Observations about Objective and Subjective Ocular Torsion

Kushner, Burton J.; Hariharan, Luxme

doi:10.1016/j.ophtha.2009.03.047

Cited by 69 publications

(74 citation statements)

References 26 publications

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“…The lack of ipsilateral fundus excyclotorsion may be a clinical indication of a tight ipsilateral SR muscle, as this may negate the effect of excyclotorsion caused by SO palsy. 17 In previous studies, 17% to 46% of patients with unilateral SOP had accompanying ipsilateral SR contracture. 10,18,26 SR contracture mainly occurs when there is a large angle of longstanding strabismus regardless of fixation preference.…”

Section: Discussionmentioning

confidence: 91%

“…Diagnosis of unilateral SOP was made by the following criteria: (1) hyperdeviation in the primary position; (2) unilateral underdepression in adduction with or without overelevation in adduction; (3) the absence of reversal of the hypertropia on the diagnostic fields of gaze or head tilt and absence of cyclotorsional features suggesting bilateral SOP 17 ; and (4) lack of evidence of other ocular motility disorders causing vertical deviation, including contracture of the vertical rectus muscle except secondary contracture of superior rectus (SR) muscle associated with SOP, paresis of multiple vertical muscles, previous muscle surgery, skew deviation, myasthenia gravis, and vertical deviation-related horizontal strabismus as well as structural abnormalities such as muscle pulley heterotopy or craniosynostosis. The etiology was defined as congenital based on clinical grounds with photographic evidence or reliable historical documentation of longstanding strabismus or torticollis since infancy, large fusional amplitudes of vertical deviation, and absence of torsional diplopia.…”

Section: Methodsmentioning

confidence: 99%

“…Objective ocular torsion was evaluated by fundus photographs obtained using KOWA VX-10 (Kowa Company, Ltd., Tokyo, Japan) and TRC-50IA (Topcon, Inc., Tokyo, Japan) fundus cameras using internal fixation. Based on the methods described by Kushner and Hariharan, 17 the direction of torsion and the number of degrees of rotation from horizontal plane were recorded. For analysis of torsion, we encountered objective torsion by measuring the relative position of the disc and fovea on fundus photographs.…”

Section: Clinical Measurementmentioning

confidence: 99%

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Ocular Torsion According to Trochlear Nerve Absence in Unilateral Superior Oblique Palsy

Lee

Yang

Kim

et al. 2017

Invest. Ophthalmol. Vis. Sci.

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Citation: Lee JE, Yang HK, Kim JH, Hwang J-M. Ocular torsion according to trochlear nerve absence in unilateral superior oblique palsy. Invest Ophthalmol Vis Sci. 2017;58:5526-5531. DOI:10.1167/iovs.17-22452 PURPOSE. To investigate the relationship between objective ocular torsion and the presence or absence of the trochlear nerve in subjects with unilateral superior oblique palsy (SOP). METHODS.A total of 159 subjects with congenital and acquired unilateral SOP were reviewed. Eighty-four subjects who had a normal trochlear nerve (present group) and 75 subjects without a trochlear nerve (absent group) were included. Cyclovertical motility parameters and objective ocular torsion were compared between groups, and factors related to ocular torsion were evaluated. RESULTS.The degree of ''net'' excyclotorsion in the paretic eye was larger in the absent group compared to the present group (P ¼ 0.002). The proportion of net excyclotorsion in the paretic eye was greater in the absent group (11% vs. 37%), while net incyclotorsion was greater in the present group (41% vs. 23%) (P < 0.001). Net excyclotorsion of the paretic eye was associated with absence of the trochlear nerve (P < 0.001) and smaller size of the paretic SO (P < 0.001). Net incyclotorsion of the paretic eye was related with a normal trochlear nerve (P ¼ 0.005), larger size of the paretic SO (P ¼ 0.002), and greater hypertropia during ipsilateral gaze (P ¼ 0.024).CONCLUSIONS. The status of the trochlear nerve, paretic SO size, and hypertropia during ipsilateral gaze which reflects the tensile strength of the ipsilateral superior rectus, significantly contribute to ocular torsion in unilateral SOP.Keywords: superior oblique palsy, trochlear nerve, ocular torsion R ecent investigations based on advanced imaging modalities and functional anatomy have offered novel approaches to understand the etiology and pathophysiology of superior oblique palsy (SOP).1-11 Absence of the trochlear nerve has been well recognized as one of the major pathologic etiologies of SOP. 5,6,10 In our earlier study of congenital SOP, 73% showed ipsilateral trochlear nerve absence and a variable extent of SO hypoplasia, whereas the remainder had a normal-appearing SO and trochlear nerve on both sides. 10The relevance of ocular torsion in the diagnosis of SOP is well recognized.12,13 Identification of bilateral excyclotorsion provides essential information in diagnosing bilateral SOP, 14 and incyclotorsion of the hypertropic eye suggests skew deviation. 15 However, torsional patterns in unilateral SOP have shown inconsistent results, and little is known about the torsional changes in SOP according to its pathogenic etiology. To date, there are only few studies 10,11,16 investigating subjective and objective torsion in SOP according to its major etiologies. In our previous report, 10 objective ocular torsion using fundus photographs with an internal fixator did not show any differences according to the presence of the trochlear nerve; however, the investigation was conducted only in con...

