Skip to main content
SpringerLink
Log in

New instrument for quantitative measurements of passive duction forces and its clinical implications

  • Pediatrics
  • Published:
Graefe's Archive for Clinical and Experimental Ophthalmology Aims and scope Submit manuscript

Abstract

Purpose

Evaluating the passive duction force of the extraocular muscles is important for the diagnosis of and surgical planning for strabismus. This is especially relevant in patients with an observable limitation of duction movement. The purpose of this study was to validate passive duction forces in healthy subjects using a novel instrument.

Methods

An instrument for making continuous quantitative measurements of passive duction forces was designed. Tension was measured as the eyeball was rotated horizontally or vertically from the resting position under general anesthesia 10 mm (50°) away from the direction of force to be tested (opposite side).

Results

Seventy eyes of 35 subjects were enrolled in this study (age range of 4–80 years and mean age of 36.3 years). The passive duction force was measured at 49.0 ± 15.3 g (mean ± standard deviation) for medial rotation, 44.8 ± 13.2 g for lateral rotation, 50.5 ± 14.8 g for superior rotation, and 53.5 ± 13.8 g for inferior rotation. The passive duction forces were similar for all gaze positions, but it was larger for inferior rotation than for lateral rotation (P = 0.009). The passive duction force was significantly larger for vertical rotation (51.9 ± 14.4 g) than for horizontal rotation (46.9 ± 14.4 g) (P = 0.006). The passive duction force did not differ significantly with sex (P = 0.355), side (P = 0.087), or age (P = 0.872).

Conclusions

These measurements of passive duction forces in a healthy population provide valuable information for diagnosing specific strabismic problems and could be useful for increasing the precision of strabismus surgery.

Graphical abstract

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6

Similar content being viewed by others

Data availability

Raw data table

References

  1. Metz HS, Cohen GH (1984) Quantitative forced duction measurement. Am Orthop J 34:28–38

    Article  Google Scholar 

  2. Kushner BJ, Vrabec M (1987) Theoretical effects of surgery on length tension relationships in extraocular muscles. J Pediatr Ophthalmol Strabismus 24:126–131

    CAS  PubMed  Google Scholar 

  3. Vishwanath M, Ansons A (2009) Midoperative forced duction test as a guide to titrate the surgery for consecutive exotropia. Strabismus. 17:41–44

    Article  Google Scholar 

  4. Kim S, Yang HK, Hwang JM (2018) Surgical outcomes of unilateral recession and resection in intermittent exotropia according to forced duction test results. PLoS One 13:e0200741

    Article  Google Scholar 

  5. Jung JH, Holmes JM (2015) Quantitative intraoperative torsional forced duction test. Ophthalmology. 122:1932–1938

    Article  Google Scholar 

  6. Metz HS (1976) Forced duction, active force generation, and saccadic velocity tests. Int Ophthalmol Clin 16:47–73

    CAS  PubMed  Google Scholar 

  7. Scott AB, Collins CC, O’Meara DM (1972) A forceps to measure strabismus forces. Arch Ophthalmol 88:330–333

    Article  CAS  Google Scholar 

  8. Collins CC, O’Meara D, Scott AB (1975) Muscle tension during unrestrained human eye movements. J Physiol 245:351–369

    Article  CAS  Google Scholar 

  9. Collins CC, Carlson MR, Scott AB, Jampolsky A (1981) Extraocular muscle forces in normal human subjects. Invest Ophthalmol Vis Sci 20:652–664

    CAS  PubMed  Google Scholar 

  10. Lennerstrand G, Schiavi C, Tian S, Benassi M, Campos EC (2006) Isometric force measured in human horizontal eye muscles attached to or detached from the globe. Graefes Arch Clin Exp Ophthalmol 244:539–544

    Article  Google Scholar 

  11. Rosenbaum AL, Myer JH (1980) New instrument for the quantitative determination of passive forced traction. Ophthalmology. 87:158–163

    Article  CAS  Google Scholar 

  12. Bekerman I, Gottlieb P, Vaiman M (2014) Variations in eyeball diameters of the healthy adults. J Ophthalmol 2014:503645

    Article  Google Scholar 

  13. Lim HW, Lee DE, Lee JW, Kang MH, Seong M, Cho HY, Oh JE, Oh SY (2014) Clinical measurement of the angle of ocular movements in the nine cardinal positions of gaze. Ophthalmology. 121:870–876

