Skew deviation is an acquired common vertical strabismus. The clinical manifestation includes head tilt， eye rotation and subjective vertical visual tilt. In these patients， the subjective visual world tilts in the vertical direction. In order to restore vertical positioning， the eyes and head rotate in the direction of the subjective visual world. The etiology of this disease is an injury to the vestibular-ocular reflex pathway. This article reviews the etiology， clinical manifestations and clinical types of skew deviation， and differentiates it from superior oblique palsy. The objective of this paper is to increase awareness of skew deviation among ophthalmic clinicians and to avoid a misdiagnosis of superior oblique palsy or ignore possible lesions in the utricular otolith or central nervous system.
Pansell T， Schworm HD， Ygge J. Torsional and vertical eye movements during head tilt dynamic characteristics[J]. Invest Ophthalmol Vis Sci，2003，44（7）：2986-2990.
[3]
Wong AM， Sharpe JA. Cerebellar skew deviation and the torsional vestibuloocular reflex[J]. Neurology，2005，65（3）：412-419.
[4]
Yoshikawa A， Hirata Y. Mechanism of frequency selectivity in VOR motor learning： frequency channel or waveform learning?[J]. Conf Proc IEEE Eng Med Biol Soc，2006，1：6217-6220.
[5]
Dieterich M. Central vestibular disorders[J]. J Neurol，2007，254（5）：559-568.
[6]
Brodsky MC. Three dimensions of skew deviation[J]. Br J Ophthalmol，2003，87（12）：1440-1441.
[7]
Vaphiades MS. The ocular tilt reaction[J]. Am Orthopt J，2003， 53：127-132.
[8]
Baier B， Bense S， Dieterich M. Are signs of ocular tilt reaction in patients with cerebellar lesions mediated by the dentate nucleus?[J]. Brain，2008，131（Pt 6）：1445-1454.
[9]
Colen CB， Ketko A， George E， et al. Periodic alternating nystagmus and periodic alternating skew deviation in spinocerebellar ataxia type 6[J]. J Neuroophthalmol，2008，28（4）：287-288.
[10]
Radtke A， Bronstein AM， Gresty MA， et al. Paroxysmal alternating skew deviation and nystagmus after partial destruction of the uvula[J]. J Neurol Neurosurg Psychiatry，2001，70（6）：790-793.
[11]
Hoyt CS， Mousel DK， Weber AA. Transient supranuclear disturbances of gaze in healthy neonates[J]. Am J Ophthalmol， 1980，89（5）：708-713.
[12]
Wong AM， Colpa L， Chandrakumar M. Ability of an upright-supine test to differentiate skew deviation from other vertical strabismus causes[J]. Arch Ophthalmol，2011，129（12）：1570-1575.
浙公网安备 33030202001892号