Ocular torsion: rotations around the “WHY” axis.

Burton Kushner // Publications // Feb 01 2004

PubMed ID: 14970791

Author(s): Kushner BJ. Ocular torsion: rotations around the “WHY” axis. J AAPOS. 2004 Feb;8(1):1-12. PMID 14970791

Journal: Journal Of Aapos : The Official Publication Of The American Association For Pediatric Ophthalmology And Strabismus, Volume 8, Issue 1, Feb 2004

BACKGROUND Traditional teaching holds that there is a partial compensatory countertorsion after head tilt because the intorters in the eye on the side of the head tilt and the extorters in the contralateral eye are stimulated. This teaching is inconsistent with a number of clinical observations.

METHODS Review of existing literature, reanalysis of data from the investigator’s previous experiments, and inductive and deductive reasoning were used to reconcile inconsistencies and present a theory on why torsional movements occur.

RESULTS The inconsistencies can be reconciled if one considers that during the dynamic phase of head tilt, there is an alternating series of intorsional and extorsional movements of both eyes. Each eye has slow dynamic compensatory counterrolling phases that serve as torsional “doll’s-head” movements to stabilize the image during head tilt. This counterrolling is partially eliminated by a series of anticompensatory torsional saccades in the direction of head tilt, which is in contrast to traditional teaching.

CONCLUSION Dynamic compensatory counterrolling occurs during head tilt. It is largely eliminated by anticompensatory torsional saccades in the opposite direction so that by the end of head tilt only minimal static countertorsion remains. The dynamic compensatory counterrolling motion is necessary to minimize peripheral visual movement during head tilt. The elimination of most of the counterrolling by the end of head tilt is necessary to preserve convergence and stereopsis.