Skew deviation: clinical outcomes and prognostic factors in a case series

Skew deviation is an acquired vertical strabismus of supranuclear origin associated with abnormalities of the central vestibulo-ocular pathways. Although many cases resolve spontaneously, some develop persistent diplopia that requires surgical treatment. The objective was to analyze the clinical outcomes and potential prognostic factors in patients with skew deviation.

A retrospective observational study of a series of patients diagnosed with skew deviation treated at a tertiary care center. Demographic variables, etiology, presence of nystagmus, treatment administered, and final outcome were analyzed. A good outcome following treatment was defined as the disappearance or significant improvement of diplopia.

The predominant etiology was vascular (60%), with a clinical presentation characterized by the triad of vertical deviation, nystagmus (100%), and ocular torsion (60%). The deviation was predominantly non-comitant (80%) and showed significant reduction with a change in posture from sitting to supine. Treatment was heterogeneous, with a predominance of strabismus surgery. The outcome was satisfactory in 37.5% of cases, with persistent nystagmus being the main cause of functional failure. Factors that tended to be associated with a good outcome were younger age, male sex, and non-vascular etiology.

Skew deviation exhibits a heterogeneous clinical course. Treatment was largely ineffective. A younger age may be associated with a better prognosis, while the presence of nystagmus may act as a negative prognostic factor. Studies with larger sample sizes are needed. Clinical variability and neurological etiology necessitate individualized surgical planning.