This month I would like to discuss the retrobulbar (or ciliary) ganglion. Actually, ciliary ganglion is the more commonly used term, but I like the retrobulbar name, partly because it describes its location so well, but also because it avoids confusion with the similarly sounding “celiac plexus”. For ophthalmologists that is not a problem, but for those of us occupied with whole-body medicine, we don’t want to confuse the two.
The retrobulbar ganglion is one of the smallest of the named ganglia – about the size of a pinhead and situated in the back of the orbit. It is one of four parasympathetic ganglia on each side of the head, the others being the sphenopalatine (pterygopalatine), otic and submandibular ganglia. An excellent diagram and description of the retrobulbar neuroanatomy can be found at: http://www.medrounds.org/ocular-pathology-study-guide/2006/03/where-is-ciliary-ganglion.html
It is the parasympathetic control of the anterior eye muscles that is of most interest to the clinician. In Adie’s syndrome, ciliary ganglion disease produces a fixed pupil, unresponsive to light but able to accommodate to near vision. Most of the time this syndrome is idiopathic. However the ganglion can also be injured by surgical repair of orbital fractures.
For the physician practicing neural therapy, the retrobulbar ganglia are interesting for another reason. Interference fields in the retrobulbar ganglia are not rare and can cause problems far removed from the eyes! Physical examination of the eyes usually provides no clue as to their presence.
These two cases presented in my office this year:
A very active and physically fit woman of 50 (who works with her husband as a logger!) presented with low back pain of 1½ years duration. The pain was not disabling, but her low back ached, sometimes felt warm and was exacerbated by forward bending. At times pain radiated into her groin and posterior legs to her feet. There was no immediately preceding trauma or strain but she had hurt her back in a fall 5 years before and a year after that had an episode of low back pain lasting a few weeks. Past surgery included partial hysterectomy at age 35 and PRK (laser vision correction or photorefractory keratectomy) two years before.
No lasting relief from her back pain had been obtained by manipulation, intramuscular (needle) stimulation, prolotherapy or caudal epidural block. Her health was otherwise good.
Musculoskeletal examination showed relatively good body symmetry, muscle balance and range of low back movement. Autonomic response testing revealed an interference field behind the left eye. This was treated with a Tenscam device resulting in abolition of the interference field and restoration of previously blocked regulation. The next day the low back pain disappeared. Except for a short lasting relapse after a fall a few weeks later, the patient has been pain-free for seven months.
A 54 year old man presented with chronic low back pain of 8 years duration. The pain began with a motor vehicle accident and was exacerbated by a second accident a year later. In both accidents he was thrown forward torquing his trunk around the diagonally placed belt across his chest. Within a few weeks of the second accident, pain began to develop in his left groin, medial thigh and calf, with numbness in his foot. In the ensuing years a similar pain began to develop in the right leg as well.
Previous trauma included lacerations of this right wrist 17 years before, requiring surgical repair. His only other surgery was correction of a “lazy eye” at age 16. Medical problems included cigarette addiction, recurring pneumonia, depression and fatigue.
Examination of his musculoskeletal system showed considerable asymmetry, muscle imbalance and muscle tightness. The most important of many somatic dysfunctions was an “oscillating” right sacral shear, i.e. a sacrum that oscillated between positions of shear and neutral in synchrony with the craniosacral (primary respiratory) rhythm. This was treated using an osteopathic unwinding technique. Two weeks later he reported that he felt “like a truck had run over (me)”; then an overall improvement. On his second visit he was again treated by manipulation – of his left foot, pelvic floor and cranium. This resulted in a shift in location of pain, but no improvement. At this point a search for interference fields was begun, especially of the lungs, teeth and surgical scars. A “therapy localization sign” (see page 51 of http://www.neuraltherapybook.com) was found on the left side and an interference field in the left retrobulbar ganglion area. This was treated with the Tenscam. On the next visit he reported that he had “got a lot better”.
In the ensuing months, he followed an up-and-down course. His fatigue and depression were investigated and were treated (mostly by nutrition). The retrobulbar ganglion required a second treatment 3 months later but overall his progress has been in a positive direction.
In both of these cases, an interference field in a retrobulbar ganglion played a significant role in generating chronic low back pain. In the first, the more simple one, the interference field developed in a classical manner as a result of PRK. As the popularity of laser vision correction increases, we will need to be on the lookout for this.
The second case was more complex. Eye surgery had been performed many years before the onset of the back pain. And clearly injuries from the two motor vehicle accidents had played important roles. However, the retrobulbar interference field had no doubt been present “below the surface” all along. Its identification and treatment made a big difference in this case’s positive outcome.
The moral to these stories is that interference fields can be found anywhere! And a careful, detailed history is essential for knowing where to look.