n = 19)
Control (n = 43) Acupuncture (GV26, PC6, SP6, Ex-HN3, GV23, GV20, GB12, GB20, BL10, ST2, Ex-HN5, Ex-HN4, Ex-HN7), Western medication 3rd level: Excellent (n = 14), Good (n = 12), Poor (n = 10)
Male (n = 25)
Female (n = 18)
Pan (2015) [30] Experimental (n = 46) Acupuncture (BL1, Ex-HN4, Ex-HN10, Ex-HN7, ST2, GB20, GV26, SP6), Herb medication, Western medication 4th level: Excellent, Good, fair, poor VAS: Ptosis, Size of pupil, Eye Movement, Diplopsia 4th level: Excellent (n = 13), Good (n = 19), Fair (n = 13), Poor (n = 10) Total efficiency: 93.48% p < 0.05
Male (n = 30) Ptosis 2.68 ± 0.55→7.11 ± 0.46
Female (n = 16) Size of pupil 4.53 ± 0.32→3.56 ± 0.25
Eye Movement 2.36 ± 0.76→0.78 ± 0.56 Ptosis p < 0.05
Diplopsia 4.42 ± 1.02→2.35 ± 0.56 Size of pupil p < 0.05
Control (n = 46) Western medication 4th level: Excellent (n = 8), Good (n = 15), Fair (n = 13), Poor (n = 10) Eye Movement p < 0.05
Male (n = 30) Ptosis 2.67 ± 0.57→5.63 ± 0.38 Diplopsia p < 0.05
Female (n = 16) Size of pupil 4.52 ± 0.35→3.89 ± 0.31
Eye Movement 2.34 ± 0.78→1.34 ± 0.95
Diplopsia 4.45 ± 1.05→3.43 ± 0.89
Wang (2014) [31] Experimental (n = 55) Acupuncture (BL1, Ex-HN4, Ex-HN10, ST2, GB20, LI4, ST36, TE23, ST1, GV20, Ashi) 3rd level: Excellent, Good, Poor light reflex Diopter Palpebral fissure width 3rd level: Excellent (n = 29), Good (n = 18), Poor (n = 8) Total efficiency: 85.5% p < 0.05
Male (n = 29) Light reflex 4.28 ± 0.84→3.41 ± 0.64
Female (n = 26) Diopter 53.76 ± 9.73→98.56 ± 10.39
Palpebral fissure width 2.72 ± 0.56→6.95 ± 0.79 Light reflex p < 0.05
Control (n = 55) Rehabilitation treatment 3rd level: Excellent (n = 21), Good (n = 15), Poor (n = 19) Diopter p < 0.05
Male (n = 27) Light reflex 4.34 ± 0.90→3.79 ± 0.73 Ocular width p < 0.05
Female (n = 28) Diopter 52.04 ± 11.23→92.23 ± 12.12
Palpebral fissure width 2.63 ± 0.71→6.58 ± 0.64
Chen (2014) [32] Experimental (n = 20) Acupuncture (BL1, BL2, GB14, GB1, LI4, ST36, SP6, ST1, LR3, GB37, SP3) 3rd level: Excellent, Good, Poor Diplopsia Palpebral fissure width 3rd level: Excellent (n = 3), Good (n = 16), Poor (n = 1) Total efficiency: 95.0% p < 0.05
Male (n = 13) Diplopsia 4.25 ± 1.12→3.58 ± 1.25
Female (n = 7) Palpebral fissure width 2.54 ± 0.31→6.47 ± 0.19 Diplopsia p < 0.05
Control (n = 20) Western medication 3rd level: Excellent (n = 1), Good (n = 13), Poor (n = 6) Palpebral fissure width p < 0.05
Male (n = 11) Diplopsia 4.53 ± 1.27→2.67 ± 1.03
Female (n = 9) Palpebral fissure width 2.44 ± 0.28→6.68 ± 0.21
Chen (2013) [33] Experimental (n = 29) XNKQ Acupuncture (BL1, Ex-HN4, Ex-HN10, Ex-HN7, ST2, GB20, GV26, SP6, GV20, Ex-HN3, GV23, PC6, GB12, BL10) 4th level: Excellent, Good, fair, poor Palpebral fissure width Size of pupil 4th level: Excellent (n = 21), Good (n = 5), Fair (n = 2), Poor (n = 1) Total efficiency: 96.55% p < 0.05
Male (n = 16) Palpebral fissure width 2.66 ± 0.52→7.15 ± 0.43
Female (n = 13) Size of pupil 4.58 ± 0.42→3.61 ± 0.34 Palpebral fissure width p < 0.05
Control (n = 26) Acupuncture (BL1, Ex-HN4, Ex-HN10, Ex-HN7, ST2, GB20, LI4, GV26, SP6, GV20, Ex-HN3, GV23, PC6, GB12, BL10) 4th level: Excellent (n = 9), Good (n = 7), Fair (n = 4), Poor (n = 6) Size of pupil p < 0.05
