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Causes of vertical strabismus in children

David K Coats, MD
Evelyn A Paysse, MD
Section Editor
Richard A Saunders, MD
Deputy Editor
Carrie Armsby, MD, MPH


Strabismus is the term used to describe an anomaly of ocular alignment. Ocular misalignment can involve one or both eyes and can occur in any direction; it can be congenital or acquired, latent or manifest, constant or intermittent, and fixed or variable depending upon the position of gaze. (See "Evaluation and management of strabismus in children", section on 'Terminology'.)

The causes of strabismus can be classified according to the direction of deviation: inward toward the nose (esodeviations), outward (exodeviations), upward (hyperdeviations), or downward (hypodeviations) (figure 1). (See "Evaluation and management of strabismus in children", section on 'Terminology'.)

Vertical strabismus usually is caused by weakness or restriction of one of the eight extraocular muscles involved in vertical eye positioning (table 1). The two medial and two lateral rectus muscles do not contribute significantly to normal vertical ocular alignment and movement.

The causes of vertical strabismus are reviewed here. The evaluation of strabismus and the causes of horizontal strabismus are discussed separately. (See "Evaluation and management of strabismus in children" and "Causes of horizontal strabismus in children".)


Although the cyclovertical muscles also have secondary functions, three pairs of extraocular muscles move each eye in three primary directions: vertically (superior and inferior), horizontally (medial [adduction] and lateral [abduction]), and torsionally (intorsion, when the superior part of the eye rotates nasally around its visual axis, and extorsion, when the superior part of the eye rotates temporally around its visual axis). The superior oblique muscle is innervated by cranial nerve IV, the lateral rectus muscle by cranial nerve VI, and all others by cranial nerve III (table 1).

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Literature review current through: Oct 2017. | This topic last updated: Aug 15, 2017.
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