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Skew Deviation

Correspondence: Requests for reprints should be addressed to: Sean P. Donahue, M.D., Ph.D., Vanderbilt Eye Center, Vanderbilt University Medical Center, 8000 Medical Center East, Nashville, TN 37232.

Introduction: Skew deviation is a vertical ocular misalignment that can be confused with oblique muscle palsies. Current knowledge now allows some understanding of the pathophysiology of this disorder.

Methods: Review of current literature.

Results: Patients with skew deviation have a hypertropia, a head tilt, and ocular torsion of one or both eyes. The torsion and head tilt are toward the hypotropic eye. Skew is caused by lesions of the prenuclear pathways that come from the vestibular system and project to the vertical extraocular muscle nuclei. Careful observation of ocular torsion may be the only way to distinguish patients having oblique palsy from those with skew.

Conclusion: New insights about the mechanisms responsible for skew deviation allow us to better characterize and treat this rare disorder of ocular motility.

Key words: skew deviation, torsion, head tilt