Male (n = 15) Palpebral fissure width 2.71 ± 0.65→5.84 ± 0.47
Female (n = 11) Size of pupil 4.51 ± 0.36→3.96 ± 0.32
Yang (2012) [34] Experimental (n = 74) Acupuncture (BL2, GB14, Ex-HN4, GB1, ST2, LI4, ST36, TE23, SP6, LR3, BL11, CV12, ST40, KI6, GB43, Scalp), Western medication 4th level: Excellent, Good, fair, poor 4th level: Excellent (n = 45), Good (n = 15), Fair (n = 6), Poor (n = 8) Total efficiency: 89.2% p < 0.05
Male (n = 42)
Female (n = 32)
Control (n = 58) Western medication 4th level: Excellent (n = 20), Good (n = 13), Fair (n = 3), Poor (n = 22)
Male (n = 30)
Female (n = 28)
Liu (2008) [35] Experimental (n = 24) Acupuncture (BL1, Ex-HN10, ST36, TE23, SP6, LR3, GV20, ST40), Western medication 3rd level: Excellent, Good, Poor 3rd level: Excellent (n = 15), Good (n = 8), Poor (n = 1) Total efficiency: 95.8% p < 0.05
Male (n = 13)
Female (n = 11)
Control (n = 24) Western medication 3rd level: Excellent (n = 9), Good (n = 8), Poor (n = 7)
Male (n = 14)
Female (n = 10)
Liu (2013) [36] Experimental (n = 30) Acupuncture (BL1, ST1, Ashi) 3rd level: Excellent, Good, Poor Palpebral fissure width 3rd level: Excellent (n = 7), Good (n = 19), Poor (n = 4) Total efficiency: 86.7% p < 0.05
Male (n = 17) Palpebral fissure width 0.80 ± 0.76→5.67 ± 2.70
Female (n = 13)
Control (n = 30) Western medication 3rd level: Excellent (n = 9), Good (n = 8), Poor (n = 7) Palpebral fissure width p < 0.05
Male (n = 18) Palpebral fissure width 0.88 ± 0.72→4.27 ± 2.01
Female (n = 12)
Yang (2017) [37] Experimental (n = 30) Acupuncture (ST1, BL1, Ex-HN4, GB1, BL2, Ex-HN3, GB14, ST2, GB20, GV23, LI4, LR3) 3rd level: Excellent, Good, Poor VAS: Diplopsia Size of pupil Palpebral fissure width 3rd level: Excellent (n = 17), Good (n = 12), Poor (n = 1) Total efficiency: 96.67% p < 0.01
Male (n = 16) Diplopsia 4.73 ± 0.980→1.33 ± 0.959
Female (n = 14) Size of pupil 3.350 ± 0.2862→3.180 ± 0.4080
Palpebral fissure width 4.833 ± 0.5213→9.560 ± 0.5399 Diplopsia p < 0.05
Control (n = 30) Acupuncture (GB14, BL2, Ex-HN4, TE23, BL60, Ashi) 3rd level: Excellent (n = 10), Good (n = 13), Poor (n = 7) Size of pupil p < 0.01
Male (n = 13) Diplopsia 5.07 ± 0.015→1.93 ± 0.640 Palpebral fissure width p < 0.01
Female (n = 17) Size of pupil 5.300 ± 0.3206→3.710 ± 0.3898
Palpebral fissure width 4.860 ± 0.5449→8.323 ± 0.5380
Yang (2017) [38] Experimental (n = 20) Acupuncture (BL1, BL2, Ex-HN4, GB1, Ex-HN10, LI4, ST36, TE23), Western medication 3rd level: Excellent, Good, Poor VAS: Diplopsia Palpebral fissure width 3rd level: Excellent (n = 11), Good (n = 8), Poor (n = 1) Total efficiency: 95.0% p < 0.05
Male (n = 12) Diplopsia 4.30 ± 1.49→1.20 ± 1.64
Female (n = 8) Size of pupil 5.35 ± 1.04→3.45 ± 0.60
Palpebral fissure width 4.85 ± 1.39→7.55 ± 1.19 Diplopsia p < 0.05
Control (n = 20) Western medication 3rd level: Excellent (n = 7), Good (n = 9), Poor (n = 4) Palpebral fissure width p < 0.05
Male (n = 12) Diplopsia 4.70 ± 1.17→2.60 ± 2.16
Female (n = 8) Size of pupil 5.15 ± 0.88→3.95 ± 0.89
Palpebral fissure width 4.35 ± 0.81→6.45 ± 1.32
