Torsional augmentation for the treatment of lateropulsion and torticollis in partial ocular tilt reaction

Abstract

Purpose We describe a new surgical treatment for lateropulsion and torticollis arising from an ocular tilt reaction. Methods Visual sensory parameters and postural abnormalities were retrospectively reviewed in a patient with a partial ocular tilt reaction who was treated with horizontal transposition of the vertical rectus muscles to surgically augment preexisting binocular torsion. Results Torsional augmentation eliminated the sensation of lateropulsion and produced almost complete resolution of her torticollis and associated body tilt. Conclusions Binocular torsional augmentation can be used to reduce both lateropulsion and torticollis in the setting of an ocular tilt reaction.

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“…Horizontal transposition of the vertical recti has been described to reduce abnormal head tilts in nystagmus (von Noorden et al, 1993) and improve torticollis and lateropulsion in ocular tilt reaction (Brodsky and Holmes, 2012). von Noorden et al ( (2000) instead performed a diagonal half to full tendon-width transposition of a vertical muscle ("skew transposition"), often in the unaffected eye coupled to a contralateral vertical muscle resection or recession in 10 patients with SO palsy.…”