[Alternating oblique deviation of the gaze. 3 cases]

Area of Science:

• Ophthalmology
• Neurology
• Neuroscience

Background:

• Alternating skew deviation is an uncommon ocular motility disorder characterized by vertical misalignment of the eyes.
• Understanding its underlying pathophysiology is crucial for accurate diagnosis and management.

Observation:

• Three cases of alternating skew deviation were analyzed.
• Two cases presented with oculomotor disorders indicative of medial mesencephalic lesions.
• The third case was associated with tuberculous meningo-encephalitis.

Findings:

• Computed tomography (CT) scans revealed abnormalities of the third ventricle in patients with mesencephalic involvement.
• Pathophysiological mechanisms likely involve bilateral superior recti muscle disorders and inferior oblique muscle overaction.
• These findings suggest a medial supranuclear dysfunction.

Implications:

• This study highlights the association between alternating skew deviation and medial mesencephalic lesions.
• It provides insights into the neuroanatomical basis of vertical interocular divergence.
• Further research into supranuclear gaze control is warranted.