Dong (2012) [39] Experimental (n = 30) Acupuncture (Upper eye point 1, 2, 3, Lower eye point 1,2) 3rd level: Excellent, Good, Poor VAS: Diplopsia Size of pupil Palpebral fissure width 3rd level: Excellent (n = 18), Good (n = 10), Poor (n = 2) Total efficiency: 93.3% p < 0.05
Male (n = 16) Diplopsia 4.41 ± 1.11→1.00 ± 1.48
Female (n = 14) Size of pupil 5.39 ± 0.49→3.13 ± 0.57
Palpebral fissure width 4.72 ± 1.59→9.24 ± 1.80 Diplopsia p < 0.05
Control (n = 30) Acupuncture (GB14, Ex-HN4, BL2, BL1, TE23) 3rd level: Excellent (n = 10), Good (n = 14), Poor (n = 6) Size of pupil p < 0.05
Male (n = 17) Diplopsia 4.45 ± 0.89→1.87 ± 1.66 Palpebral fissure width p < 0.05
Female (n = 13) Size of pupil 5.21 ± 0.51→3.65 ± 0.76
Palpebral fissure width 4.58 ± 1.43→8.30 ± 1.92
Guo (2013) [41] Experimental (n = 20) Pharmacopuncture (BL1, GB14, GB1, Ex-HN10, ST2, GB20) 4th level: Excellent, Good, fair, poor Eyeball movement degree Palpebral fissure width Size of pupil 4th level: Excellent (n = 46), Good (n = 82), Fair (n = 81), Poor (n = 19) Total efficiency: 91.7% p < 0.05
Male (n = 13) Eyeball movement degree
Female (n = 7) Musculus rectus medialis 8.0 ± 1.4→20.6 ± 1.2
Superior rectus muscle 2.2 ± 0.5→4.4 ± 0.5
Musculus rectus inferior 2.3 ± 0.4→4.8 ± 0.3
Infer oblique muscle 3.9 ± 0.2→4.7 ± 0.3
Palpebral fissure width 2.2 ± 0.5→6.8 ± 0.2
Size of pupil 4.5 ± 0.3→3.4 ± 0.3 Eyeball movement degree
Control (n = 20) Western medication 4th level: Excellent (n = 25), Good (n = 75), Fair (n = 68), Poor (n = 60) Musculuc rectus medialis p < 0.05
Male (n = 11) Eyeball movement degree Palpebral fissure width p < 0.05
Female (n = 9) Musculus rectus medialis 8.1 ± 1.3→17.1 ± 1.1
Superior rectus muscle 2.4 ± 0.6→4.3 ± 0.4
Musculus rectus inferior 2.6 ± 0.2→4.1 ± 0.3
Infer oblique muscle 4.0 ± 0.1→4.5 ± 0.6
Palpebral fissure width 2.3 ± 0.6→4.9 ± 0.4
Size of pupil 4.6 ± 0.4→3.4 ± 0.2
Song (2013) [40] Experimental (n = 24) Fire-needle therapy (GB14, BL2, Ex-HN4, TE23, Ex-HN5, ST2, ST36) 3rd level: Excellent, Good, Poor 3rd level: Excellent (n = 15), Good (n = 8), Poor (n = 1) Total efficiency: 95.8% p < 0.05
Male (n = 21)
Female (n = 3)
Control (n = 24) Acupuncture (BL20, BL18, BL23, ST36, GB37, GB20, GB14, BL2, TE23, Ex-HN5, ST2) 3rd level: Excellent (n = 10), Good (n = 7), Poor (n = 7)
Male (n = 19)
Female (n = 5)
Zhan (2012) [42] Group 1 (n = 24) Electroacupuncture (BL1, BL2, GB14, Ex-HN4, ST2, ST36, TE23, SP6, ST1, SP10) 3rd level: Excellent, Good, Poor Efficiency 3rd level: Excellent (n = 12), Good (n = 8), Poor (n = 4) Total efficiency:
Male (n = 10) Diopter 3rd level: Excellent (n = 12), Good (n = 9), Poor (n = 3)
Female (n = 14) Group 1 83.30%
Group 2 (n = 23) Rehabilitation treatment Efficiency 3rd level: Excellent (n = 5), Good (n = 7), Poor (n = 11) Group 3 96.00% p < 0.05
Male (n = 12) Diopter 3rd level: Excellent (n = 5), Good (n = 8), Poor (n = 10) Diopter efficiency:
Female (n = 11) Group 1 85.20%
Group 3 (n = 25) Electroacupuncture, Rehabilitation treatment Efficiency 3rd level: Excellent (n = 21), Good (n = 3), Poor (n = 1) Group 3 96.00% p < 0.05
Male (n = 16) Diopter 3rd level: Excellent (n = 21), Good (n = 3), Poor (n = 1)
Female (n = 9)

