The effect of torsional muscle dysfunction and surgery on eye position under general anesthesia

Under general anesthesia, normal eyes exhibit 2.0 degrees to 2.5 degrees of extorsion. To investigate the effect of torsional muscle dysfunction and surgery on eye position under general anesthesia, we measured the torsional change before and after torsional muscle surgery in 26 eyes of 18 patients with clinical torsional muscle dysfunction. Under general anesthesia, compared with normals, eyes with preoperative intorter overaction or extorter underaction demonstrated a significant intorsional change (P < .01). However, eyes with intorter underaction or extorter overaction did not demonstrate a significant extorsional change. Postoperatively, while patients remained under general anesthesia, intorter weakening procedures produced measurable extorsion while intorter strengthening procedures and extorter weakening procedures produced measurable intorsion. Superior oblique tenotomy produced a greater net torsional change than inferior oblique weakening surgery (P < .01). Under general anesthesia, eyes with preoperative torsional muscle dysfunction exhibit torsion in the direction consistent with the dysfunction. After surgery on the torsional muscles, a measurable torsional effect can be demonstrated while the patient is still under general anesthesia.