Vertical Deviations Secondary to Supranuclear Origins

A vertical deviation is a relatively common finding in a pediatric ophthalmology and adult strabismus practice. Fortunately, vertical deviations secondary to supranuclear entities occur somewhat less frequently, given the neuro- logical implications associated with many of them. Because of the lower incidence of supranuclear vertical deviations, they can easily be overlooked or misdiagnosed if special care is not taken in its evaluation. The purpose of this paper is to assist the clinician in recognizing vertical deviations specific to supranuclear disorders, the associated findings, and the diagnostic tools geared toward them.