RCT, randomized controlled trial.

Table 3.
Frequency of acupoints in 36 articles.
Frequency Acupoint
24 BL1, BL2
22 ST2, TE23
21 Ex-HN5
20 LI4
19 GB14
18 ST36
17 GB20
16 GB1
13 GV20
12 LR3
11 SP6
7 TE5
5 GV26, EX-HN7
4 GV23, TE17
3 LI11, GB12, BL10
2 CV12, GB43, GB39, SI6
1 LI10, GB41, KI10, SI18, ST37, LR1, SP10, SP3, BL18, BL20, ST40, Ashi

References

1. Lee JH, Lee HB, Huh W, Hong YJ. Ophthalmology. Seoul (Korea): Iljogak. 2008:401–403. [in Korean].

2. Varunwald E. Harrison’s Principles of Internal Medicine. 15th ed. Seoul (Korea): MIP. 2003:178–179. [in Korean].

3. Korean Neurological Association. Textbook of Neurology. 3rd ed. Seoul (Korea): Panmun education. 2017:168–170. [in Korean].

4. Noh SS. Otolaryngology. 3rd ed. Seoul (Korea): IBC. 2007:296, [in Korean].

5. Lee SE, Kim YB. Two cases of paralytic strabismus treated with acupuncture and herbal medicine. J Korean Med Opthalmol Otolaryngol Dermatol. 2003;16:168–178. [in Korean].

6. Hira [Internet]. Seoul (Korea): Health Insurance Review & Assessment Service, 1976-2018. [cited 2019 Mar 27]. Available from: http://opendata.hira.or.kr/op/opc/olap4thDsInfo.do.

7. Lei Y, Meng XG, Zhao Q, Wu LZ, Wu MY, Du YZ. Professor Wu Lianzhong’s experience in treating oculomotor nerve paralysis with the method of “cross-belt and giant thorn”. Chin Acupunct Moxibustion. 2018;38:757–760. [in Chinese].

8. Luo ZJ, Chen CM. Acupuncture combined with chiropractic for the treatment of cervical oculomotor palsy: a case report. J Basic Chin Med. 2018;24:385–386. [in Chinese].

