Comparison of head tilt test between sagging eye syndrome and acquired unilateral trochlear nerve palsy.

PURPOSE: To investigate the distinction between sagging eye syndrome (SES group) and acquired unilateral trochlear nerve palsy (Trochlear group) in the Bielschowsky head tilt test (BHTT). METHODS: Fifteen patients in the SES group (mean age 74.6 ± 5.2 years) and 14 patients in the Trochlear group (55.2 ± 15.9 years) visited the Department of Ophthalmology, Hyogo Medical University Hospital between November 2016 and October 2022 for treatment of their diplopia. Eye position was measured with the alternate prism cover test, and values for fixation of the dominant eye, or unaffected eye, were used. Cyclodeviation was measured with the synoptophore and the Glaucoma Module Premium Edition of the SPECTRALIS optical coherence tomography. In the BHTT, eye position was measured in three head postures: primary position (PP), head tilt to the side with hypertropia (Hyper), and head tilt to the side with hypotropia (Hypo). The differences in vertical deviation between PP and Hyper (Hyper - PP), PP and Hypo (PP - Hypo) and Hyper - Hypo were measured and compared. RESULTS: Vertical deviation in primary position was 7.3 ± 4.5 PD in the SES group and significantly larger (17.1 ± 8.4 PD) in the Trochlear group (p = 0.002). The vertical deviation in Hyper was significantly larger in the Trochlear group with 7.7 ± 4.7 PD and 22.1 ± 9.4 PD, respectively (p < 0.001), whereas the that in Hypo was not significantly different between the two groups with 6.5 ± 3.4 PD and 8.4 ± 6.6 PD, respectively (p = 0.725). The SES group showed no significant difference according to the 3 head postures (p = 0.311), while the Trochlear group showed a significantly different with smaller mean values in vertical deviation in Hypo (p < 0.001). The difference in the vertical deviation for the 3 head postures was the largest in Hyper - Hypo (1.7 ± 2.1 PD and 13.6 ± 7.1 PD, respectively), and the accuracy of SES was at the cutoff value of 6 PD, and it was considered not to be SES if the value was 6PD or higher. The accuracy of SES determination was 100% sensitivity and 100% specificity, and the area under the curve was 1.0. CONCLUSION: The difference in Hyper - Hypo in the BHTT may be the most useful index in differentiating SES from acquired unilateral trochlear nerve palsy; if the difference was more than 6 PD, the probability of SES was very low.

Yearly changes in cases of acute acquired comitant esotropia during a 12-year period.

PURPOSE: The number of patients with acute acquired comitant esotropia (AACE) has been increasing in Japan. The purpose of this study was to investigate the changes in the number and characteristics of patients with AACE examined in our institution during a 12-year period. METHODS: We retrospectively reviewed the medical records of patients with AACE aged < 30 years who suddenly developed diplopia or esotropia and were examined in Hyogo College of Medicine Hospital from January 2008 to December 2021. We investigated the association of the yearly changes in the number of patients with the age category, refractive error category, AACE type, esotropia type, and use or nonuse of smartphones. RESULTS: The total number of patients with AACE was 171, and this number significantly increased each year (Pearson correlation coefficient, 0.9450; p < 0.0001). Significant increases were found among students in junior high school and beyond, patients with myopia, patients with Bielschowsky type AACE, and patients with basic esotropia (p < 0.0001 for all). We compared two age groups, elementary school students and below versus junior high school students and above, and found that the rate of increase was significantly higher in the junior high school students and above (estimate, 1.951; p < 0.0001), and the non-myopia group and myopia group and found that the rate of increase was significantly higher in the myopia group (estimate, 1.891; p < 0.0001). Excessive use of smartphones was confirmed in 82 of 133 patients, and the rate of the increase in the number of patients with AACE was significantly greater among patients with than without excessive use of smartphones (estimate, 1.098; p = 0.0009). CONCLUSION: This study confirmed a significant increase in the number of patients with AACE in recent years. The excessive use of smartphones may be associated with the increase in AACE.

A Novel Method for Evaluation of Ocular Torsion Angle by Optical Coherence Tomography.

Purpose: The Glaucoma Module Premium Edition (GMPE) software for the SPECTRALIS optical coherence tomography (OCT) is able to automatically track the anatomic centers of both the fovea and the optic disc. We investigated the efficacy of the OCT in measuring the ocular torsion angle before and after strabismus surgery. Methods: Between June 2017 and December 2018, 40 patients with cyclodeviation who had undergone strabismus surgery at Hyogo College of Medicine were enrolled. Ocular torsion angle measurements, including OCT and nonmydriatic fundus camera for objective measurements and synoptophore for subjective measurements, were performed before surgery and 1 day after surgery. Results: The ocular torsion angles were measured as follows: synoptophore preoperative (-8.8° ± 4.1°) and postoperative (-3.1° ± 2.8°), fundus photography preoperative (-27.2° ± 6.4°) and postoperative (-18.6° ± 5.9°), and OCT preoperative (-25.9° ± 6.8°) and postoperative (-18.2° ± 5.8°). In all cases, symptoms related to cyclodeviation resolved postoperatively. All measurements were positively correlated before surgery. Postoperatively, changes in all measurements were also correlated. However, all synoptophore-related data were underestimated when compared with OCT and fundus photography. Conclusions: For measuring the ocular torsion angle, the OCT-based technology GMPE appears to provide information regarding anatomic fundus torsion that is similar to that obtained using fundus photography. Translational Relevance: This new objective measurement for the ocular torsion angle is helpful for treating cyclotropia.