Author(s):Kushner BJ. Effect of ocular torsion on A and V patterns and apparent oblique muscle overaction. Arch Ophthalmol. 2010 Jun;128(6):712-8. doi: 10.1001/archophthalmol.2010.88. PMID 20547948
Journal: Archives Of Ophthalmology (Chicago, Ill. : 1960), Volume 128, Issue 6, Jun 2010
OBJECTIVE To determine if ocular torsion is a major cause of A and V patterns and oblique muscle overaction or merely a contributing factor.
METHODS Three separate investigations were conducted. (1) The trajectory of eyes with oblique muscle overaction was plotted across the horizontal field of gaze from videographs to determine if it was linear or curvilinear. (2) The effect of successful Harada-Ito surgery to reduce extorsion on overelevation in adduction in patients with fourth cranial nerve palsy was studied. (3) The effect of successful surgery to treat pattern strabismus in the form of vertical transposition of the horizontal rectus muscles on objective torsion was studied.
RESULTS (1) Three eyes with inferior oblique muscle overaction and 2 with superior oblique muscle overaction had a curvilinear rise or fall (respectively) as they moved into adduction. (2) Surgery that successfully decreased extorsion had a negligible effect on overelevation in adduction in 2 patients. (3) Horizontal rectus muscle transposition that was uniformly successful in eliminating A or V patterns consistently caused an increase in objective torsion in all 5 patients studied.
CONCLUSION Ocular torsion may contribute to A or V patterns and overelevation or overdepression in adduction, but it is probably not the major cause of these phenomena.