{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2022,10,19]],"date-time":"2022-10-19T05:17:40Z","timestamp":1666156660306},"reference-count":30,"publisher":"Georg Thieme Verlag KG","issue":"10","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Klin Monbl Augenheilkd"],"published-print":{"date-parts":[[2022,10]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>\n          Background The lack of a positive Bielschowsky head tilt test (BHTT) is commonly seen as an indicator that superior oblique paresis (SOP) is not present. This study investigated the\n\t\t\t\t\tinfluence of fusion on the BHTT in unilateral SOP.<\/jats:p><jats:p>\n          Patients\/Methods and Material We analyzed vertical fusional vergence using our eye-tracking haploscope and the value of BHTT difference (BHTTD) in 11 patients who were diagnosed with\n\t\t\t\t\tcongenital unilateral SOP and able to fuse.<\/jats:p><jats:p>\n          Results Patients used one of three different mechanisms of vertical vergence to achieve fusion. The three fusional mechanisms were associated with a significantly different BHTTD\n\t\t\t\t\t(p\u2009&lt;\u20090.05). Seven of the eleven patients used vertical recti-mediated fusion and had a mean BHTTD\u2009\u00b1\u2009SD of 21.7\u2009\u00b1\u20096.3 prism diopters (PD). Three of these patients whom we measured after a\n\t\t\t\t\tpatch test for at least 30\u2009min showed a decreased BHTTD (12.7\u2009\u00b1\u20093.8 PD). Three of the eleven patients used a mixed (oblique\/rectus) fusional mechanism and had a mean BHTTD\u2009\u00b1\u2009SD of 9.3\u2009\u00b1\u20098.6\n\t\t\t\t\tPD. Of these patients, the one whom we measured after patching showed an increase of 11 PD in BHTTD. The remaining patient used oblique muscle-mediated fusion and had a BHTTD of only 3 PD\n\t\t\t\t\tthat increased to 21 PD after patching. One explanation for this BHTT behavior in the latter patient involves lingering vergence adaptation of the \u201cparetic\u201d superior oblique muscle (SOM) and\n\t\t\t\t\tcontralateral inferior oblique muscle, which makes these muscles more effective when activated, as is the case on ipsilateral head tilt (part of the ocular counter-roll mechanism), lessening\n\t\t\t\t\tthe expected increase in hyperdeviation. Similarly, in our patients with mixed fusion, the vergence-adapted \u201cparetic\u201d SOM and contralateral superior rectus muscle are activated on\n\t\t\t\t\tipsilateral and contralateral tilt, respectively, lessening the hyperdeviation in both directions. In the other seven patients, however, the vergence-adapted ipsilateral inferior rectus\n\t\t\t\t\tmuscle and contralateral superior rectus muscle are activated on contralateral tilt, accentuating the BHTTD.<\/jats:p><jats:p>\n          Conclusion Depending upon the specific muscles used for vertical fusion, the BHTTD is decreased or increased. The presence of a large BHTTD points to lingering or persisting fusional\n\t\t\t\t\ttonus involving the vertical rectus muscles. The lack of a positive BHTT does not rule out the diagnosis of SOP, but rather may be caused by lingering or persevering fusional tonus involving\n\t\t\t\t\tthe oblique muscles. Performing the BHTT after a patch test for a minimum of 30 minutes may be necessary to reveal the BHTTD, supporting the diagnosis of SOP.<\/jats:p>","DOI":"10.1055\/a-1933-3223","type":"journal-article","created":{"date-parts":[[2022,10,18]],"date-time":"2022-10-18T22:36:26Z","timestamp":1666132586000},"page":"1213-1220","source":"Crossref","is-referenced-by-count":0,"title":["How Lingering Fusional Adaptation Influences the Bielschowsky Head Tilt Test in Superior Oblique Paresis"],"prefix":"10.1055","volume":"239","author":[{"given":"Kristina","family":"Irsch","sequence":"additional","affiliation":[{"name":"The Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States"},{"name":"Vision Institute \u2013 CNRS, INSERM, Sorbonne University, Paris, France"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"David L.","family":"Guyton","sequence":"additional","affiliation":[{"name":"The Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Howard S.","family":"Ying","sequence":"additional","affiliation":[{"name":"Boston Eye Care Center, Cambridge, United States"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"194","published-online":{"date-parts":[[2022,10,18]]},"reference":[{"key":"ref1","doi-asserted-by":"crossref","first-page":"237","DOI":"10.1007\/BF01701547","article-title":"\u00dcber das Vorkommen von wahren Rollungen des Auges um die Gesichtslinie","volume":"17","author":"A