eng Science and Education Publishing Neuro Ophthalmology & Visual Neuroscience 2572-7281 2022-03-20 7 1 1 4 10.12691/novn-7-1-1 NOVN2022711 article Anupama Janardhanan 1 Shashikant Shetty uniqanu91@gmail.com 2 Paediatric Ophthalmology and strabismus Fellow, Department of Paediatric Ophthalmology and Adult Strabismus, Aravind Eye Hospital, Madurai, India Head of the Department, Department of Paediatric Ophthalmology and Adult Strabismus, Aravind Eye Hospital, Madurai, India Ocular tilt reaction is an uncommon phenomenon. It is usually misdiagnosed as superior oblique palsy. One of the rare oculomotor presentations of multiple sclerosis is ocular tilt reaction. Large number of people get affected by multiple sclerosis every year. Prompt diagnosis and timely intervention helps in long term rehabilitation and prevents irreversible sequele. We report a case of a young girl with no prior history of any co morbidity, presented with double vision and was diagnosed with ocular tilt reaction. The only attributable history was of receiving COVID vaccine. On further evaluation and literature review the case was differentiated from an adverse reaction of COVID vaccination. A diagnosis of multiple sclerosis was determined that enabled early initiation of appropriate systemic therapy for her. In our knowledge, this becomes the first case report that describes, an ocular tilt reaction as a manifestation of multiple sclerosis following COVID vaccination. http://pubs.sciepub.com/novn/7/1/1/novn-7-1-1.pdf skew deviation ocular tilt reaction COVID vaccine multiple sclerosis vertical deviation