9. Yin Y, Ouyang YX, Zhang XF, Pan L. 30 Cases of Oculomotor Paralysis Treated with Acupuncture. World J Acupunct Moxibustion. 2009;19:45–48. [in Chinese].

10. Kim SB, Jeong YK, Yang JY, Mun SK, Jung WS, Kwon SW, et al. A Case Report of a Patient with Ptosis and Ataxia Diagnosed as Claude’s Syndrome Who Was Treated with Korean Medicine. J Int Korean Med. 2017;38:93–102. [in Korean].
crossref pdf
11. Frenkel M, Frenkel J. Oculomotor nerve palsy treated with acupuncture. Altern Ther Health Med. 2002;8:118–120.
pmid
12. Jeung SH, Cho CK, Ji YS, Kim HJ, Kim YI. A Case Report of Oculomotor Nerve Palsy Patient Treated by Traditional Korean Medicine. J Haehwa Med. 2015;23:45–52. [in Korean].

13. Jeung KH, Kim MS, Hwang HS, Jeon JC, Park JY, Lee TH, et al. Case Report of Three Cases of Idiopathic Oculomotor Nerve Palsy Treated with Hominis Placenta Pharmacopuncture. J Pharmacopuncture. 2009;12:91–97. [in Korean].
crossref pdf
14. Lee CH, Lee CH, Park MK, Jeung WH, Choi BS, Lee JM, et al. Case Reports: An Idiopathic Oculomotor Nerve Palsy Patient Treated by Acupuncture Complex Therapy. J Korean Acupunct Moxib Soc. 2010;27:233–238. [in Korean].

15. Kim NK. One Case of paralytic strabismus (oculomotor nerve palsy) which was treated electroacupuncture at oculomotor muscles. J Korean Med Ophthalmol Otolaryngol Dermatol. 2006;19:232–236. [in Korean].

16. Kim JM, Nam HJ. A Case of Occurred Oculomotor Nerve Palsy on the Same Side after Recovery of Abducent Nerve Palsy at Right Eye. J Korean Med Ophthalmol Otolaryngol Dermatol. 2009;22:238–250. [in Korean].

17. Kim HJ, Lee GY, Kim YB. A Case Report of Traumatic Oculomotor Nerve Palsy Treated with Acupuncture and Herbal Medicine. J Korean Med Ophthalmol Otolaryngol Dermatol. 2004;17:167–173. [in Korean].

18. Eom YJ, Hong CH. A case study of ocular motility disorders caused by thalamus, midbrain and pontine infarctions. J Korean Med Ophthalmol Otolaryngol Dermatol. 2015;28:130–141. [in Korean].
crossref pdf
19. Son JH, Jung MH, Kim JH, Cho KH, Jung WS, Kwon SW, et al. A Case Report of Diplopia and Limitation of Eye Movement in Oculomotor Nerve Palsy Treated with Korean Medicine. J Int Korean Med. 2017;38:190–194. [in Korean].
crossref pdf
20. Jeung SM, Kim SJ, Jeung JA, Ann JJ, Jeon SY, Hong S, et al. A Case of the Oculomotor Nerve Palsy in Benedikt`s Syndrome Patient. Korean J Orient Int Med. 2005;26:670–676. [in Korean].

21. Jeong EJ, Yang DJ, Chung KH, Roh JH, Moon SK, Cho KH. A Case of the Oculomotor Nerve Palsy in Benedikt`s Syndrome. J Korean Oriental Med. 2000;21:225–230. [in Korean].

22. Lee SE, Kim YB. Two Cases of Paralytic Strabismus Treated with Acupuncture and Herbal Medicine. J Korean Med Ophthalmol Otolaryngol Dermatol. 2003;16:168–178. [in Korean].

23. Eom YS, Sim SY, Nam HJ, Kim GJ. A Clinical Case Report of Oculomotor Nerve Palsy. J Korean Med Ophthalmol Otolaryngol Dermatol. 2004;17:126–130. [in Korean].