Nagel","year":"1871","journal-title":"Albrecht v Graefe\u02bcs Arch Ophthalmol"},{"key":"ref2","doi-asserted-by":"crossref","first-page":"174","DOI":"10.1007\/BF01943498","article-title":"Die Verwendung der Kopfneigung zur Diagnostik von Augenmuskell\u00e4hmungen aus der Heber- und Senkergruppe","volume":"51","author":"F B Hofmann","year":"1900","journal-title":"Albrecht v Graefe\u02bcs Arch Ophthalmol"},{"key":"ref3","doi-asserted-by":"crossref","first-page":"387","DOI":"10.1001\/archopht.1967.00980030399024","article-title":"Extraocular muscles and head tilting. Electromyographic mechanics of activity of individual muscles","volume":"78","author":"A B Scott","year":"1967","journal-title":"Arch Ophthalmol"},{"key":"ref4","doi-asserted-by":"crossref","first-page":"1983","DOI":"10.1016\/0042-6989(85)90023-9","article-title":"Bielschowsky head-tilt test \u2013 II. Quantitative mechanics of the Bielschowsky head-tilt test","volume":"25","author":"D A Robinson","year":"1985","journal-title":"Vision Res"},{"key":"ref5","doi-asserted-by":"crossref","first-page":"1977","DOI":"10.1016\/0042-6989(85)90022-7","article-title":"Bielschowsky head-tilt test \u2013 I. Ocular counterrolling and Bielschowsky head-tilt test in 23 cases of superior oblique palsy","volume":"25","author":"H J Simonsz","year":"1985","journal-title":"Vision Res"},{"key":"ref6","first-page":"25","article-title":"Das ungel\u00f6ste Problem des Bielschowsky-Kopfneigeph\u00e4nomens","volume":"12","author":"G Kommerell","year":"1985","journal-title":"Orthoptik \u2013 Pleoptik"},{"key":"ref7","doi-asserted-by":"crossref","first-page":"101","DOI":"10.3109\/01658108608997334","article-title":"Adaptive changes of the otolith-ocular reflex after injury to the trochlea","volume":"6","author":"G Kommerell","year":"1986","journal-title":"Neuroophthalmology"},{"key":"ref8","doi-asserted-by":"crossref","first-page":"142","DOI":"10.1055\/s-2005-857929","article-title":"Das Kopfneigeph\u00e4nomen bei einseitigen und beidseitig symmetrischen Trochlearisparesen","volume":"222","author":"M Gr\u00e4f","year":"2005","journal-title":"Klin Monbl Augenheilkd"},{"key":"ref9","first-page":"1055","article-title":"[Motor adaptation in the Bielschowsky head-tilt test in cases of superior oblique palsy]","volume":"96","author":"H Ohtsuki","year":"1992","journal-title":"Nihon Ganka Gakkai Zasshi"},{"key":"ref10","doi-asserted-by":"crossref","first-page":"854","DOI":"10.1016\/S0002-9394(00)00639-5","article-title":"Large Bielschowsky head-tilt phenomenon and inconspicuous vertical deviation in the diagnostic positions in congenital superior oblique palsy","volume":"130","author":"H Ohtsuki","year":"2000","journal-title":"Am J Ophthalmol"},{"key":"ref11","doi-asserted-by":"crossref","first-page":"3292","DOI":"10.1152\/jn.01157.2004","article-title":"Magnetic resonance imaging of human extraocular muscles during static ocular counter-rolling","volume":"94","author":"J L Demer","year":"2005","journal-title":"J Neurophysiol"},{"key":"ref12","doi-asserted-by":"crossref","first-page":"175","DOI":"10.1167\/iovs.08-2393","article-title":"Absence of relationship between oblique muscle size and Bielschowsky head tilt phenomenon in clinically diagnosed superior oblique palsy","volume":"50","author":"R Kono","year":"2009","journal-title":"Invest Ophthalmol Vis Sci"},{"key":"ref13","doi-asserted-by":"crossref","first-page":"201","DOI":"10.1167\/iovs.08-3035","article-title":"Relationship between static ocular counterroll and Bielschowsky head tilt phenomenon","volume":"51","author":"I Hamasaki","year":"2010","journal-title":"Invest Ophthalmol Vis Sci"},{"key":"ref14","doi-asserted-by":"crossref","first-page":"498","DOI":"10.1016\/j.jaapos.2008.01.019","article-title":"A novel haploscopic viewing apparatus with a three-axis eye tracker","volume":"12","author":"N A Ramey","year":"2008","journal-title":"J AAPOS"},{"key":"ref15","doi-asserted-by":"crossref","first-page":"1152","DOI":"10.1167\/iovs.08-2739","article-title":"Video-based head movement compensation for novel haploscopic eye tracking apparatus","volume":"50","author":"K Irsch","year":"2009","journal-title":"Invest Ophthalmol Vis Sci"},{"key":"ref16","doi-asserted-by":"crossref","first-page":"3108","DOI":"10.1167\/iovs.12-11368","article-title":"Vertical vergence adaptation produces an objective vertical deviation that changes with head tilt","volume":"54","author":"K Irsch","year":"2013","journal-title":"Invest Ophthalmol Vis Sci"},{"key":"ref17","doi-asserted-by":"crossref","first-page":"5362","DOI":"10.1167\/iovs.15-16604","article-title":"Mechanisms