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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.
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]
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.
Whether the test was performed with/without glasses; Whether the test was performed with/without a compensatory head posture; In a poorly controlled phoria recovery may not occur and the deviation will be manifest - make a note of this also; Examples of a cover test recording: [1] CT: cc sml LXT/XT' nhf CT: sc mod E/E' c r.r CT: cc RET holds ...
Although glasses and/or patching therapy, exercises, or prisms may reduce or help control the outward-turning eye in some children, surgery is often required. A common form of exotropia is known as "convergence insufficiency" that responds well to orthoptic vision therapy including exercises. This disorder is characterized by an inability of ...
Surgery or special glasses (prisms) may be advised if there is no recovery in 6 to 12 months. If diplopia turns out to be intractable, it can be managed as last resort by obscuring part of the patient's field of view. This approach is outlined in the article on diplopia occurring in association with a condition called horror fusionis.