Listing's plane dependence on alternating fixation in a strabismus patient

Listing's law of the eye is one of the best studied findings in motor control, but its functional meaning is still incompletely understood and its status in neurological disorders and in strabismus is almost entirely unknown. We investigated the mechanisms underlying Listing's law and its possible clinical relevance. The dual magnetic search coil technique was used to record three-dimensional binocular eye movements in a stereoblind strabismic patient with good visual acuity in both eyes and capable of voluntarily alternating fixation. This technique yielded an accurate, objective and simultaneous measure of ocular misalignment in three dimensions and showed that the squint angle depended on which eye was fixating. Saccadic eye movement data throughout the oculomotor range were used to fit Listing's plane. Listing's primary position and the thickness of the plane for each eye were calculated for three different fixation conditions. For comparison, control measurements were taken from four normals. In the patient, no large deviations from normal values for the thickness of Listing's plane and the confidence limits of the Listing primary position were found. The most remarkable abnormality was that the orientation of Listing's plane depended on which eye was fixating. Both the change in ocular misalignment and the shift of Listing's primary positions observed when changing fixation are probably linked to accommodation-related vergence. Despite repeated surgery at early age, the patient had well-defined Listing planes for both eyes, but their alignment during left-eye fixation was abnormal. The obedience to Listing's law may reflect a strategy which minimizes muscular effort in each eye separately. The abnormal fixation-condition dependence is probably due to an aberrant coupling with vergence.