of vertical fusional vergence in patients with \u201ccongenital superior oblique paresis\u201d investigated with an eye-tracking haploscope","volume":"56","author":"K Irsch","year":"2015","journal-title":"Invest Ophthalmol Vis Sci"},{"key":"ref18","doi-asserted-by":"crossref","first-page":"151","DOI":"10.1016\/S1091-8531(99)70060-1","article-title":"The Lancaster red-green test before and after occlusion in the evaluation of incomitant strabismus","volume":"3","author":"J M Hwang","year":"1999","journal-title":"J AAPOS"},{"key":"ref19","doi-asserted-by":"crossref","first-page":"478","DOI":"10.1001\/archopht.116.4.478","article-title":"Distance\/near differences in intermittent exotropia","volume":"116","author":"B J Kushner","year":"1998","journal-title":"Arch Ophthalmol"},{"key":"ref20","doi-asserted-by":"crossref","first-page":"145","DOI":"10.1067\/mpa.2002.122521","article-title":"Motor mechanisms of vertical fusion in individuals with superior oblique paresis","volume":"6","author":"A V Mudgil","year":"2002","journal-title":"J AAPOS"},{"key":"ref21","first-page":"399","volume-title":"Sensory Adaptations to Cyclodeviations","author":"D L Guyton","year":"1978"},{"key":"ref22","doi-asserted-by":"crossref","first-page":"1451","DOI":"10.1016\/S0161-6420(79)35376-3","article-title":"Clinical observations in cyclodeviations","volume":"86","author":"G K von Noorden","year":"1979","journal-title":"Ophthalmology"},{"key":"ref23","doi-asserted-by":"crossref","first-page":"279","DOI":"10.1113\/jphysiol.1992.sp019164","article-title":"Unexpected role of the oblique muscles in the human vertical fusion reflex","volume":"451","author":"J T Enright","year":"1992","journal-title":"J Physiol"},{"key":"ref24","doi-asserted-by":"crossref","first-page":"2307","DOI":"10.1016\/0042-6989(94)90109-0","article-title":"Eye torsion associated with disparity induced vertical vergence in humans","volume":"34","author":"L J Van Rijn","year":"1994","journal-title":"Vision Res"},{"key":"ref25","doi-asserted-by":"crossref","first-page":"1188","DOI":"10.1001\/archopht.117.9.1188","article-title":"Vertical fusional vergence: the key to dissociated vertical vergence in humans","volume":"117","author":"E W Cheeseman","year":"1999","journal-title":"Arch Ophthalmol"},{"key":"ref26","doi-asserted-by":"crossref","first-page":"565","DOI":"10.1016\/j.jaapos.2006.08.010","article-title":"\u201cInverted Brown pattern\u201d: a tight inferior oblique muscle masquerading as superior oblique underaction \u2013 clinical characteristics and surgical management","volume":"10","author":"A Awadein","year":"2006","journal-title":"J AAPOS"},{"key":"ref27","doi-asserted-by":"crossref","first-page":"298","DOI":"10.1055\/s-2004-812885","article-title":"Strabisme surso-adducteur d\u00e9compens\u00e9","volume":"221","author":"G Klainguti","year":"2004","journal-title":"Klin Monbl Augenheilkd"},{"key":"ref28","doi-asserted-by":"crossref","first-page":"874","DOI":"10.1055\/s-0031-1281759","article-title":"Behandlung des Strabismus sursoadductorius (congenital superior oblique palsy) im Kindesalter","volume":"228","author":"S Schmidt","year":"2011","journal-title":"Klin Monbl Augenheilkd"},{"key":"ref29","doi-asserted-by":"crossref","first-page":"847","DOI":"10.1167\/iovs.07-0739","article-title":"Ocular torsion reveals the mechanisms of cyclovertical strabismus: the Weisenfeld lecture","volume":"49","author":"D L Guyton","year":"2008","journal-title":"Invest Ophthalmol Vis Sci"},{"key":"ref30","first-page":"128","volume-title":"Craniofacial Anomalies and Strabismus","author":"L CF DeSa","year":"1995"}],"container-title":["Klinische Monatsbl\u00e4tter f\u00fcr Augenheilkunde"],"original-title":[],"language":"de","link":[{"URL":"http:\/\/www.thieme-connect.de\/products\/ejournals\/pdf\/10.1055\/a-1933-3223.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,10,18]],"date-time":"2022-10-18T22:37:46Z","timestamp":1666132666000},"score":1,"resource":{"primary":{"URL":"http:\/\/www.thieme-connect.de\/DOI\/DOI?10.1055\/a-1933-3223"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,10]]},"references-count":30,"journal-issue":{"issue":"10","published-online":{"date-parts":[[2022,10,18]]},"published-print":{"date-parts":[[2022,10]]}},"URL":"https:\/\/doi.org\/10.1055\/a-1933-3223","archive":["Portico","CLOCKSS"],"relation":{},"ISSN":["0023-2165","1439-3999"],"issn-type":[{"value":"0023-2165","type":"print"},{"value":"1439-3999","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,10]]}}}