How is cyclotorsion assessed in trochlear nerve palsy (fourth nerve palsy)?

Updated: Oct 08, 2019
  • Author: Zafar A Sheik, MD, MD; Chief Editor: Andrew G Lee, MD  more...
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Cyclotorsion may be measured using double Maddox rod test. [11, 25, 26] Details are as follows:

  • Patients are seated in a dark room to minimize their reliance on environmental cues.
  • Red Maddox rod is placed before each eye with axes oriented obliquely at about 5-10° from the vertical. A prism could be placed in front of one eye to vertically separate the images; this would help the patient to compare the two images better.
  • Patient is asked to rotate 1 frame until the 2 lines are parallel.

Patients with bilateral disease typically show more than 10° of excyclotorsion.

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