Relationship between Static Ocular Counterroll and Bielschowsky Head Tilt Phenomenon

Hamasaki, Ichiro; Hasebe, Shinji; Furuse, Takashi; Ohtsuki, Hiroshi

doi:10.1167/iovs.08-3035

Cited by 9 publications

(9 citation statements)

References 34 publications

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“…In previous studies, the difference between vertical deviations at head tilt to the paretic side and at upright head position was suggested as a better indicator of the superior oblique muscle function in patients with idiopathic superior oblique muscle palsy. [26][27][28] The suggestion was proven true by the present results as mentioned above.…”

Section: Discussionsupporting

confidence: 81%

“…5,18,19 The allele frequency of ARIX 153G to A in the 5¢-untranslated region of the exon 1 (rs140850664) was higher in patients with idiopathic superior oblique muscle palsy (8/31¼0. 26) compared with normal subjects (4/54¼0.07) 18,19 while PHOX2B 1121A to C in the exon 3 (rs17884724) was found only in patients with idiopathic superior oblique muscle palsy, but not in the normal subjects. 19 In this study, we chose, as quantitative phenotypes, namely, quantitative traits, vertical deviation and cyclodeviation in eye alignment on clinical testing as well as the extent of the superior oblique muscle hypoplasia on imaging, and analyzed ARIX and PHOX2B polymorphisms as genotypes in patients with idiopathic superior oblique muscle palsy.…”

Section: Introductionmentioning

confidence: 88%

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Phenotype–phenotype and genotype–phenotype correlations in patients with idiopathic superior oblique muscle palsy

et al. 2011

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Idiopathic superior oblique muscle palsy presents, as quantitative phenotypes, vertical deviation and cyclodeviation in eye alignment on clinical testing, and superior oblique muscle hypoplasia on imaging. We determined ARIX and PHOX2B polymorphisms as genotypes, and analyzed phenotype-phenotype and genotype-phenotype correlations in 37 patients with idiopathic superior oblique muscle palsy. Vertical deviations were measured at upright position of the head and head tilt for 301 to either side, and angles of objective excyclodeviations were determined by image analysis on fundus photographs. Crosssectional areas of the superior oblique muscle near the eye globe-optic nerve junction were measured by image analysis on coronal sections of magnetic resonance imaging to calculate the paretic-side/normal-side ratios. Among the phenotypes, the increase in vertical deviations elicited by head tilt to the paretic side, the decrease in vertical deviations elicited by head tilt to the normal side and the difference of angles of objective excyclodeviations between the paretic side and normal side were significantly correlated inversely with the paretic-side/normal-side ratios of the cross-sectional areas of the muscle (r¼À0.43 with P¼0.0084, r¼À0.34 with P¼0.038, and r¼À0.43 with P¼0.009, respectively, n¼37, Pearson's correlation test). Fifteen patients with ARIX and/or PHOX2B polymorphisms had significantly greater paretic-side/normal-side ratios of the muscle compared with 20 patients without the polymorphisms (P¼0.017, n¼35, Mann-Whitney U-test). The patients with ARIX and/or PHOX2B polymorphisms had less hypoplastic superior oblique muscles.

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Section: Discussionsupporting

confidence: 81%

Section: Introductionmentioning

confidence: 88%

Phenotype–phenotype and genotype–phenotype correlations in patients with idiopathic superior oblique muscle palsy

et al. 2011

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“…Previously, Hamasaki et al 19 used a video camera to record the iris and reported that the amplitude of OCR-I in a paretic eye during ipsilesional head tilting was smaller than s-OCR in control subjects during head tilting; however, they did not present their P value. They mainly compared s-OCR in ipsilesional and contralesional head tilting in each eye, but their analysis was based on the assumption that s-OCR in ipsilateral and contralateral eyes was equal in normal subjects.…”

Section: Discussionmentioning

confidence: 96%

“…Because ocular torsional disconjugacy was observed in other studies, we compared OCR-I between paretic and fellow eyes. 13,20,21 Hamasaki et al 19 also reported that there was no significant correlation between OCR-I in the paretic eye and the degree of hyperdeviation on ipsilesional head tilt. But, they found a significant negative relationship between OCR-I in the paretic eye and the difference between hyperdeviation with ipsilateral head tilt and in the head-upright position.…”

Section: Discussionmentioning

confidence: 99%

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Does Decreased Static Ocular Counter Rolling Account for Bielschowsky Head Tilt Test in Unilateral Superior Oblique Palsy?

Choi

Lee

Park

et al. 2017

Invest. Ophthalmol. Vis. Sci.

