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The patient is asked to fixate on a target while the examiner places a 4 prism dioptre base-out prism over the patient's eye, observing the response of the fellow eye. [1] The target is a single isolated distance target of approximately 1-2 lines better than best corrected acuity at distance.
If the patient saw a red line to the right and white light to the left, they are said to have esotropia or esophoria (uncrossed diplopia) in which base out (BO) prisms of increasing strength are used until the lines are superimposed.
Treatment options for esotropia include glasses to correct refractive errors (see accommodative esotropia below), the use of prisms, orthoptic exercises, or eye muscle surgery. The term is from Greek eso meaning "inward" and trope meaning "a turning".
Esotropia. In an Esotropic (ET) deviation, the patient will experience uncrossed diplopia. When questioned about the position of the lights, they will report that: They see 5 lights, 2 red and 3 green; The lights are horizontally displaced, seen side by side; The 2 red lights from the right eye are seen on the right side
If the residual esotropia is small, or if the patient is unfit or unwilling to have surgery, prisms can be incorporated into their glasses to provide more permanent symptom relief. When the deviation is too large for prismatic correction to be effective, permanent occlusion may be the only option for those unfit or unwilling to have surgery.
Fig. 3: Fixation disparity as a function of the forced vergence angle which is induced by base-in prisms and base-out prisms in front of the eyes. These prism FD-curves have widely been used for subjective fixation disparity and the clinical implications are described below.
Incomitant strabismus cannot be fully corrected by prism glasses, because the eyes would require different degrees of prismatic correction dependent on the direction of the gaze. Incomitant strabismus of the eso- or exo-type are classified as "alphabet patterns": they are denoted as A- or V- or more rarely λ -, Y- or X-pattern depending on the ...
Suppression of an eye is a subconscious adaptation by a person's brain to eliminate the symptoms of disorders of binocular vision such as strabismus, convergence insufficiency and aniseikonia. The brain can eliminate double vision by ignoring all or part of the image of one of the eyes.
Treatment. In general, strabismus can be approached and treated with a variety of procedures. Depending on the individual case, treatment options include: Correction of refractive errors by glasses; Prism therapy (if tolerated, to manage diplopia) Vision Therapy; Patching (mainly to manage amblyopia in children and diplopia in adults)
Prism correction is measured in prism dioptres. A prescription that specifies prism correction will also specify the "base". The base is the thickest part of the lens and is opposite from the apex. Light will be bent towards the base and the image will be shifted towards the apex.
