The Ophthalmology
Survival Guide
Hypertropia
Hypertropia is a vertical misalignment of the eyes in which the visual axis of the deviating eye is above that of the fixating eye.​​
​
A hypertropia in one eye implies a simultaneous hypotropia in the other.
Survival Tips!
-
Evaluations of eye alignment are a critical survival skill, as abnormalities can be a sign of serious, and occasionally life-threatening pathology.
​
-
Use the Hirschberg test or alternate cover test for these evaluations.
​
-
The corneal light reflex, or penlight highlight, will appear inferior to the pupil.
​
-
The magnitude of strabismus is measured in prism diopters.
​
Symptoms to look for:
-
Diplopia, or double vision, is the symptom that most strongly suggests an abnormality of eye alignment, but it may not always be present (e.g. very young children often do not complain of diplopia, even when there is an acute onset of strabismus). ​
​
-
The presence of strabismus without diplopia generally (but not always) suggests something more longstanding and less worrisome.​
​
-
The presence of a habitual head tilt or face turn is suggestive of strabismus.​​
​
Remember:​
​
-
Strabismus can be acquired, which is generally a bad thing. It suggests that something dysfunctional is going on with the brain, the cranial nerves controlling EOMs, the EOMs themselves, or occasionally the retina.
Emergency Care To Note
-
Remember, the key to survival is to recognizing red flags, and taking the appropriate steps to evaluate them without undue delay. Acute onset strabismus is a red flag.
​​​
​
-
Retinoblastoma most often present as a new onset strabismus secondary to vision loss.
