Skew deviation

Skew  deviation is  vertical misalignment  in which the eyes move in  opposite directions equally, an acquired hypertropia secondary to sensory  imbalance of graviceptive pathways that run from utricle and semicircular  canals to supranuclear centers  (interstitial nucleus of Cajal [INC] and the  rostral interstitial nucleus of  the medial longitudinal fasciculus [riMLF]) crossing at the pontine level. By convention, higher eye  and term  hypertropia are always used as a reference  regardless  of  affected side:  such as on denoted above face picture left eye is higher, thus  – left  hypertropia,  not right hypotropia. Skew deviation may be associated with  head tilt and ocular torsion, together representing an ocular tilt reaction  (OTR).