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Section: Discussionmentioning

confidence: 91%

Section: Methodsmentioning

confidence: 99%

Section: Clinical Measurementmentioning

confidence: 99%

See 1 more Smart Citation

Ocular Torsion According to Trochlear Nerve Absence in Unilateral Superior Oblique Palsy

Lee

Yang

Kim

et al. 2017

Invest. Ophthalmol. Vis. Sci.

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“…Correlation between subjective and objective torsion was studied by Kushner and Hariharan 25 and the authors claim that better correlation exists in patients with late onset strabismus or with good stereopsis. They also observed that patients with early onset strabismus with absent binocularity may not experience subjective torsion.…”

Section: Eyementioning

confidence: 99%

“…They also observed that patients with early onset strabismus with absent binocularity may not experience subjective torsion. 25 An experimental study published by Kushner 26 evaluated whether ocular torsion is a primary factor for the development of pattern strabismus, or is just a contributing factor. He studied trajectory of eye movements in five patients with oblique muscle overaction and found that for all five patients elevation or depression of the eye was curvilinear as the eye was moved from abduction to adduction owing to primary oblique muscle overaction.…”

Section: Eyementioning

confidence: 99%

Pattern strabismus and torsion needs special surgical attention

Kekunnaya

Mendonca

Sachdeva

2014

Eye

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Torsion and Pattern Strabismus

Kushner¹

2013

JAMA Ophthalmol

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Importance: Rectus muscle transposition to treat pattern strabismus or torsion may have an adverse outcome if the surgeon is unaware that it will affect both pattern strabismus and torsion in contradictory ways.Objective: To highlight the potential adverse affects of rectus muscle transposition on torsion or pattern strabismus.Design and Participants: A retrospective nonblinded medical record review of patients treated by the author between January 1, 1990, and June 30, 2009, in whom rectus muscle transposition to address pattern strabismus worsened torsion, or in whom transposition to address torsion worsened pattern strabismus. The main outcome was a worsening of either torsion or pattern strabismus.Setting: A tertiary care university referral center.Intervention: Rectus muscle transposition surgery to either treat pattern strabismus or torsion. Main Outcome Measures:The presence of new or worsened pattern strabismus or torsion. The outcome measures were determined before data collection began.Results: Eight patients were identified by the review, 5 in whom torsion developed because of transposition to address pattern strabismus and 3 in whom pattern strabismus developed after transposition to address torsion. The presence of bifoveal fusion and/or Graves orbitopathy were risk factors for these adverse outcomes.Conclusions and Relevance: Rectus muscle transposition to address pattern strabismus may cause torsion, and transposition to address torsion may cause pattern strabismus.

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Observations about Objective and Subjective Ocular Torsion

Cited by 69 publications

References 26 publications

Ocular Torsion According to Trochlear Nerve Absence in Unilateral Superior Oblique Palsy

Ocular Torsion According to Trochlear Nerve Absence in Unilateral Superior Oblique Palsy

Pattern strabismus and torsion needs special surgical attention

Torsion and Pattern Strabismus

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