1. The “images” as perceived by the patient are “incyclotorted” since the patients eyes themselves are “excyclotorted”?

    1. Yes. A good way to demonstrate this is the double Maddox rod test where you place a white Maddox rod lens before one eye and a red Maddox rod lens before the other eye in a set of trial frames and then hold a light source such as a penlight or muscle light in front of the patient in a dimly lit room. When they have superior oblique palsies, they perceive that one of the two horizontal lines created by the Maddox rod lenses is “tilted”. When you ask them to twist the lenses and align the lines in a parallel fashion, they turn the lens to an excyclotorted position and you record the degrees of excyclotorsion from the trial lens frame…usually 5 degrees or less for unilateral palsies and usually more than 10-15 degrees for bilateral palsies. The fact that they are turning the lens in an excyclorotation means that they are perceiving and incyclorotated image…they correct this by excyclorotating it to straight.

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