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    By David A. Plager, MD
    Subspecialty Day 2012: Pediatric Ophthalmology
    Pediatric Ophth/Strabismus

    Dr. David A. Plager learned his lesson about the importance of measuring torsion when a 36-year-old male presented to him with a 10-year history of diplopia and 5 degrees of excyclotorsion. After performing a 4.5 mm left superior rectus recession with a spacer in the right superior oblique, the patient had 10 degrees of excyclotorsion. Dr. Plager describes additional surgeries required to improve outcomes. His take-home message: Make sure you measure torsion, and after you measure it, don’t ignore it. In a bifixating patient, torsion trumps all.