NOTE: Don’t do test too slowly, record the size of the deviation, do aided and unaided.
If it moves out it WAS IN, hence the patient has an ESOPHORIA and vice versa for an exophoria
This time, look at the covered eye when you remove the cover.
If neither eye moves, check for heterophoria.
If when covering one eye, the other eye moves in – it means it WAS OUT and therefore the patient has an EXOTROPIA and vice versa for an esotropia.
Look at the uncovered eye when covering the other eye.
Ask the patient to look at a letter 1 line above the patient’s worst.
If they are amblyopic is it strabismic or anisometropic? How to examine Binocular Vision Anomalies Three per cent of children are amblyopic. If a patient is comitant and has a strabismus do they have a sensory or motor fusion issue? Are they amblyopic? Check Strabismus = Abnormal alignment of the eyes Heterophoria = when the eyes are dissociated there is lack of fusion. Incomitancy = when the angle of deviation is not the same in all positions of gazeĬomitancy = when the angle of deviation is the same regardless of position of gaze
BV anomalies can be comitant or incomitant and heterphoric or strabismic.
Family history of strabismus, amblyopia, refractive error or pathology?.
General history and symptoms, medications?.
Rule out pathology – check the pupils, ophthalmoscopy and visual field defects.
Observe the patient, head tilt? Walking funny?.
It is important we are properly screening for it and not skimming over it. 5% of all patients we see will have a Binocular Vision Anomaly.
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