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PURPOSE. To understand the relationship of static ocular counter rolling (s-OCR) and clinical manifestations in acquired unilateral superior oblique palsy subjects during the Bielschowsky head tilt test.METHODS. Nineteen subjects that were diagnosed with acquired unilateral superior oblique palsy were included. Fundus photographs were obtained at different head tilt angles to evaluate static ocular counter rolling using a fundus camera with a cervical range of motion device. Using a graphics editing program, we calculated s-OCR from fundus photography.RESULTS. The incycloductional s-OCR (OCR-I) in the paretic eye was significantly smaller than the OCR-I in the fellow eye (P ¼ 0.02, <0.001, 0.002 for 108, 208, and 308, respectively, paired t-tests). In contrast, the excycloductional s-OCR (OCR-E) showed no significant difference between the paretic eye and the fellow eye for all angles. There was a significantly positive correlation between the amplitude of OCR-I in the paretic eye and the degree of hypertropia on ipsilesional head tilt (q ¼ 0.612, 0.679, 0.474, P ¼ 0.02, 0.002, 0.07 for 108, 208, and 308 respectively, Spearman's correlation). The amplitude of OCR-I in the paretic eye also showed a positive correlation with head tilt test difference, which is the degree of hyperdeviation difference between ipsilesional and contralesional head tilts (q ¼ 0.445, 0.694, 0.579, P ¼ 0.09, 0.002, 0.024 for 108, 208, and 308 respectively, Spearman's correlation).CONCLUSIONS. In unilateral SOP, OCR-I in the paretic eye was smaller than that in the fellow eye, and this was positively associated with the degree of hypertropia during ipsilesional head tilting, as well as the head tilt test difference.Keywords: superior oblique palsy, static ocular counter rolling, Bielschowsky head tilt test, cervical range of motion device O cular counter rolling (OCR) is a partially compensatory torsional eye movement that occurs when the head is tilted toward the shoulder.1 Static OCR (s-OCR) is mediated by an otolith-ocular reflex in response to a gravitational direction change, while dynamic OCR is mediated by the semicircular canal-ocular reflex in response to torsional angular acceleration during active head movement.2 The s-OCR is thought to be the biomechanic basis of the Bielschowsky head-tilt test (BHTT). [3][4][5][6] Clinically, superior oblique palsy (SOP) subjects exhibit positive BHTT, which means the paretic eye shows greater hypertropia during head tilt to the ipsilesional side compared to the contralesional shoulder. According to traditional s-OCR theory, when the head is tilted to the left shoulder, the intorters (superior oblique [SO] and superior rectus [SR]) of the left eye and the extorters (inferior oblique and inferior rectus) of the right eye are activated while extorters of the left eye and intorters of the right eye are inhibited. In left SOP, downward torque of the superior oblique is absent, so unopposed upward movement by the activated superior rectus is thought to contribute to hypertropia of the left eye du...

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How Lingering Fusional Adaptation Influences the Bielschowsky Head Tilt Test in Superior Oblique Paresis

Irsch

Guyton

Ying

2022

Klin Monbl Augenheilkd

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Background The lack of a positive Bielschowsky head tilt test (BHTT) is commonly seen as an indicator that superior oblique paresis (SOP) is not present. This study investigated the influence of fusion on the BHTT in unilateral SOP. Patients/Methods and Material We analyzed vertical fusional vergence using our eye-tracking haploscope and the value of BHTT difference (BHTTD) in 11 patients who were diagnosed with congenital unilateral SOP and able to fuse. Results Patients used one of three different mechanisms of vertical vergence to achieve fusion. The three fusional mechanisms were associated with a significantly different BHTTD (p < 0.05). Seven of the eleven patients used vertical recti-mediated fusion and had a mean BHTTD ± SD of 21.7 ± 6.3 prism diopters (PD). Three of these patients whom we measured after a patch test for at least 30 min showed a decreased BHTTD (12.7 ± 3.8 PD). Three of the eleven patients used a mixed (oblique/rectus) fusional mechanism and had a mean BHTTD ± SD of 9.3 ± 8.6 PD. Of these patients, the one whom we measured after patching showed an increase of 11 PD in BHTTD. The remaining patient used oblique muscle-mediated fusion and had a BHTTD of only 3 PD that increased to 21 PD after patching. One explanation for this BHTT behavior in the latter patient involves lingering vergence adaptation of the “paretic” superior oblique muscle (SOM) and contralateral inferior oblique muscle, which makes these muscles more effective when activated, as is the case on ipsilateral head tilt (part of the ocular counter-roll mechanism), lessening the expected increase in hyperdeviation. Similarly, in our patients with mixed fusion, the vergence-adapted “paretic” SOM and contralateral superior rectus muscle are activated on ipsilateral and contralateral tilt, respectively, lessening the hyperdeviation in both directions. In the other seven patients, however, the vergence-adapted ipsilateral inferior rectus muscle and contralateral superior rectus muscle are activated on contralateral tilt, accentuating the BHTTD. Conclusion Depending upon the specific muscles used for vertical fusion, the BHTTD is decreased or increased. The presence of a large BHTTD points to lingering or persisting fusional tonus involving the vertical rectus muscles. The lack of a positive BHTT does not rule out the diagnosis of SOP, but rather may be caused by lingering or persevering fusional tonus involving the oblique muscles. Performing the BHTT after a patch test for a minimum of 30 minutes may be necessary to reveal the BHTTD, supporting the diagnosis of SOP.

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Relationship between Static Ocular Counterroll and Bielschowsky Head Tilt Phenomenon

Abstract: The absolute value of the hypertropia on ipsilesional head tilt in clinically diagnosed SO palsy does not directly assess the function of the SO muscle. The difference in hypertropia between ipsilesional head tilt and the upright position, however, may be a better indicator of SO function.

Cited by 9 publications

References 34 publications

Phenotype–phenotype and genotype–phenotype correlations in patients with idiopathic superior oblique muscle palsy

Phenotype–phenotype and genotype–phenotype correlations in patients with idiopathic superior oblique muscle palsy

Does Decreased Static Ocular Counter Rolling Account for Bielschowsky Head Tilt Test in Unilateral Superior Oblique Palsy?

How Lingering Fusional Adaptation Influences the Bielschowsky Head Tilt Test in Superior Oblique Paresis

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