The Absence of So-called Compensatory Ocular Countertorsion

Jampel, Robert S.

doi:10.1001/archopht.120.10.1331

Cited by 30 publications

(30 citation statements)

References 43 publications

(21 reference statements)

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“…Recently, however, there is some controversy about the existence of ocular counterroll. 43 We provided further evidence to confirm its existence by demonstrating that the magnitude of ocular counterroll responses is dependent on the age of subjects, viewing distance, target characteristics, and whether or not the target moves simultaneously with the head. 44,45 The ocular tilt reaction is a pathological synkinetic triad of skew deviation, ocular torsion, and head tilt.…”

Section: Distinguishing From Trochlear Nerve Palsymentioning

confidence: 59%

Understanding skew deviation and a new clinical test to differentiate it from trochlear nerve palsy

Wong¹

2010

Journal of American Association for Pediatric Ophthalmology and

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SUMMARYSkew deviation is a vertical strabismus caused by a supranuclear lesion in the posterior fossa. Because skew deviation may clinically mimic trochlear nerve palsy, it is sometimes difficult to differentiate the 2 conditions. In this review we compare the clinical presentations of skew deviation and trochlear nerve palsy and examine the pathophysiology that underlies skew deviation. We then describe a novel clinical test-the upright-supine test-to differentiate skew deviation from trochlear nerve palsy: a vertical deviation that decreases by ≥50% from the upright to supine position suggests skew deviation and warrants investigation for a lesion in the posterior fossa as the cause of vertical diplopia.Skew deviation is a vertical strabismus caused by supranuclear lesions. It is often associated with ocular torsion and head tilt, which together constitute the ocular tilt reaction. [1][2][3][4] Skew deviation is often the initial manifestation of diseases that affect the brainstem, cerebellum, or peripheral vestibular system. [4][5][6][7][8][9][10] Because both skew deviation and trochlear nerve palsy may result from intracranial lesions or trauma, and because some skew deviations may clinically mimic trochlear nerve palsy, differentiating these 2 conditions can be challenging. Understanding skew deviation remains difficult, partly because it requires knowledge of the underlying anatomy and pathophysiology. In this review, we first compare the clinical presentation of skew deviation versus trochlear nerve palsy. We then focus on the pathophysiologic mechanism of skew deviation and examine some current evidence that shows that skew deviation results from an imbalance of the utriculo-ocular pathway. We then present a novel upright-supine test that can be used clinically to differentiate skew deviation from trochlear nerve palsy at the bedside. Clinical PresentationSkew deviation was first induced experimentally in animals by Magendie 11 and later Hertwig, 12 who produced skew deviation in cats by sectioning the middle cerebellar peduncle. It was first observed in humans with cerebellar tumors by Stewart and Holmes in 1904. 13 Skew deviation is a vertical misalignment of the visual axes caused by a disturbance of supranuclear inputs as a result of lesions in the brainstem, cerebellum, or peripheral CIHR Author ManuscriptCIHR Author Manuscript CIHR Author Manuscript vestibular system (ie, the inner ear and its afferent projections). The vertical misalignment may be comitant or incomitant. Rarely, it alternates with eye position (eg, right hypertropia on right gaze and left hypertropia on left gaze). 14,15 Skew deviation often is associated with other neurologic signs and may be part of the ocular tilt reaction, which consists of a triad of skew deviation, ocular torsion, and head tilt. [1][2][3]10 In ocular tilt reaction, the pathologic head tilt is ipsilateral to the hypotropic eye, and the ocular torsion is such that the upper poles of both eyes rotate in the same direction as that of the head tilt (ie, the h...

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Section: Distinguishing From Trochlear Nerve Palsymentioning

confidence: 59%

Understanding skew deviation and a new clinical test to differentiate it from trochlear nerve palsy

Wong¹

2010

Journal of American Association for Pediatric Ophthalmology and

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“…Because research on torsional eye movements using whole angle body rotation (0°-360°) in the roll plane has shown that the relationship between s-OCR and head tilt can be fitted to a sine function, 14 we fitted the following function to the whole data: (1) where, f(q) denotes the amount of torsional eye movement in degrees, and, q denotes head-tilt angle (degrees).…”

Section: Resultsmentioning

confidence: 99%

“…Therefore, our results do not support the hypothesis that s-OCR is an artifact and does not actually exist. [1][2][3] Although definitions of gain of s-OCR differ among investigators, the gain of s-OCR previously reported with the scleral search coil technique is roughly 9%-26%, 4,5 and that with image-processing analysis is 13%-22%. [6][7][8] The gains of s-OCR found in our study (15%-29%) are in good agreement with these values, and we can conclude that s-OCR does play a role, in collaboration with d-OCR, in stabilizing retinal images against head movements in the roll plane, although the effect is only partial.…”

Section: Discussionmentioning

confidence: 99%

Static Ocular Counterroll: Video-based Analysis After Minimizing the False-Torsion Factors

2005

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“…Unlike previous studies using photographic or video-based measurements to record the anterior part of the eye or invasive scleral coil methods, we noninvasively recorded the fundus itself to precisely measure torsional movement. [15][16][17][18] Moreover, we used a CROM device during the fundus photography procedure to maintain the head tilt angle and avoid chin-up or down effects. We calculated s-OCR from fundus photography using the graphics editing program (Adobe Systems, Inc.) as we rotated the fundus photograph of head tilt position until it matched the fundus photograph of the primary position.…”

Section: Discussionmentioning

confidence: 99%

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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The Absence of So-called Compensatory Ocular Countertorsion

Cited by 30 publications

References 43 publications

Understanding skew deviation and a new clinical test to differentiate it from trochlear nerve palsy

Understanding skew deviation and a new clinical test to differentiate it from trochlear nerve palsy

Static Ocular Counterroll: Video-based Analysis After Minimizing the False-Torsion Factors

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

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