A 7-year-old girl is found to have upward drift of the left eye during routine examination. When the right eye is covered, the left eye comes down to take up fixation and the newly uncovered right eye drifts upward. The elevation is greater after prolonged occlusion, and there is no true hypotropia of the fellow eye. What is the diagnosis?
- A Inferior oblique overaction
- B Dissociated vertical deviation ✓
- C Double elevator palsy
- D Skew deviation
Correct answer: B. Dissociated vertical deviation
Explanation
DVD is a dissociated, usually bilateral, upward movement of either eye when fixation is blocked, classically elicited by covering one eye. Its hallmarks are that it worsens with prolonged dissociation, does not obey the three-step test pattern, and the fellow eye shows no true hypotropia because the same phenomenon would occur if it were covered. Inferior oblique overaction is gaze dependent, greatest in adduction, and produces a true contralateral hypotropia on cover testing.
Reference: Kanski's Clinical Ophthalmology, 9th ed.
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