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Bielschowsky head-tilt test—I. Ocular counterrolling and Bielschowsky head-tilt test in 23 cases of superior oblique palsy

1985; Elsevier BV; Volume: 25; Issue: 12 Linguagem: Inglês

10.1016/0042-6989(85)90022-7

1878-5646

H.J. Simonsz, Robert A. Crone, J. van der Meer, C.F. Merckel-Timmer, A.M. van Mourik-Noordenbos,

Ophthalmology and Visual Impairment Studies

We have measured the amplitude of ocular counterrolling (OCR) and the change in vertical deviation in the Bielschowsky head-tilt test (BHT) in 23 cases of unilateral superior oblique palsy. OCR was measured with a photographical method, using limbal, conjunctival vessels as landmarks. Average OCR of the healthy eye was 5.4 +/- 2.4 (SD) deg either side, at 45 deg of body-tilt. BHT and OCR (of the healthy eye) were not related in the group as a whole. An important perturbing factor was the duration of the palsy. To clarify the relation between BHT, OCR and duration of palsy, the BHT/OCR ratio was calculated in each patient. Six cases with a palsy of presumed recent onset had BHT/OCR ratio of 0.57 +/- 0.09, while twelve cases of long-standing palsy had a BHT/OCR ratio of 1.04 +/- 0.71. This means that in cases of recent onset, the relation was relatively fixed. All high BHT/OCR ratio's occurred in long-standing palsies, whether acquired or congenital. In our opinion, disproportionately large amplitudes in the Bielschowsky head-tilt test are caused by secondary innervational changes or contractures.