Ocular Tilt Reaction

ABSTRACT

PURPOSE: To report the clinical manifestations of patients with ocular tilt reaction (OTR) and the differential point from other disorders with abnormal head posture. METHODS: The clinical manifestations of four patients who complained of abnormal head posture and diplopia and who were diagnosed to have OTR from January, 2001 to January, 2002 were investigated. The diagnoses were made with alternate cover test, duction and version test, Lancaster test, Bielschowsky head tilt test, fundus photography, and brain MRI. RESULTS: All the four patients showed ipsilateral head tilt, ocular torsion, and vertical deviation. Type of their OTR was tonic OTR. Subjective tilting of visual vertical was observed in one patient. Only with the 3-step test, OTR could be misdiagnosed as an extraocular muscle palsy. The most important sign in differentiation from other disorders of abnormal head posture was ocular torsion. Duction and version examination and tilt of subjective visual vertical were also helpful for the differentiation. CONCLUSIONS: OTR should be considered in patients with ocular torsion, vertical deviation and ipsilateral head tilt. In patients with diplopia and head tilt, examination of ocular torsion should be performed with the 3-step test in order not to make a misdiagnosis of extraocular muscle palsy.