【Location】On the face,0.1 cun above the inner canthus.
【Manipulation Method】Close the eyes,push the eyeball to the lateral aspect and puncture slowly perpendicularly 0.3-0.5 cun along the orbital wall without twisting or lifting and thrusting the needle vigorously.
【Indications】Pain and swelling in the eyes,blurred vision,lacrimation with wind,dizzy,cloudiness of the cornea,myopia,night blindness,color blindness,headache,acute lumbago.
【Stratified anatomy】(Fig.1-8)
Fig.1-8 Transverse section of Jingming(BL 1)(right side)
(1)Skin The skin is distributed by supratrochlear n..
(2)Subcutaneous tissue There are branches of supratrochlear n.,branches or tributaries of angular a. & v..
(3)Orbicularis oculi The orbicularis oculi is located in the deep surface of superficial fascia around the rima oculi.
(4)Adipose body of orbit The adipose body of orbit is composed of the adipose tissue which is filled among the intraorbital eyeball,the ocular muscle and the periorbita.
(5)Between the rectus medialis and the orbital plate(ethmoid bone) The rectus medialis is located in the slightly lateral position of needling and the inside of eyeballs,while the orbital plate(ethmoid bone)is the medial orbital wall which is located in the medial position of needling.
【Adjacent structures】
(1)The common tendinous ring and the optic n.foramen and its content The common tendinous ring and the optic n.foramen are located in the directly posterior and slightly lateral position of needling.The common tendinous ring with a circle appearance is formed by connecting closely of the initial tendons of muscles which moving eyeball,and it is a kind of tendinous structure surrounding and attaching to the optic n.foramen and the internal end of superior orbital fissure.The optic n.foramen at the apex of the orbit is actually a 5mm osseous short canal within the optic n.and the ophthalmic a.which passes backward into the middle cranial fossa.The optic n.,which is formed by the axons aggregating of ganglion cells over the retina,passes through the wall of eyeball backward and the optic n.foramen into the middle cranial fossa.For the ophthalmic a.,it is the branch of the internal carotid a..
(2)The superior orbital fissure and its content The superior orbital fissure which is the fissure between the paries superior orbitae and the lateral wall of orbit is located in the posterior-lateral position of needling.It is the biggest passageway of the orbit and the middle cranial fossa.The structures,which pass through the superior orbital fissure,are the oculomotor n.,the trochlear n.,the abducent n.,the ophthalmic n.of the first trigeminal n.,the maxillary n.of the second trigeminal n.and the superior ophthalmic v..
【Cautions】
(1)Bleeding As the angular a.within the subcutaneous tissue can move easily for the loose tissue,usually it cannot be injured as long as the slow needle-inserting.If there is a severe damage to the vessel,the local hematoma occurs.If the depth of needling is more than 0.8 cun and the needling position is close to the medial orbital wall,the anterior and posterior ethmoidal a.as well as the anterior ethmoidal n.can be easy to puncture badly.As here is the fixed position where the arteries mentioned before pass through the anterior and posterior ethmoidal foramens,it is easy to needle the arteries.When there is a heavy bleeding after needling,the complaints of patients are the distention of eyeballs,a feeling of protruding and the ecchymosis of eyelids.Hence,when needle-inserting,the needle point shall not so close to the medial orbital wall that damages the anterior and posterior ethmoidal a..While removing the needle,there shall be with a gentle manner and half minute’s pressing of cotton ball for avoiding bleeding.
(2)Needle-inserting in the eyeballs When there is the needle-inserting without pressing the eyeballs or with the close distance to eyeballs,there may be needle-inserted in the eyeballs.As the firm and tenacious episcleral layer of eyeball wall and a viscous feeling of needle point when needling on the eyeballs,it is not easy to needle-insert into the eyeball as long as needle-inserting slowly.But there is one point needed to be paid more attention that the thinnest part of sclera with only 0.4-0.5mm is the “equator” of eyeballs.If this location is needled,the eyeballs can be needle-inserted.
(3)Needle-inserting in the common tendinous ring and the optic n. If the depth of needling is more than 1.8 cun,it is easy to needle-insert in the common tendinous ring and the optic n.in the directly posterior position of needling.If the common tendinous ring is needle-inserted,there is a viscous feeling of needle point.If the optic n.is needle-inserted,the complaints of patients are the blurred vision(stimulation of the optic n.),headache and dizziness(stimulation of the dura mater),as well as nausea and vomiting symptoms for the serious condition.
(4)Needle-inserting in the superior orbital fissure and its deep structure If the depth of needle point is more than 2 cun with the extreme posterior-lateral position of needling,the needle point can arrive in the superior orbital fissure.At this moment,not only can the nerves and vessels passing through the superior orbital fissure be needle-inserted,but the cavernous sinus in the middle cranial fossa can also be injured by needling through the superior orbital fissure.Even there is the intracranial hemorrhage caused by needle-inserting in the front end of temporal lobe of brain accompanying with the following symptoms: serious dizziness,headache,nausea,vomiting,even shock and death.