Relationship between Static Ocular Counterroll and Bielschowsky Head Tilt Phenomenon

Abstract

This study was conducted to assess how hyperdeviation of a paretic eye during ipsilesional head tilt-the Bielschowsky head tilt phenomenon (BHP)-can be explained by decreased compensatory ocular counterrolling (OCR) due to the depressed torque of the paretic superior oblique (SO) muscle. Thirty-three patients with clinically diagnosed SO palsy and 11 control subjects were studied. With a head-mounted video camera, static ocular counterrolling (s-OCR) was determined by measuring the inclination of a line connecting the two centroids of the characteristic iris pattern and corneal reflex. The BHP was measured with the alternate prism and cover test. The mean (SD) amplitude of s-OCR in paretic eyes based on the fit of the regression sine curve against the ipsilesional head tilt angle was significantly decreased compared with that for contralesional head tilt, 6.3 (3.5) degrees for ipsilesional and 11.3 (3.9) degrees for contralesional (P < 0.001), and was significantly smaller than that in normal subjects: 10.9 (2.6) degrees (P < 0.001). No significant linear relation was noted between hyperdeviation on ipsilesional head tilt and the amplitude of s-OCR in paretic eyes (r(2) = 0.04; P = 0.29). However, the differences between the hyperdeviation with ipsilesional 30 degrees head tilt and with head-upright position correlated significantly with the amplitudes of s-OCR in paretic eyes (r(2) = 0.19, P = 0.01). 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.