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Surgical correction of the hypertropia is desired to achieve binocularity, manage diplopia and/or correct the cosmetic defect. Steps to achieve the same depend on mechanism of the hypertropia and identification of the offending muscles causing the misalignment.
The prism cover test (PCT) is an objective measurement and the gold standard in measuring strabismus, i.e. ocular misalignment, or a deviation of the eye. It is used by ophthalmologists and orthoptists in order to measure the vertical and horizontal deviation and includes both manifest and latent components. [1]
Prism correction. Prism lenses (here unusually thick) are used for pre-operative prism adaptation. Eye care professionals use prism correction as a component of some eyeglass prescriptions. A lens which includes some amount of prism correction will displace the viewed image horizontally, vertically, or a combination of both directions.
Bielschowsky's head tilt test. Step 1: Determine which eye is hypertropic in primary position. If there is right hypertropia in primary position, then the depressors of the R eye (IR/SO) or the elevators of the L eye are weak (SR/IO).
For an abnormal result, based on where the light lands on the cornea, the examiner can detect if there is an exotropia (abnormal eye is turned out), esotropia (abnormal eye is turned in), hypertropia (abnormal eye higher than the normal one) or hypotropia (abnormal eye is lower than the normal one).
Maddox rod. The Maddox rod test can be used to subjectively detect and measure a latent, manifest, horizontal or vertical strabismus for near and distance. The test is based on the principle of diplopic projection. [1]
It is mainly used in strabismus clinics. Through this test, suppression, microtropia, diplopia and manifest deviations can be noted. However this test should always be used in conjunction with other clinical tests, such as Worth 4 dot test, Cover test, Prism cover test and Maddox rod to come to a diagnosis.
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.
The test is indicated with the use of a presence of a prism in individuals with a strabismus and fusion is considered present if 4 lights are maintained, with or without the use of a prism. The W4LT can also be indicated when aiding a person to develop and strengthen their fusional capacities.
Phakic IOLs can be used to correct hypermetropia up to +20 diopters. Non laser procedures. Conductive keratoplasty (CK): Conductive keratoplasty is a non laser refractive procedure used to correct presbyopia and low hypermetropia (+0.75D to +3.25D) with or without astigmatism (up to 0.75D).