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The Ocular Tilt Reaction

Correspondence: Requests for reprints should be addressed to: Michael S. Vaphiades, D.O., UAB Dept. of Ophthalmology, 700 S. 18th Street, Suite 601, Birmingham, AL 35233.

A patient with ocular motility findings consistent with a right superior oblique palsy was found to have binocular ocular torsion and a head tilt that led to the diagnosis of an ocular tilt reaction. Magnetic resonance imaging disclosed a right pontine lesion presumably involving the descending tract from the interstitial nucleus of Cajal to the contralateral vestibular nucleus. This lesion is located more inferiorly than one would expect in a superior oblique palsy. Physicians should be aware that patients with a vertical deviation and a head tilt might have an ocular tilt reaction, as opposed to a superior oblique palsy.

Key words: ocular tilt reaction, superior oblique palsy, skew deviation