Spontaneous Resolution of Ocular Tilt Reaction

Abstract

A 30-year-old man presented to the ophthalmologic clinic with sudden onset of vertical and torsional diplopia. Concomitant skew deviation with right hypertropia was observed. Funduscopy revealed that the fovea was located above the lower edge of the optic disc in the right eye; incyclotorsion was present. Conversely, the fovea was located below the lower edge of the optic disc in the left eye; excyclotorsion was present. He was diagnosed to have ocular tilt reaction (OTR). Neurological examination was unremarkable. Cranial magnetic resonance imaging demonstrated no abnormalities and no evidence of acute ischemia, demyelination, or vestibular nerve abnormality. The patient was followed without any treatment. One month later, his diplopia had disappeared. Incyclotorsion in the right eye and excyclotorsion in the left eye were also improved. Torsional deviation is difficult to detect with a standard eye exam. A fundus photograph is useful for diagnosis in such cases if it can be obtained.