In this issue of Archives, Parulekar et al1 document the resolution of ocular torsion and skew deviation when patients are examined in the reclined position. While some of its methodology may strike the general reader as abstruse and academic, this study is original, clever, and innovative in its clinical application.
Until recently, ophthalmologists and neurologists lacked a mechanistic understanding of skew deviation. The term was generally used to describe a comitant vertical deviation that signified major injury to posterior fossa structures.2,3 Skew deviation differed from other forms of vertical diplopia in that its size generally remained the same in different positions of gaze, it was unassociated with a primary or secondary deviation, and it did not change with head tilt.4 As such, it was considered a diagnosis of exclusion that was confined to neurologic patients.
Brodsky MC. Vertical StrabismusDiagnosis From the Ground Up. Arch Ophthalmol. 2008;126(7):992-993. doi:10.1001/archopht.126.7.992