Skew Deviation

ABSTRACT

Ocular skew deviation is an acute vertical misalignment resulting from the disruption of vestibular input to the interstitial nucleus of Cajal, involving the utriculo-ocular pathway, the cerebellum or the thalamus. A large percentage of skew cases associated with globe torsion and head tilt have complex or sinister etiologies, necessitating its differentiation from more common causes of acute onset vertical deviation in a sensitive and cost-efficient manner.

This paper briefly reviews the anatomy and vestibular function of the inner ear, outlines the utriculo-ocular pathway, and discusses the things you need to know about skew to aid in clinical oculo-motor practice in 2022.

KEYWORDS:

• Skew
• ocular tilt reaction
• vertical strabismus
• supranuclear strabismus

Disclosure statement

No potential conflict of interest was reported by the author(s).

Notes

^a Rotational movement – the head turns around the horizontal, vertical or anterior-posterior axis. Translational movement – the head does not turn or rotate, but moves horizontally or vertically from point A to point B.