Tonic ocular torsions can arise from a variety of central or peripheral, vestibular, and nonvestibular lesions. However, the role of tonic ocular torsions in neurotology has been limited to surgical patients after unilateral vestibular deafferentation. By using 12 patients with a spectrum of well-defined unilateral peripheral vestibular lesions confirmed by electronystagmography (ENG), we identified a link between ipsiversive tonic ocular torsion compensation and vestibulospinal compensation, as measured by computerized dynamic posturography. In the context of ENG findings and posturography, the differential diagnosis of ocular torsions may be localized to the otoliths by using a decision matrix. Specifically, conditions of absent vision and sway-referenced support on computerized dynamic posturography associated with concurrent static ocular torsional abnormalities may suggest an otolith disorder. Furthermore, static ocular torsion assessment provides another important window on central vestibular compensation.