title: Ophthalmological adverse effects of (chiropractic) upper spinal manipulation: evidence from recent case reports.
abstract: OBJECTIVE
  Upper spinal manipulation (USM) is frequently used by chiropractors and other health care professionals to treat minor complaints. This systematic review aimed to summarize ophthalmological adverse effects of USM recently reported in the medical literature.
  
  
  METHODS
  Five electronic databases were searched for all case reports of ophthalmological adverse effects after USM published between January 1995 and April 2003. No language restrictions were applied. Key data from the primary publications thus located were extracted and critically evaluated.
  
  
  RESULTS
  Fourteen case reports were found. Clinical symptoms and signs were diverse and included loss of vision, ophthalmoplegia, diplopia and Horner's syndrome. The underlying mechanism was arterial wall dissection in most cases. The eventual outcome varied and often included permanent deficits. Causality was frequently deemed likely or certain.
  
  
  CONCLUSIONS
  Upper spinal manipulation is associated with ophthalmological adverse effects of unknown frequency. Ophthalmologists should be aware of its risks. Rigorous investigations must be conducted to establish reliable incidence figures.
authors.affiliation: Complementary Medicine, Peninsula Medical School, Universities of Exeter and Plymouth, Exeter, UK. Edzard.Ernst@pms.ac.uk
authors.forename: Edzard
authors.initials: E
authors.lastname: Ernst
mesh_terms: D000529:Complementary Therapies; D016208:Databases, Factual / Q000706:statistics & numerical data; D005128:Eye Diseases / Q000209:etiology*; D006801:Humans; D026882:Manipulation, Chiropractic / Q000009:adverse effects*