Clinical and theoretical aspects of cyclotropia

The practical aspects of this work may be summarized as follows: The absence of subjective cyclotropia in patients with cyclovertical muscle paralysis is frequently associated with a congenital or infantile onset of the palsy. The Maddox double rod test provides quantitative information about the degree of cyclotropia but, due to its disassociating characteristics, may easily be misinterpreted. For instance, a positive Maddox test may be found in a cyclotropic patient with adequate cyclofusion who is asymptomatic. The Bagolini striate lenses are introduced as a superior test for cyclotropia since they provide information under more natural conditions of seeing. The Bagolini lenses not only permit us to measure the degree of cyclotropia but also tell us how a patient copes with it. The phase difference haploscope of Aulhorn provides similar information but is not readily available in clinical practice. The occurrence of cyclotropia in the non-paretic eye emphasizes that the diagnosis of a cyclovertical paralysis must not be made exclusively on the basis of subjective tests for cyclotropia. These tests are helpful only in the context of other clinical information of which the laterality of fixation preference of the patient has gained special significance. An apparent over-response to surgery for cyclotropia as evidenced, for example, by complaints of image tilting to the opposite side during the postoperative period after surgery for superior oblique paralysis may be caused by persistence of abnormal spatial localization. As a rule, this problem is only temporary and will disappear as normal egocentric localization re-establishes itself and the anatomical vertical and horizontal retinal meridians of the formerly cyclotropic eye assume their physiological spatial response.(ABSTRACT TRUNCATED AT 250 WORDS)