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Measurement of Ocular Cyclotorsion in Superior Oblique Palsy Using a Single Maddox Rod

Almog, Yehoshua MD; Nemet, Arie Y. MD; Ton, Yokrat MD

doi: 10.1097/WNO.0000000000000148
Original Contribution

Background: To describe a modified technique to measure ocular cyclotorsion using only 1 Maddox rod and compare it with the traditional double Maddox rod test (DMR).

Methods: Ocular cyclotorsion was prospectively measured in 48 consecutive patients with superior oblique palsy. Four measurements were taken; 2 using 2 Maddox rods: (A) a red rod in front of the affected eye and a white rod in front of the fellow eye and (B) red rod in front of the sound eye and red in front of the affected eye. Two additional sets of measurements were taken using 1 red Maddox rod in front of 1 eye only, where horizontal lines in the room served as a reference: (C) the red rod in front of the affected eye and (D) the red rod in front of the sound eye.

Results: Mean ocular cyclotorsion in 48 patients was 6.7°, 6.8°, 6.6°, and 6.1° in measures A, B, C, and D, respectively. The agreement between A and C did not differ statistically, whereas the agreement between B and D was statistically different (P < 0.0001). There was high repeatability in both comparisons.

Conclusions: Ocular cyclotorsion may be measured using a single Maddox rod instead of two. It is simpler to conduct than the DMR.

Department of Ophthalmology, Meir Medical Center and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.

Address correspondence to Arie Y. Nemet, MD, Meir Medical Center, 59 Tchernichovsky Street, Kfar Saba 44281, Israel; E-mail:

Presented at the North American Neuro-ophthalmology Society meeting, February 25-March 2, 2006, Tucson, AZ.

The authors report no conflicts of interest.

© 2014 by North American Neuro-Ophthalmology Society