24. Jo SE, Kang JH, Kim YJ, Hong SJ, Lee H. Clinical Study on One Patient with Diabetes-associated Oculomotor Nerve Palsy. Acupunct. 2014;31:213–221. [in Korean].
crossref
25. Yan AG. Acupuncture and moxibustion for treatment of diabetic oculomotor nerve palsy and its therapeutic effect. Diabetes New World. 2017;20:172–173. [in Chinese].

26. Zou D, Guan DX, Zhang YY, Wang L. Clinical observation of acupuncture and moxibustion for treatment of 50 patients with oculomotor nerve palsy. Clin J Chin Med. 2018;10:128–129. [in Chinese].

27. Li SQ. Therapeutic effect of acupuncture combined with drugs on oculomotor nerve palsy. J Binzhou Med Univ. 2017;40:330–332. [in Chinese].

28. Sun L. Clinical observation of the treatment of oculomotor nerve palsy with Rongjianjing acupuncture. Tianjin J Tradit Chin Med. 2015;2:725–727. [in Chinese].

29. Yu XT, Zeng JH. Clinical observation of acupuncture and moxibustion for treating oculomotor nerve paralysis after stroke. Chin J Practical Nerv Dis. 2015;18:14–16. [in Chinese].

30. Pan LS, Wu J. Clinical study on the treatment of post-stroke oculomotor nerve palsy with Xingnao Kaiqiao acupuncture combined with Huangqi Guizhi Wuwu Decoction. Henan Tradit Chin Med. 2015;35:1762–1764. [in Chinese].

31. Wang CW, Zhou DA. Therapeutic effect of acupuncture combined with rehabilitation training on oculomotor nerve palsy. Int Eye Sci. 2014;14:1165–1167. [in Chinese].

32. Chen QX, Zou W, Yan D, Zhu LW, Sun XW. Acupuncture treatment of 20 cases of oculomotor nerve palsy. Chin Acupunct Moxibustion. 2014;30:31–33. [in Chinese].

33. Chen J, Cao CH, Zhang W. Clinical observation of acupuncture and moxibustion for treatment of oculomotor nerve paralysis after stroke. Tianjin J Tradit Chin Med. 2013;30:534–536. [in Chinese].

34. Yang JU, Peng XL, Bai JM, Du XZ, Xue Y. Clinical study on acupuncture treatment of diabetic oculomotor nerve palsy. Gansu Med J. 2012;31:650–652. [in Chinese].

35. Liu B, Chen HT, Liu JL. Clinical observation of acupuncture treatment of diabetic oculomotor nerve palsy. Liaoning J Tradit Chin Med. 2008;1579–1580. [in Chinese].

36. Liu YD. [Dissertation]. Clinical study on the time-effect relationship of ocular nerve palsy based on eye 3 acupuncture. Heilongjiang (China): University of Traditional Chinese Medicine, 2013. [in Chinese].

37. Yang Y. [Dissertation]. Clinical study on treatment of oculomotor nerve palsy with multi-needle shallow thorn method. Changchun (China): Changchun University of Traditional Chinese Medicine, 2017. [in Chinese].

38. Yang Y. [Dissertation]. Clinical observation of acupuncture combined with Western medicine in the treatment of oculomotor nerve palsy. Liaoning (China): Liaoning University of Traditional Chinese Medicine, 2017. [in Chinese].

39. Dong M. [Dissertation]. Clinical observation of acupuncture and eye treatment for oculomotor nerve palsy. Heilongjiang (China): Heilongjiang University of Traditional Chinese Medicine, 2012. [in Chinese].

40. Song XL, Ma XP, Li Z. Observation on the therapeutic effect of acupuncture combined with fire acupuncture on oculomotor nerve palsy. Shanghai J Acu-Mox. 2013;32:931–932. [in Chinese].

41. Guo SQ, Ren H, Cao YX, Wang L. A multicenter randomized controlled trial of acupoint injection of traditional Chinese medicine for oculomotor nerve palsy. World J Acupunct Moxibustion. 2013;23:9–14. [in Chinese].
crossref
42. Zhan HL, Jiang ZQ, Tang QP, Ouyang CH. Clinical observation of electroacupuncture combined with rehabilitation training for treatment of oculomotor nerve palsy. J Tradit Chin Med. 2012;32:68–70. [in Chinese].

