Dissociated vertical deviation (DVD): The saccadic and slow eye movements

Dissociated vertical deviation (DVD), a vertical strabismus, is often associated with infantile esotropia, latent nystagmus and excyclo-torsion. DVD usually becomes apparent at about three years of age. The authors wished to determine whether DVD is a manifestation of an abnormal motor vergence system or is part of a visual system disorder. Vertical eye movements of six subjects with DVD, on cover-uncover and alternate cover tests, were studied using the magnetic search eye coil system. Asymmetry between the eyes' saccades were quantified during the DVD upward movement and during a trial of pure vertical saccades. In three subjects the vertical deviation increased to its full amount through a smooth vertical divergence movement, and in the other three patients through a combination of smooth and asymmetrical saccade-like movements. The latencies of the DVD, the peak velocity of the deviation movements, its time constant and the asymmetries in the saccades suggest that DVD represents an abnormal vertical vergence system.