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Medical Forum / General / Vision / January 2007Torsional Diplopia
Ok, So, Let's say, I have a 4th Nerve Palsy which is causing a torsional diplopia. My fusional amplitudes are pretty good and I converge the images correctly most of the time, unless I go for those dissociation tests such as W4D and Maddox, but every now and again in the real world, I begin to decompensate. Now, would any prism glasses help with the decompensation, or would prism glasses help all the time to relieve any mental/physical strain with having to compensate all the time (if indeed that's what Im doing)? Am I getting a hang of these things now? Think I finally understand it. Ta Simon Simon Dean <sjdean@simtext.plus.com> wrote in news:51sgsfF1lvu49U1 @mid.individual.net: > Now, would any prism glasses help with the decompensation, or would > prism glasses help all the time to relieve any mental/physical strain > with having to compensate all the time (if indeed that's what Im doing)? If the diplopia is truly torsional, I don't think that a prism would help. Possibly, you might be able to use prisms to bring the eye to a horizontal/vertical position where secondary and tertiary muscles would resolve the torsional disparity, but it wouldn't be the same as using prism to resolve a horizontal disparity. I think there would be a low probability of success, and would require alot of trial and error, in any case. The good news is that torsional fusion is more forgiving than vertical and horizontal, so you don't need to get as close.  SignatureScott Reverse name to reply > The good news is that torsional fusion is more forgiving than vertical > and horizontal, so you don't need to get as close. By the way, I'm not a doctor, and don't treat people. I'm sure you'd get a much more reliable answer from a good strab surgeon. SignatureScott Reverse name to reply >> The good news is that torsional fusion is more forgiving than vertical >> and horizontal, so you don't need to get as close. > > By the way, I'm not a doctor, and don't treat people. I'm sure you'd get a > much more reliable answer from a good strab surgeon. In my downward gaze, covering and uncovering my eye, I see, for example: /\ ie, looking at my keyboard now, in the left eye, the keyboard slopes up to the right. Right eye, keyboard slopes down from the left. With my right eye covered, in my straight ahead gaze, my computer screen appears down and to the right (compared to my right eye) and slopes downwards. vertical lines appear to skew off to the right... and even more worryingly now, my colour vision in my left eye appears to be slightly different to my right eye. Either my left eye is greyer, or my right eye is yellower. Er... Im getting a bit freaked out now. Cya Simon > If the diplopia is truly torsional, I don't think that a prism would help. I tend to agree. Torsions are tough to fix. One time I resorted to frosting one lens with scotch tape just so he could function. -MT About the only thing that helps a 4th nerve paresis with torsional problems is surgery. If there is vertical misalignment, the inferior oblique in that eye and perhaps the inferior rectus in the other eye may need weakening. Some surgeons like to do a tuck on the weakened superior oblique, at the risk of causing an iatrogenic Brown's antielevation syndrome. I personally don't do tucks. If the problem is almost exclusively torsional (excyclotorsion of the globe0 then a Harada-Ito surgery to advance the anterior portion of the superior oblique tendon is useful, but does not always fully correct it either. David Robins, MD Board certified Ophthalmologist Pediatric ophthalmology and adult strabismus subspecialty On 1/25/07 4:11 PM, in article rsKdnUJNhPy72iTYnZ2dnUVZ_uyknZ2d@giganews.com, "Mike Tyner" <mtyner@mindspring.com> wrote: >> If the diplopia is truly torsional, I don't think that a prism would help. > > I tend to agree. Torsions are tough to fix. One time I resorted to frosting > one lens with scotch tape just so he could function. > > -MT >> If the diplopia is truly torsional, I don't think that a prism would help. > > I tend to agree. Torsions are tough to fix. One time I resorted to frosting > one lens with scotch tape just so he could function. > > -MT Thanks Mike, David, Scott... Just to make sure, I say torsional, because reading about the diplopa problems caused by a fourth nerve palsy, I don't believe that I tuck my chin in and bow my head forward. I actually tilt my head to the right (or was it the left) as was observed by the opthalmologists. I also remember seeing the images in one of the maddox tests, in which I saw two lines but not parallel to each other. There is a certain amount of vertical displacement though when I cover each eye in turn which I don't know whether prisms would at least help with that bit? Im glad therefore everyone has said prisms won't help. The doctor said this too.... I took him at his word.... But I was concerned about whether having to fuse images were causing any great physical or mental strain and therefore whether the appropriate glasses would have any benefit. So the end result is, if this is torsional diplopa, prisms won't help, I just have to put up with the effects of decompensating and sort out exactly why I decompensate. Thanks Simon
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