Re: Torsional Diplopia

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Re: Torsional Diplopia

David Robins, MD

26 Jan 2007 05:31

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

Mike Tyner	26 Jan 2007 00:11
> 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

Scott Seidman

25 Jan 2007 20:38

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.

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Simon Dean

25 Jan 2007 20:05

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

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