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Prism therapy (if tolerated, to manage diplopia) Vision Therapy; Patching (mainly to manage amblyopia in children and diplopia in adults) Botulinum toxin injection; Surgical correction; Surgical correction of the hypertropia is desired to achieve binocularity, manage diplopia and/or correct the cosmetic defect. Steps to achieve the same depend ...
Method for measuring vertical deviations: 1. The Maddox Rod is held in front of the patient's right eye with the cylinders vertical, making the red line horizontal. 2. The patient is then asked whether the white light is superimposed on the red line or if it appears above or below the red line.
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]
The Parks–Bielschowsky three-step test, also known as Park's three-step test or Bielschowsky head tilt test, is a method used to isolate the paretic extraocular muscle, particularly superior oblique muscle and trochlear nerve (fourth cranial nerve), in acquired vertical double vision.
Prism lenses reduce vertical fusional demands by allowing the eyes to rest in their vertically misaligned state. When they are removed the patient may experience vertical diplopia they find hard to resolve due to the rested state of their eyes.
Types include esotropia, where the eyes are crossed ("cross eyed"); exotropia, where the eyes diverge ("lazy eyed" or "wall eyed"); and hypertropia or hypotropia where they are vertically misaligned. They can also be classified by whether the problem is present in all directions a person looks (comitant) or varies by direction (incomitant). [3]
Esotropias measuring more than 15 prism diopters (PD) and exotropias more than 20 PD that have not responded to refractive correction can be considered candidates for surgery. Techniques Disinserting the medial rectus muscle. The goal of strabismus surgery is to correct misalignment of the eyes.
Prism spectacles with a single prism perform a relative displacement of the two eyes, thereby correcting eso-, exo, hyper- or hypotropia. In contrast, spectacles with prisms of equal power for both eyes, called yoked prisms (also: conjugate prisms, ambient lenses or performance glasses) shift the visual field of both eyes to the same extent.
If there is little or no vertical separation, vertical prism can be used to separate the lines. The patient is asked if one or both lines are tilted. The lines can be straightened subjectively by rotating the glasses in the trial frame and the degree of cyclotropia recorded.
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).