[Clinical manifestations and treatment of Skew deviation]

Skew deviation is a vertical strabismus caused by supranuclear lesions. It is often associated with ocular torsion and head tilt, which together constitute the ocular tilt reaction. Skew deviation can result from any injury within the posterior fossa, and is often the initial manifestation of diseases that affect the brainstem, cerebellum, or peripheral vestibular system. Clinical subtypes include comitant, nonconcomitant, paroxysmal (intermittent), periodic or slowly alternating, lateral alternating and transient neonatal skew deviation. It should be differentiated from superior oblique muscle palsy, inferior oblique muscle palsy and primary oblique muscle overaction. Most skew deviations are transient and spontaneous recovery. Prisms, botulinum toxin, and vertical rectus muscle recession have all been used for vertical diplopia secondary to persistent skew deviation.