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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.
Other options for strabismus management are vision therapy and occlusion therapy, corrective glasses (or contact lenses) and prism glasses, and strabismus surgery. The effects that are due only to the toxin itself (including the side effects) generally wear off within 3 to 4 months.
Prism lenses do not address torsional misalignment and this may limit their use in certain cases. An additional consideration of prism lenses is that they must be worn at all times. Prism lenses reduce vertical fusional demands by allowing the eyes to rest in their vertically misaligned state.
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.
Diplopia with normal binocular function is treated with prism glasses, botulinum injections into the muscles, or repeated surgery. If binocular function is not normal, a more individualized approach is necessary to best suit the patient's needs.
When a patient has a manifest strabismus the uncovered eye will take up fixation when the fixing eye is covered. The cover/ uncover test is performed at near using a flashlight as a target. Shining a light in the patient's eye allows the orthoptist to observe their corneal reflection.