Skew Deviation

Aka: Skew Deviation, Vertical Ocular Misalignment, Vertical Heterotropia, Vertical Strabismus, Vertical Squint, Hypertropia, Hypotropia, Test of Skew

II. Definitions

  1. Skew Deviation (Vertical Ocular Misalignment, Vertical Strabismus, Vertical Heterotropia or Vertical Squint)
    1. Eye gaze deviation due to abnormal vestibular system inputs
      1. Typically from a posterior circulation Cerebrovascular Accident (Cerebellar CVA or Brainstem CVA)
    2. One eye may be directed forward normally, while the the other is directed either up (Hypertropia) or down (Hypotropia)

III. Exam

  1. Perform as with Alternate Eye Cover Test (used to evaluate for horizontal Strabismus in children)
  2. Alternately cover one eye and then the other
  3. Observe for quick vertical gaze corrections (abnormal)
    1. Uncovered eye shifts to center from its abnormal, vertically displaced position

IV. Interpretation

  1. Abnormal skew test with quick vertical gaze corrections suggests a central cause (e.g. Brainstem CVA) of Acute Vestibular Syndrome

V. Associated Conditions

  1. Head Tilt
    1. Often accompanies Skew Deviation

VI. References

  1. Kattah (2009) Stroke 40: 3504-10 [PubMed]

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Related Studies

Ontology: Hypertropia (C0020575)

Definition (NCI) Vertical strabismus in which there is permanent upward deviation of the visual axis of one eye.
Concepts Disease or Syndrome (T047)
MSH D013285
ICD9 378.31
ICD10 H50.2
SnomedCT 194109005, 40608009
English Hypertropias, Unspecified hypertropia, hypertropia (diagnosis), hypertropia, nonparalytic hypertropia, Unspecified hypertropia (disorder), Hypertropia (disorder), Hypertropia
Dutch hypertropie, Hypertropie
Spanish Hipertropía, Hipertropia, hipertropía no especificada (trastorno), hipertropía no especificada, hipertropía (trastorno), hipertropía
Japanese 上斜視, ｼﾞｮｳｼｬｼ
Portuguese Hipertropia
French Hypertropie
German Hypertropie, Fixation nach oben
Czech Hypertropie, hypertropie
Hungarian Hypertropia
Italian Ipertropia
Norwegian Hypertropi
Derived from the NIH UMLS (Unified Medical Language System)

Ontology: Hypotropia (C0152208)

Definition (NCI) Vertical strabismus in which there is permanent downward deviation of the visual axis of one eye.
Concepts Disease or Syndrome (T047)
ICD9 378.32
SnomedCT 29491004
English hyop - Hypotropia, hypotropia (diagnosis), hypotropia, deviation downward eye, downward deviation of eyes, Downward deviation of eyes, Hypotropia, Hypotropia (disorder), Downward Ocular Deviation, Sunset Sign
Dutch neerwaartse afwijking van de ogen, hypotropie
French Hypotropie, Déviation du regard vers le bas
German Hypotropie, nach unten gerichtete Abweichung der Augen
Italian Ipotropia, Deviazione degli occhi verso il basso
Portuguese Hipotropia, Desvio dos olhos para baixo
Spanish Hipotropía, Desviación hacia abajo de los ojos, hipotropía (trastorno), hipotropía
Japanese 下斜視, 眼の下方偏位, ｶｼｬｼ, ﾒﾉｶﾎｳﾍﾝｲ
Czech Deviace očního bulbu dolů, Hypotropie
Hungarian Hypotropia, Szemek lefele irányuló deviatiója
Derived from the NIH UMLS (Unified Medical Language System)

Ontology: Manifest vertical squint (C0271364)

Concepts Disease or Syndrome (T047)
ICD10 H50.2
SnomedCT 111530003, 246731005
German Strabismus verticalis
Korean 수직 사시
English Manifest vertical squint (finding), Vertical strabismus, Manifest vertical squint, Manifest vertical squint (disorder), heterotropia; vertical, strabismus; vertical, vertical; heterotropia, vertical; strabismus, Vertical heterotropia, NOS, Vertical heterotropia
Dutch heterotropie; verticaal, strabismus; verticaal, verticaal; heterotropie, verticaal; strabismus, Verticaal strabismus
Spanish estrabismo vertical, heterotropía vertical (trastorno), heterotropía vertical
Derived from the NIH UMLS (Unified Medical Language System)

Ontology: Skew Deviation (C0271381)

Concepts Finding (T033)
MSH D015835
SnomedCT 40631009
Portuguese Desvio Oblíquo
Spanish Desviación Oblicua, desviación oblicua (trastorno), desviación oblicua
French Phénomène de Hertwig-Magendie, Syndrome de Hertwig-Magendie, Disjonction des mouvements du regard, Stéréodéviation
German Magendie-Hertwieg-Schielstellung
English skew deviation (physical finding), skew deviation, skew deviation was seen, Deviation, Skew, Deviations, Skew, Skew Deviations, Skew deviation, Skew deviation (disorder), deviation; skew deviation, Skew Deviation
Czech šikmá deviace bulbů
Norwegian Vertikal blikkdeviasjon
Italian Deviazione obliqua
Dutch deviatie; skew deviation
Derived from the NIH UMLS (Unified Medical Language System)

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