Clinical characteristics according to the laterality of ocular torsion in unilateral superior oblique palsy

Ju-Yeun Lee,Kyung-Ah Park,Sei Yeul Oh,Hyo Jeong Kim,Shin Yeop Oh

doi:10.1186/s12886-018-0977-x

Ju-Yeun Lee, Kyung-Ah Park + Show 3 more

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https://doi.org/10.1186/s12886-018-0977-x

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Abstract

BackgroundTo compare clinical characteristics according to the laterality of objective ocular torsion in patients with unilateral superior oblique palsy (SOP).MethodsThis retrospective study included all patients with a diagnosis of unilateral SOP. They were classified into subgroups according to correspondence between the paretic eye and the extorted eye using fundus photography. Ocular alignment and muscle action were tested by the prism and alternate cover tests and 4-scale movement measure. Various clinical factors, including the amount of preoperative ocular torsion and change in ocular torsion postoperative, were compared between the accordance and disaccordance groups.ResultsA total of 70 Asian patients (140 eyes) were included and underwent fundus photography preoperatively. Excyclotorsion in the paretic eye was defined as accordance (45 patients), excyclotorsion in the nonparetic eye was defined as disaccordance (25 patients). The presence of horizontal strabismus was detected in 28 (62%) patients in the accordance group and only 8 (32%) patients in the disaccordance group (p = 0.024). All horizontal strabismus observed in the accordance group involved exodeviation. The proportion of horizontal strabismus surgery was also significantly larger in the accordance group than the disaccordance group (p = 0.039). Among those patients, there were 26 who underwent fundus photography postoperatively. There was significant reduction in ocular excyclotorsion postoperatively in the accordance group (p = 0.001), but no significant reduction postoperatively in the disaccordance group (p = 0.270). There was no significant correlation between the amount of torsional reduction and the amount of vertical deviation reduction (p = 0.979).ConclusionsIn cases of preoperative excyclotorsion in paretic eyes, careful consideration of combined horizontal misalignment which may require surgical correction is helpful to manage unilateral SOP.

Highlights

To compare clinical characteristics according to the laterality of objective ocular torsion in patients with unilateral superior oblique palsy (SOP)
Superior oblique muscle palsy (SOP) is common cranial nerve palsy that may be caused by trauma, vascular disease, or congenital conditions [1]
Patients with a unilateral SOP typically have hypertropia of the paretic eye that increases on ipsilateral head tilt [2]

Summary

Introduction

To compare clinical characteristics according to the laterality of objective ocular torsion in patients with unilateral superior oblique palsy (SOP). Excyclotorsion in the paretic eye is one of the features in SOP. Patients with a unilateral SOP typically have an excyclotorsion in the paretic eye, excyclotorsion of the non-paretic fellow eye has been reported [5, 6]. Na et al reported 25% of ocular excyclotorsion in non-paretic eyes in unilateral SOP, and Lee et al reported 38.7% of this discordance in acquired SOP. Because this seemingly paradoxical test result can complicate the diagnosis of SOP, we believed that it deserved further clinical study.

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