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D.L. Rousie, P. Salvetti, S. Delcroix, S. Rasson, F. Hamon; Correcting Ocular Torsion in craniofacial asymmetries . Invest. Ophthalmol. Vis. Sci. 2004;45(13):5005.
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Purpose: Unilateral ocular torsion(OT) is widely described as a consequence of CNS and/or vestibular disorders but is also specific of craniofacial asymmetries(CFA). CFA involves asymmetry of the orbits and basicranium including labyrinths.We measured ocular torsion(OT)with an easy, reproducible and fast exam, to provide optical correction for the torsion. Methods: We examined 61 patients, who all had visual acuity measures according to the ETDRS as well as a binocular vision study. Fundus images of both eyes were taken using the HRA (Heidelberg retinal angiograph) while the patient was wearing a special helmet to verify the 0° head position, with IR and RF filters. On the red free images, the position of the fovea was measured in degrees using the AOB angle, O being the centre of the papilla, OA the horizontal line drawn from O,OB the line to the foveola.OCT was performed in all patients to crosscheck the location of fixation point as well as to evaluate the anatomical normality of the eye.Follow up after prismation was obtained. Results:Ocular torsion was present with a mean angle of 6.2°(+–3.8°) in 90% of patients and 82% of patients show a left torsion. CFA are present in 72% of cases.Refractive errors are common (74%of study subjects), astigmatism is present in 41% of patients and 54% have an oculomotor deficit, mostly Ksyndromes(41%). Subjective pain evaluation was improved before and after prismation as well as cessation of migraines: in 77% of cases patients were able to stop pain medications. Conclusions: Ocular torsion seems to be common in the population that presents cervical pain and migraines, because of the associated head tilt in roll.Prevalence of the left torsion can possibly be explained by developmental factors.Prismation can correct the tilt of the head based on oculocephalogyrus reflex, by exciting a refixation saccade.Prismation seems to be an effective therapy that can possibly help in reducing the need for analgesics and correcting posture problems in adults as in children.
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