43. Kim JM. Neuroanatomy Physiology. Seoul (Korea): Jeongdam. 2000:184–185. [in Korean].

44. Biouss V, Newman NJ. Third nerve palsies. Semin Neurol. 2000;20:55–56.
crossref pmid pdf
45. Park KA, Lee WT. Medical Neuroanatomy. Seoul (Korea): Korea Medical Book Publisher Co. 1996:528–829. [in Korean].

46. Rush JA, Younge BR. Paralysis of cranial nerves III, IV, and VI. Cause and prognosis in 1,000 case. Arch Ophthalmol. 1981;99:19–27.

47. Park KY, Lee SH, Byeon WG, Shin DI, Shim MS, Lee SS, et al. A Case of Germinoma Presenting with Pupil-involving Isolated Oculomotor Nerve Palsy. J Korean Neuropsychiatr Assoc. 2001;19:423–426. [in Korean].
crossref
48. Journal of Korea Neurological Society. Neurosurgery. 2nd ed. Seoul (Korea): Joonang Moonwha Co. 2002:22–26. [in Korean].

49. Noh YB. Paralytic strabismus. Korean J Ophthalmol. 1986;27:81–86. [in Korean].

50. Lee JW. Clinical Study on Paralytic Strabismus. Korean J Ophthalmol. 1993;34:549–554. [in Korean].

51. Lee SE, Kim YB. Two cases of Oriental medicine treatment of Paralytic Strabismus. J Korean Med Ophthalmol Otolaryngol Dermatol. 2003;16:168–178. [in Korean].

52. Kim NK. A Case of Paralytic Strabismus in Children Using Extraocular Mucle Electroacupuncture. J Korean Med Ophthalmol Otolaryngol Dermatol. 2006;19:232–236. [in Korean].

53. Kim JM, Nam HJ. A case of occurred oculomotor nerve palsy on the same side after recovery of abducent nerve palsy at right eye. J Korean Med Ophthalmol Otolaryngol Dermatol. 2009;22:238–250. [in Korean].

54. Chen XQ, Teng JY, Pan HL. Study on the Clinical Acupoints of Acupuncture Treatment of Oculomotor Paralysis. Hubei J Tradit Chin Med. 2018;40:3–7. [in Chinese].

Appendices

Appendix 1.
NDSL
#1 Search (((“oculomotor nerve paralysis”) OR (“oculomotor nerve palsy”)) OR (“third nerve palsy”))) 2469
#2 Search (((“Acupuncture”) OR (“Electroacupuncture”)) OR (“Pharmacopuncture” OR (“Dry needling”)) OR (“Acupotomy”))) 50560
#3 Search (#1) AND #2 24
Cochran library
#1 Search (((“oculomotor nerve paralysis”) OR (“oculomotor nerve palsy”)) OR (“third nerve palsy”))) 41
#2 Search (((“Acupuncture”) OR (“Electroacupuncture”)) OR (“Pharmacopuncture” OR (“Dry needling”)) OR (“Acupotomy”))) 11773
#3 Search (#1) AND #2 3
CNKI
#1 Search (((“oculomotor nerve paralysis”) OR (“oculomotor nerve palsy”)) OR (“third nerve palsy”))) 1117
#2 Search (((“Acupuncture”) OR (“Electroacupuncture”)) OR (“Pharmacopuncture” OR (“Dry needling”)) OR (“Acupotomy”))) 107883
#3 Search (#1) AND #2 169
OASIS
#1 Search (((“oculomotor nerve paralysis”) OR (“oculomotor nerve palsy”)) OR (“third nerve palsy”))) 22
#2 Search (((“Acupuncture”) OR (“Electroacupuncture”)) OR (“Pharmacopuncture” OR (“Dry needling”)) OR (“Acupotomy”))) 6233
#3 Search (#1) AND #2 8
Pubmed
#1 Search ((oculomotor nerve paralysis) OR oculomotor nerve palsy) OR third nerve palsy 5171
#2 Search ((((Acupuncture) OR Electroacupuncture) OR Pharmacopuncture) OR Dry needling) OR Acupotomy 30418
#3 Search (#1) AND #2 15


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