How is ocular tension 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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Examine fundus photography for ocular torsion. The disc-fovea angle is used to estimate the amount of ocular torsion and can be measured as the angle between the line from the optic disc center to the fovea and a horizontal line through the optic disc center. [26] Dieterich et al discovered a 2°-8° ocular torsion in patients with trochlear nerve palsy, and Lefevre et al observed 10.7° ± 3.8° of excyclotorsion in the paretic eye and 8.8° ± 5.7° in the nonparetic eye. [28, 29] In a study by Roh et al, this test was more sensitive (100%) than both the Lancaster red-green test and double Maddox rod test. [30]

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