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Influence of eye dominance on objective and subjective excyclotorsion in unilateral superior oblique muscle palsy: objective cyclotorsion measured by fundus photography



To study the effect of eye dominance on excyclotorsion in unilateral superior oblique palsy (USOP).

Study design

Retrospective clinical study


Objective excyclotorsion was measured as the disc-to-fovea angle by fundus photography OU. Subjective excyclotorsion was determined with a major amblyoscope based on the difference in the earth vertical and subjective visual vertical. Eye dominance was determined by the hole-in-the-card method. A p-value ≤ 0.05 was considered statistically significant.


Data of 24 USOP patients were retrospectively collected. The diagnosis was mainly made by the Parks 3-step method, history and the presence of characteristic excyclotorsion. When possible, orbital magnetic resonance imaging findings were obtained.


The median angle of objective excyclotorsion in the paretic eyes was significantly larger than in the nonparetic eyes. Both median angles of objective/subjective excyclotorsion in the dominant eye were significantly smaller than those of the non-dominant eye. Patients were subdivided into two groups: group A, those whose paretic eye was the dominant eye (n = 13); group B, those whose paretic eye was the non-dominant eye (n = 11). The objective/subjective excyclotorsional angles of the paretic eye were significantly larger than of the non-paretic eye only in group B.


In USOP the angle of excyclotorsion in the dominant eye is smaller than in the non-dominant eye. This may imply that the vertical sense of visual space is mainly adapted to the dominant eye, keeping the subjective vertical close to the earth vertical.

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Professional medical English editing was provided by Brian Quinn, Editor-in-chief, Japan Medical Communication.

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Correspondence to Akihiko Oohira.

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Corresponding Author: Akihiko Oohira

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Oohira, A. Influence of eye dominance on objective and subjective excyclotorsion in unilateral superior oblique muscle palsy: objective cyclotorsion measured by fundus photography. Jpn J Ophthalmol 65, 644–650 (2021).

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  • Eye dominance
  • Excyclotorsion
  • Objective and subjective
  • Superior oblique palsy