    Article  Google Scholar 

  14. Stephens KF, Reinecke RD (1967) Quantitative forced duction. Trans Am Acad Ophthalmol Otolaryngo 71:324–329

    CAS  Google Scholar 

  15. Schillinger RJ (1966) The prevention of over-correction and under-correction in horizontal strabismus surgery. J Pediatr Ophthalmol Strabismus 3:38–41

    Google Scholar 

  16. Scott AB (1971) Extraocular muscle forces in strabismus. In: Bach-Y-Rita P, Collins CC, Hyde JE (eds) The Control of Eye Movements. Academic Press, New York, pp 327–342

    Chapter  Google Scholar 

  17. Gao Z, Guo H, Chen W (2014) Initial tension of the human extraocular muscles in the primary eye position. J Theor Biol 353:78–83

    Article  Google Scholar 

  18. Hertle RW, Granet DB, Zylan S (1993) The intraoperative oculocardiac reflex as a predictor of postoperative vaso-vagal responses during adjustable suture surgery. J Pediatr Ophthalmol Strabismus 30:306–311

    CAS  PubMed  Google Scholar 

  19. Sainsbury P, Gibson JB (1954) Symptoms of anxiety and tension and the accompanying physiological changes in the muscle system. J Neurol Neurosurg Psychiatry 17:216–224

    Article  CAS  Google Scholar 

  20. Rosenbaum AL, Santiago AP (1999) Clinical strabismus management: principles and surgical techniques. Saunders, Philadelphia, pp 39–41

    Google Scholar 

  21. Kallestad KM, Hebert SL, McDonald AA, Daniel ML, Cu SR, McLoon LK (2011) Sparing of extraocular muscle in aging and muscular dystrophies: a myogenic precursor cell hypothesis. Exp Cell Res 317:873–885

    Article  CAS  Google Scholar 

Download references

Funding

This work was supported by the Konkuk University Medical Center Research Grant 2017 (No. 201711). This sponsor had no role in the design or conduct of this research.

Author information

Authors and Affiliations

  1. Department of Mechatronics and Electronic Engineering, Konkuk University Glocal Campus, Chungcheongbuk-do, Republic of Korea

    Hyunkyoo Kang

  2. Department of Anatomy, Yonsei University College of Medicine, Seoul, Republic of Korea

    Shin-Hyo Lee

  3. Department of Ophthalmology, Research Institute of Medical Science, Konkuk University Medical Center, Konkuk University School of Medicine, 120 Neungdong-ro, Gwangjin-gu, Seoul, 05030, Republic of Korea

    Hyun Jin Shin

  4. Department of Ophthalmology, Blanton Eye Institute, Houston Methodist Hospital, Houston, TX, USA

    Hyun Jin Shin & Andrew G. Lee

  5. Department of Ophthalmology, Neurology, and Neurosurgery, Weill Cornell Medicine, New York, NY, USA

    Andrew G. Lee

  6. Department of Ophthalmology, University of Texas Medical Branch, Galveston, TX, USA

    Andrew G. Lee

  7. Department of Ophthalmology, UT MD Anderson Cancer Center, Houston, TX, USA

    Andrew G. Lee

  8. Department of Ophthalmology, Texas A&M College of Medicine, College Station, TX, USA

    Andrew G. Lee

  9. Department of Ophthalmology, University of Iowa Hospitals and Clinics, Iowa City, IA, USA

    Andrew G. Lee

  10. Department of Ophthalmology, Baylor College of Medicine and the Center for Space Medicine, Houston, TX, USA

    Andrew G. Lee

  11. Department of Ophthalmology, University of Buffalo, Buffalo, NY, USA

    Andrew G. Lee

Authors
  1. Hyunkyoo Kang
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Shin-Hyo Lee
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Hyun Jin Shin
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Andrew G. Lee
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

HK Kang developed instrument and analyzed the data. SH Lee designed the study and illustrated figures. HJ Shin designed the study, collected the data and wrote the manuscript. AG Lee revised the manuscript.

Corresponding author

Correspondence to Hyun Jin Shin.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Code availability

Not applicable

Ethics approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. The study protocol was approved by the Institutional Review Board (IRB) of Konkuk University Medical Center (registration number: KUH1100071).

Consent to participate

Informed consent was obtained from all individual participants included in the study.

Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Electronic supplementary material

ESM 1

(DOCX 25 kb)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Kang, H., Lee, SH., Shin, H.J. et al. New instrument for quantitative measurements of passive duction forces and its clinical implications. Graefes Arch Clin Exp Ophthalmol 258, 2841–2848 (2020). https://doi.org/10.1007/s00417-020-04848-9

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00417-020-04848-9

Keywords

Search

Navigation