This Article  • Full text  • PDF  • Reply to article  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citation map  • Citing articles on HighWire  • Citing articles on ISI (10)  • Contact me when this article is cited  Related Content  • Similar articles in this journal  Topic Collections  • Strabismus  • Ophthalmological Disorders, Other  • Alert me on articles by topic

The Brain Throws a Wild Pitch

Michael C. Brodsky, MD; Sean P. Donahue, MD, PhD

Arch Ophthalmol. 2001;119:1307-1314.

Background  Sensorimotor and orbital anatomical mechanisms have been invoked to explain primary oblique muscle overaction.

Methods  Review of primitive visuo-vestibular reflexes and neuroanatomical pathways corresponding to vestibulo-ocular reflexes, and correlation with known clinical abnormalities in patients with primary oblique muscle overaction.

Results  Bilateral superior oblique muscle overaction, which corresponds to a backward pitch in lateral-eyed animals, can occur when structural lesions involving the brainstem or cerebellum increase central otolithic input to the extraocular muscle subnuclei that modulate downward extraocular muscle tonus. Bilateral inferior oblique overaction, which corresponds to a forward pitch in lateral-eyed animals, may result from visual disinhibition of central vestibular pathways to the extraocular muscle subnuclei that modulate upward extraocular muscle tonus.

Conclusions  Primary oblique muscle overaction recapitulates the torsional eye movements that occur in lateral-eyed animals during body movements or directional luminance shifts in the pitch plane. These primitive ocular motor reflexes become manifest in humans when early-onset strabismus or structural lesions within the posterior fossa alter central vestibular tone in the pitch plane.

From the Departments of Ophthalmology and Pediatrics, University of Arkansas for Medical Sciences, Little Rock (Dr Brodsky); and the Departments of Ophthalmology and Visual Sciences, Pediatrics, and Neurology, Vanderbilt University School of Medicine, Nashville, Tenn (Dr Donahue).

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

Dissociated Horizontal Deviation After Surgery for Infantile Esotropia: Clinical Characteristics and Proposed Pathophysiologic Mechanisms
Brodsky and Fray
Arch Ophthalmol 2007;125:1683-1692.
ABSTRACT | FULL TEXT  

Acute Superior Oblique Palsy in Monkeys: I. Changes in Static Eye Alignment
Shan et al.
IOVS 2007;48:2602-2611.
ABSTRACT | FULL TEXT  

Multiple mechanisms of extraocular muscle "overaction".
Kushner
Arch Ophthalmol 2006;124:680-688.
ABSTRACT | FULL TEXT  

Visuo-Vestibular Eye Movements: Infantile Strabismus in 3 Dimensions
Brodsky
Arch Ophthalmol 2005;123:837-842.
ABSTRACT | FULL TEXT  

Latent Nystagmus: Vestibular Nystagmus With a Twist
Brodsky and Tusa
Arch Ophthalmol 2004;122:202-209.
ABSTRACT | FULL TEXT  

Cyclic esotropia and the treatment of over-elevation in adduction and V-pattern
Pott et al.
Br. J. Ophthalmol. 2004;88:66-68.
ABSTRACT | FULL TEXT  

Three dimensions of skew deviation
Brodsky
Br. J. Ophthalmol. 2003;87:1440-1441.
FULL TEXT  

Do You Really Need Your Oblique Muscles?: Adaptations and Exaptations
Brodsky
Arch Ophthalmol 2002;120:820-828.
ABSTRACT | FULL TEXT