Frequency of the superior rectus muscle overaction/contracture syndrome in unilateral fourth nerve palsy

Molinari, Andrea; Ugrin, María Cristina

doi:10.1016/j.jaapos.2009.08.015

Cited by 15 publications

(10 citation statements)

References 6 publications

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“…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. 10,18,26 However, the direct correlation of SR contracture with net incyclotorsion was not verified in our study due to the small number of subjects (13%) satisfying the previously published criteria of SR contracture/overaction.…”

Section: Discussionmentioning

confidence: 99%

“…10,18,26 SR contracture mainly occurs when there is a large angle of longstanding strabismus regardless of fixation preference. 10,18,26 However, the direct correlation of SR contracture with net incyclotorsion was not verified in our study due to the small number of subjects (13%) satisfying the previously published criteria of SR contracture/overaction. Therefore, we evaluated the amount of hypertropia during ipsilateral gaze to assume indirect evidence of a tight SR. 17 In the subset of patients with an absent trochlear nerve, a greater amount of hypertropia during ipsilateral gaze (b ¼ 1.20; P ¼ 0.005) and a larger paretic SO size (b ¼ 2.94; P ¼ 0.005) positively correlated with net incyclotorsion.…”

Section: Discussionmentioning

confidence: 99%

“…Ocular motility assessment for the oblique muscles was graded based on a subjective scale (0-4) of underaction (À) or overaction (þ). SR overaction or contracture was defined by clinical criteria previously published as follows 18 : a vertical deviation of 15 prism diopters (PD) or more in the primary position, equal or larger hypertropia with ipsilateral head tilt than with the eyes looking straight ahead, more than 5 PD hypertropia of the affected eye in gaze to the side of the SO palsy, hypertropia in all upgazes, and overaction of the contralateral SO muscle of þ1 or more. The ''net'' hypertropia in ipsilateral gaze was defined as the difference between hypertropia in ipsilateral gaze and the primary position, which represented the tensile strength of the ipsilateral SR. Laterality of the paretic eye, fixation dominance, dissociated vertical deviation, and associated horizontal strabismus were also noted.…”

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: 99%

Section: Discussionmentioning

confidence: 99%

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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“…From this viewpoint, Molinari and Ugrin [13] has recently reported SR muscle overaction/contracture syndrome in patients with SOP. According to their report, this syndrome was observed in 16.6% of all patients with unilateral SOP.…”

Section: Discussionmentioning

confidence: 99%

“…According to their report, this syndrome was observed in 16.6% of all patients with unilateral SOP. A positive Bielschowsky head-tilt test is considered the most relevant sign of this syndrome [13], and Jampolsky [14] suggested recession of the involved superior rectus muscle for the treatment. In our study, a positive Bielschowsky head-tilt test was exhibited by 90% of the patients.…”

Section: Discussionmentioning

confidence: 99%

Superior Rectus Muscle Recession for Residual Head Tilt after Inferior Oblique Muscle Weakening in Superior Oblique Palsy

Ahn

Choi

Kim

et al. 2012

Korean J Ophthalmol

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PurposeResidual head tilt has been reported in patients with superior oblique muscle palsy (SOP) after surgery to weaken the inferior oblique (IO) muscle. The treatments for these patients have not received appropriate attention. In this study, we evaluated the superior rectus (SR) muscle recession as a surgical treatment.MethodsThe medical records of 12 patients with SOP were retrospectively reviewed. Each of these patients had unilateral SR muscle recession for residual head tilt after IO muscle weakening due to SOP. The residual torticollis was classified into three groups on the basis of severity: mild, moderate, or severe. Both IO muscle overaction and vertical deviation, features of SOP, were evaluated in all patients. The severity of the preoperative and postoperative torticollis and vertical deviation were compared using a paired t-test and Fisher's exact test.ResultsThe torticollis improved in nine of 12 (75%) patients after SR muscle recession. The difference between the preoperative and postoperative severity of torticollis was statistically significant (p = 0.0008). After surgery, the mean vertical deviation was significantly reduced from 12.4 prism diopters to 1.3 prism diopters (p = 0.0003).ConclusionsUnilateral SR muscle recession is an effective method to correct residual head tilt after IO muscle weakening in patients with SOP. This surgical procedure is believed to decrease head tilt by reducing the vertical deviation and thereby the compensatory head tilt.

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Ocular Motor Nerve Palsies in Children

Brodsky¹

2016

Pediatric Neuro-Ophthalmology

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Frequency of the superior rectus muscle overaction/contracture syndrome in unilateral fourth nerve palsy

Cited by 15 publications

References 6 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

Superior Rectus Muscle Recession for Residual Head Tilt after Inferior Oblique Muscle Weakening in Superior Oblique Palsy

Ocular Motor Nerve Palsies in Children

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