The Nuts and Bolts of Ocular Torsion

Clinical examination of ocular torsion has become an integral part of strabismus diagnosis and management. However, the clinical manifestations of subjective and objective torsion are frequently conflated or disregarded, creating diagnostic confusion and therapeutic dilemmas. The purpose of this analysis is to outline important clinical principles to understand and manage ocular torsion. Ten clinical axioms are embedded within a neurophysiologic framework for torsional control to provide a critical neural mechanism to fortify binocular vision and balance.