Occasionally other ocular disturbances will occur such as vertical double vision - skew deviation.

The exact pathophysiology of skew deviation remains incompletely understood.

There are three types of skew deviations:

Skew deviation is usually characterized by torticollis (head tilting) and binocular torsion.

Skew deviation is an unusual ocular deviation (strabismus), wherein the eyes move upward (hypertropia), but in opposite directions.

Skew deviation is caused by abnormal prenuclear vestibular input to the ocular motor nuclei, most commonly due to brainstem or cerebellar stroke.

The incidence of Justo Major Pelvis is not found to be a strictly standard deviation type variation as it follows a tail skewed deviation to the right.

Skew deviation appears to be a perturbation of the ocular tilt reaction, which is itself probably a vestigial righting response used to keep fish and other lateral-eyed animals properly oriented.

Paralysis or paresis of vertical eye movement, skew deviation, sluggish pupillary responses to light, slight miosis and ptosis (retraction nystagmus and "tucking" of the eyelids may be associated): Supranuclear fibers to third nerve, interstitial nucleus of Cajal, nucleus of Darkschewitsch, and posterior commissure.