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The cause of congenital fourth nerve palsy is unclear in most cases. It may be neurogenic in origin, due to a dysgenesis of the CN IV nucleus or nerve, but a clinically similar palsy may result from absence or mechanical dysfunction (e.g., abnormal laxity) of the superior oblique tendon.
Esotropia (from Greek eso 'inward' and trope 'a turning' [1]) is a form of strabismus in which one or both eyes turn inward. The condition can be constantly present, or occur intermittently, and can give the affected individual a "cross-eyed" appearance. [2]
In some lenses, the curved surfaces are replaced with flat surfaces, with a different angle in each section. Such a lens can be regarded as an array of prisms arranged in a circular fashion with steeper prisms on the edges and a flat or slightly convex center. In the first (and largest) Fresnel lenses, each section was actually a separate prism.
The symptoms and signs associated with convergence insufficiency are related to prolonged, visually demanding, near-centered tasks. They may include, but are not limited to, diplopia (double vision), asthenopia (eye strain), transient blurred vision, difficulty sustaining near-visual function, abnormal fatigue, headache, and abnormal postural adaptation, among others.
A ray trace through a prism with apex angle α. Regions 0, 1, and 2 have indices of refraction, , and , and primed angles ′ indicate the ray's angle after refraction.. Ray angle deviation and dispersion through a prism can be determined by tracing a sample ray through the element and using Snell's law at each interface.
The Krimsky test is essentially the Hirschberg test, but with prisms employed to quantitate deviation of ocular misalignment by determining how much prism is required to centre the reflex [2] The Krimsky test is advisably used for patients with tropias, but not with phorias.
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