- monocular movement of an eye outward (away from the nose)
Abnormal/Anomalous Retinal Correspondence (ARC)
- adaptation to compensate for a long-standing eyedeviation; fovea of the straight (non-deviated) eye and a non-foveal retinal point of the deviated eye work together, sometimes permitting single binocular vision despite misalignment of the eyes.
Criteria for ARC:
1. Patient must have manifest esotropia (monocular or alternating) - hardly ever exo2. Must be the same amount of crossing all the time (no accommodation)3. The patient has the desire to fuse, but because of manifest deviation is unable to do so. If he fuses, it isabnormal.4. May or may not have amblyopia
(accommodative convergence/accommodation ratio) - numerical expression for relationship betweenthe amount both eyes simultaneously turn inward (converge) and the amount their lenses increase in power(accommodate). In normal individuals this ratio averages 5:1. Accommodative convergence is expressed inprism diopters (
), and accommodation is expressed in diopters (D).
Distance-near method : AC/A = 1/3 (n
) + interpupillary distance (in
) (Wilson p 121)
= near deviation
= primary position deviation
- increase in optical power by the eye to maintain a clear image (focus) as objects are movedcloser.
- that portion of the range of inward rotation (toward nose) of both eyes that occursin response to an increase in optical power for focusing (accommodation) by the eyes' lenses.
- excessive turning of an eye inward (toward nose) caused by an overactiveconvergence response to the accommodative effort necessary to keep vision clear. Eyeglass correction forthe hyperopia relaxes accommodation, allowing eyes to remain properly aligned. Sometimes bifocals arenecessary to correct excessive inturning at near.
- monocular movement of an eye inward (toward the nose).
- evaluates retinal correspondence in a horizontal deviation. With the opposite eye occluded, themacula of each eye is marked with an afterimage using a linear light flash with the fixation point blocked.Horizontal orientation is used OD, vertical OS. Then the patient reports the composite binocular imageperceived (eyes open or closed).• Interpretation:
: a symmetrical cross with a central area void of an afterimage
: a vertical line asymmetrically displaced to the right in a crossed fashion
: a vertical line asymmetrically displaced to the left in an uncrossed fashion
Agonist, primary mover
- extraocular muscle mainly responsible for moving eye into desired position.
- a deviation which can be encouraged to hold fixation with either eye.
Alternate Cover Test
- measures the entire deviation (tropia plus phoria). Test in all appropriate positions of gazeto explore for incomitance.
, ("lazy eye") - decreased vision (two lines of vision or more) in one or both eyes without detectableanatomic damage in the eye or visual pathways. Uncorrectable by optical means (e.g., eyeglasses).Including strabismic, anisometropic, refractive, ex anopsia.
Amblyopia Ex Anopsia, amblyopia of disuse
- reduction of vision fromnot seeing or disuse
Angle Kappa -
the angle between the visual axes and the anatomic(pupillary) axes. Can be positive or negative. A slightly positiveangle kappa is physiologic due to usual foveal positioningtemporal to the anatomic axis.• If
, the pupillary reflex will be seen on the
of the midline. (
type of deviation).• If
, the pupillary reflex will be seen to the
of the midline (
type of deviation).• Use the cover - uncover test to distinguish if deviation ispseudo.
- extraocular muscle whose action opposes that of thecontracting muscle (agonist) that moves the eye.
- extraocular muscle on the fellow eye whose action