Ocular Title Reaction Caused by a Polycytic Astrocytoma: A Case Report

Thong Le, BOrth&OphthSc(Hons)
Department of Clinical Vision Sciences, La Trobe University, Melbourne, Australia

An ocular tilt reaction consists of a vertical misalignment of the eyes (skew deviation), a head tilt and conjugate ocular torsion in the direction of the hypotropic eye. Ocular tilt reaction, however, may be mistaken for a superior oblique palsy due to the similarities in clinical findings of the two conditions. They both display similar vertical deviations and head tilts on presentation. In order to differentiate between the two conditions torsion needs to be assessed and measured. An ocular tilt reaction will display paradoxical conjugate torsion unlike a superior oblique palsy. This paper describes a case of a patient with an ocular tilt reaction that was initially thought to be a superior oblique palsy. An MRI scan revealed a polycystic astrocytoma in the midbrain region consistent with reports in the literature associating midbrain lesions and an ocular tilt reaction. Although rare, an ocular tilt reaction should never be ruled out until torsion is measured in patients presenting with a vertical deviation and head tilt.