The Ocular Tilt Reaction and Skew Deviation

The ocular tilt reaction composes a triad of ipsilateral head-tilt, ipsilateral conjugate ocular torsion, and skew deviation with ipsilateral hypotropia. It results from a disruption of central vestibular pathways conveying information from the semicircular canals and otoliths. Skew deviation is one component of the syndrome which may or may not be associated with the concomitant torsion and head-tilt of the ocular tilt reaction. Because of the frequent clinical presentation of skew deviation it merits special attention.