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Ocular Motor Cranial Neuropathies
Published in Vivek Lal, A Clinical Approach to Neuro-Ophthalmic Disorders, 2023
Zane Foster, Ashwini Kini, Bayan Al-Othman, Andrew G. Lee
As the fourth cranial nerve only innervates the superior oblique muscle, damage will result in excyclotorsion and hypertropia of the affected eye. Patients with lesions of this nerve will complain of vertically separated, and often tilted, images. A double Maddox rod test can quantify the degree of tilt (torsion).
Cranial Neuropathies II, III, IV, and VI
Published in Philip B. Gorelick, Fernando D. Testai, Graeme J. Hankey, Joanna M. Wardlaw, Hankey's Clinical Neurology, 2020
Tanyatuth Padungkiatsagul, Heather E. Moss
Patients with symptomatic CN IV palsies may have very subtle vertical deviation that is difficult to discern on examination. Thus, a patient with binocular vertical diplopia with one image tilted likely has a fourth nerve palsy even if the eyes appear aligned to the examiner. Tools such as the Maddox rod are useful to measure the deviation in these cases.
The accommodative-convergence complex — A review
Published in Jan-Tjeerd de Faber, 28th European Strabismological Association Meeting, 2020
R.L. Brautaset, J.A.M. Jennings
Clinical measurements of vergence or phoria adaptation can be done by the flashed Maddox rod technique described by Henson & North (1980). With this method a phoria is induced by the use of prisms and then the “new” phoria is measured at regular intervals. Between each phoria measurement the subject is allowed binocular vision through the prism. Figure 2 shows the average response of 20 pre-presbyopic subjects with normal binocular vision to both 6Δ BI and 6Δ BO while fixating at 40 cm.
Horizontal Heterophoria Modifications by Means of Thin Proprioceptive Stimulations Applied on the Foot Sole: A Randomised Study
Published in Journal of Motor Behavior, 2022
The subjects were positioned in an upright position with their feet placed in contact with the Iron L-section, head straight and gaze directed towards the LED pen torch light. The assessment of herophoria was carried out in a mesopic vision condition, in order to allow a better visibility of the LED pen torch light. The subjects held the Maddox rod in front of their right eye (and subsequently in front of their left eye), with the cylinders horizontal. The operator held the spot of light at the tested subject’s eye level, at an initial distance of 40 cm (Casillas & Rosenfield, 2006; Howarth & Heron, 2000). The distance between the tested subject and the operator was assessed by a laser distometer placed on the ground and propped against an L-shaped iron, positioned in front of the tested subject’s feet. The distometer projected the laser beam towards another L-iron, placed in front of the tested subject’s feet (Figure 2).
Measuring acquired ocular torsion with optical coherence tomography
Published in Clinical and Experimental Optometry, 2021
Christopher J Borgman, Jessica A Haynes
A 56‐year‐old African‐American male presented with sudden onset of vertical diplopia for four-days. His medical history included hypercholesterolaemia and gout. Visual acuities were R/L: 6/6 without correction. Confrontation visual fields and pupil testing were normal. Extraocular motility assessment showed elevation of the left eye in attempted adduction, suggesting overaction of the left inferior oblique. Cover testing revealed a four prism dioptre hyperdeviation in the left eye. The Parks‐Bielschowsky three‐step test isolated the left superior oblique muscle. Subjective double Maddox rod testing showed no torsion in the right eye, and 6° of excyclotorsion in the left eye. The remainder of his examination was within normal limits. Objective ocular torsion measured with Spectralis optical coherence tomography revealed normal torsion of +1.4° in the right eye and disproportionate excyclotorsion of −9.0° in the left eye, consistent with a left trochlear nerve palsy (Figure 1).
Modified Anterior Superior Oblique Tuck: A Case Series
Published in Journal of Binocular Vision and Ocular Motility, 2020
Federica Solanes, Federico G. Velez, Laura Robbins, Stacy L. Pineles
Torsion was measured using double Maddox Rod test in primary position. Two Maddox Rod lenses, one red, and one green, were placed in a trial frame over the patient’s face with the calibration mark 5–10 degrees away from the vertical to avoid falsely localizing torsion to one particular eye. If the subject was not able to distinguish the 2 lines, a 6Δ base-down prism was placed in front of one eye to create vertical displacement of the lines. All room lights were turned off to fully dissociate the eyes and the patient was asked to rotate each knob on the trial frame until the red line and the green line were both horizontal and parallel. The amount of cyclotorsional deviation was determined in degrees directly from the axis scale on the trial frame after the patient made the necessary adjustment.2