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Skew deviation

AI overview

Skew deviation is an unusual ocular deviation (strabismus), wherein the eyes move upward (hypertropia) in opposite directions.

Key points
  • Caused by abnormal prenuclear vestibular input to the ocular motor nuclei
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    Skew deviation is caused by abnormal prenuclear vestibular input to the ocular motor nuclei
  • Most commonly due to brainstem or cerebellar stroke
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    most commonly due to brainstem or cerebellar stroke
  • Other causes include multiple sclerosis and head trauma
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    Other causes include multiple sclerosis and head trauma
  • Pathophysiology remains incompletely understood
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    The exact pathophysiology of skew deviation remains incompletely understood
  • Appears to be a perturbation of the ocular tilt reaction
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    Skew deviation appears to be a perturbation of the ocular tilt reaction
Symptoms
  • Usually characterized by torticollis (head tilting)
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    Skew deviation is usually characterized by torticollis (head tilting)
  • Associated with binocular torsion
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    and binocular torsion
  • Type 1 includes sound-induced vestibular symptoms and counterclockwise rotary upward rotation of both eyes
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    sound-induced vestibular symptoms; both eyes show counterclockwise rotary upward rotation
  • Type 2 includes excyclotropia in the ipsilateral eye and hypertropia in the contralateral eye
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    excyclotropia in the ipsilateral eye; hypertropia in the contralateral eye
  • Type 3 includes simultaneous hypertropia in one eye and hypotropia in the other
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    Simultaneous hypertropia one eye and hypotropia in the other eye
Diagnosis
  • Type 1: Upward deviation of both eyes
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    Type 1: Upward deviation of both eyes
  • Type 2: Hypertropia in one eye associated with dorsolateral medullary infarctions
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    Type 2: Hypertropia in one eye; dorsolateral medullary infarctions
  • Type 3: Associated with upper brainstem lesion
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    Type 3: Simultaneous hypertropia one eye and hypotropia in the other eye; upper brainstem lesion
AI-synthesized from the Wikipedia article “Skew deviation”. Not medical advice. Verify source →

Skew deviation is an unusual ocular deviation (strabismus), wherein the eyes move upward (hypertropia) in opposite directions. Skew deviation is caused by abnormal vestibular input to the , most commonly due to brainstem or cerebellar stroke. Other causes include multiple sclerosis and head trauma. Skew deviation is usually characterized by torticollis (head tilting) and binocular torsion. The exact pathophysiology of skew deviation remains incompletely understood. Skew deviation appears to be a perturbation of the ocular tilt reaction, which is itself is most likely a vestigial righting response used to keep fish and other lateral-eyed animals properly oriented.[1]

There are three types of skew deviations:[2]

Type 1: Upward deviation of both eyes; sound-induced vestibular symptoms; both eyes show counterclockwise rotary upward rotation

Type 2: Hypertropia in one eye; dorsolateral medullary infarctions; excyclotropia in the ipsilateral eye; hypertropia in the contralateral eye

Type 3: Simultaneous hypertropia one eye and hypotropia in the other eye; upper brainstem lesion

  1. ↑ Brodsky, Michael C.; Donahue, Sean P.; Vaphiades, Michael; Brandt, Thomas (March 1, 2006). "Skew Deviation Revisited". Survey of Ophthalmology. 51 (2): 105–128. doi:10.1016/j.survophthal.2005.12.008. PMID 16500212.
  2. ↑ Brandt, T.H.; Dieterich, M. (1991). "Different types of skew deviation". Journal of Neurology, Neurosurgery, and Psychiatry. 54 (6): 549–550. doi:10.1136/jnnp.54.6.549. PMC 488598. PMID 1880519.