Like A pattern and V pattern deviations, vertical deviations are also typically caused by anomalies in the pattern of nerve supply to the rectus and oblique muscles. Vertical deviations are usually associated with esotropia or exotropia, for example in infantile strabismus. Primary oblique muscle dysfunction and dissociated vertical deviation are common in this setting.
Primary oblique muscle dysfunction is characterized by upward vertical deviation of the adducting eye during horizontal eye movements.
Dissociated vertical deviation is alternating upward deviation of the eyes. The respective non-fixating eye or the eye occluded in the cover test will be elevated.
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