[Skew deviation. Strabismological diagnosis and treatment alternatives].

BACKGROUND We undertook this study to analyze diagnostic and treatment alternatives in patients with skew deviation (SD). METHODS This is a prospective, observational and longitudinal study of patients with SD. The study took place in a third-level medical center during the period from September 2007 to May 2008. Strabismological exploration, multidisciplinary diagnosis and treatment alternatives were analyzed. RESULTS Ten patients presenting SD were studied. Diagnoses were multiple sclerosis, arteriovenous malformation, epilepsy, hydrocephalus, ischemic encephalopathy, cortical atrophy, hypoplasia of corpus callosum and thalamic hemorrhage. Psychomotor retardation was present in 80%. Other diagnoses were Cogan apraxia, Parinaud syndrome, see-saw nystagmus, Foville syndrome, and hemiplegic alterations. Related strabismuses were exotropia (5), esotropia (3), hypertropia (2), and dissociated vertical deviation (1). Lesions of II, III and VII cranial nerves were found. CONCLUSIONS Complete strabological study allows a better diagnosis of the lesion and consequently relapsing disease in order to achieve a better treatment according to each patient. Optical rehabilitation and botulinum applications are especially indicated.