A 4-year-old girl who underwent surgery for infantile esotropia at age 1 year now shows slow upward drift of whichever eye is covered, and the drifting eye returns to primary position without any corrective downward movement of the other eye. No true hypertropia is measurable, and the updrift increases when she is tired. What is the diagnosis?

• A Inferior oblique overaction
• B Dissociated vertical deviation ✓
• C Congenital superior oblique palsy
• D Alternating sursumduction with Skew deviation

Explanation

Dissociated vertical deviation is characterised by slow, dissociated elevation of either eye behind the cover, with the uncovered eye remaining stationary instead of making a secondary downward refixation movement. This absence of hypotropia of the fixating eye is the feature that separates DVD from inferior oblique overaction, in which covering the fixing eye produces elevation of the fellow eye accompanied by depression of the newly fixing eye. DVD is strongly associated with infantile esotropia and is treated, if needed, with large superior rectus recession.

Reference: Parsons' Diseases of the Eye, 23rd ed.

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Written and medically reviewed by the StethoPrep medical team.