The influence of head tilt on ocular torsion in patients with superior oblique muscle palsy

Background: The aim was to investigate the effect of inferior oblique (IO) operation (IO myectomy or graded recession and anteriorization) for unilateral and bilateral superior oblique muscle palsy (SOP); Methods: A total of 167 eyes undergoing IO surgery by a single surgeon between 2008 and 2015 were retrospectively reviewed. The method for treating symmetric bilateral SOP was bilateral IO myectomy (n = 102) and the method for treating unilateral SOP or non-symmetric bilateral SOP was IO-graded recession and anteriorization (n = 65). Associated clinical results and other factors were analyzed; Results: Head tilt, vertical deviation, IO overaction, SO underaction degree and ocular torsion angle were all clearly changed, but there was no statistically significance between these two procedures. Mean preoperative torsional angle was 15.3 ± 6.4 degree, which decreased to 5.3 ± 2.7 degree after surgery. Preoperative torsional angle, IOOA and SOUA degree were all significantly affected in postoperative torsional angle (p = 0.025, 0.003 and 0.038). Horizontal rectus muscle and IO muscle operation did not interfere with each other’s results (p = 0.98); Conclusions: Symmetric bilateral SOP could be treated with bilateral IO myectomy and IO-graded recession and anteriorization should be reserved for unilateral SOP or non-symmetric bilateral SOP.

Download Full-text

Vertical Strabismus and Positive Bielschowsky Head-Tilt Test: Atypical Presentation of a Maxillary Mucocele

Annals of Otology and Neurotology ◽

10.1055/s-0041-1724217 ◽

2021 ◽

Author(s):

Filipe André Correia ◽

Gustavo Filipe Antunes de Almeida ◽

Carolina Fernandes Pereira Bruxelas ◽

Pedro Alberto Batista Brissos de Sousa Escada

Keyword(s):

Head Tilt ◽

Visual Disturbance ◽

Oblique Muscle ◽

Tilt Test ◽

History Of ◽

Vestibular Symptoms ◽

Binocular Diplopia ◽

Superior Oblique Muscle ◽

Cover Test ◽

Superior Oblique

AbstractTest of skew has become a cornerstone in the approach of a patient with vestibular symptoms but a detected vertical misalignment may be caused by an oculomotor disturbance and not a skew deviation. We report the case of an elderly patient with a 1-month history of dizziness and visual disturbance that revealed on bedside examination a spontaneous left head-tilt and a pathologic alternate cover test, with right eye hypertropia and excyclotorsion, worse with right head-tilt. Dizziness was assumed to have a visual origin with unrecognized binocular diplopia, caused by an acquired right eye superior oblique muscle palsy. However, imaging revealed a right maxillary mucocele that eroded the orbit floor into the orbit. The change of the intraorbital component of the maxillary fluid-filled mass with head-tilt through a dehiscent orbital floor may explain the findings of vertical strabismus and positive Bielschowsky head-tilt test in this case. Endoscopic treatment improved symptoms and findings.

Download Full-text