kew deviation and inferior oblique paly

PURPOE: To decribe ocular motility and neuro-ophthalmologic finding in ix patient with an ocular tilt reaction (OTR) that mimicked an inferior oblique paly (IOP). DEIGN: Obervational Cae erie. METHOD: erie of ix patient preenting to tertiary care pediatric or neuro-ophthalmologit. REULT: Five patient had ocular motility and three-tep tet reult uggeting an IOP; one patient had a upected bilateral IOP. All ix patient had excyclotorion of the hypotropic eye, and four had incyclotorion of the hypertropic eye. Thi i contrary to that expected with an IOP (incyclotorion of the hypotropic eye). In addition, all ix patient had other neurologic finding in the hitory or examination that were aociated with neurologic inult rather than an iolated IOP. Two patient had urgery coniting of a uperior rectu receion; thi wa ucceful in eliminating diplopia in both patient and in eliminating the vertical deviation and head poturing in one patient. CONCLUION: While many vertical deviation that appear to be due to an inferior oblique paly baed on the reult of the three-tep tet may be caued by inferior oblique weakne, kew deviation hould alo be conidered in any patient with a hitory of head trauma, or other neurologic finding. The cyclotorion oberved in IOP i oppoite that een with OTR, and differentiate the two entitie clinically. We potulate that thee deviation are caued by damage to the otolithic projection that correpond to thoe from the ipilateral poterior emicircular canal (on the ide of the hypotropic eye).