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Related Experiment Video

Updated: Mar 7, 2026

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[Vertical vergence in convergence].

M Gräf1, K Weinand

  • 1Augenklinik für Schielbehandlung und Neuroophthalmologie, Justus-Liebig-Universität Giessen. michael.h.graef@augen.med.uni-giessen.de

Klinische Monatsblatter Fur Augenheilkunde
|March 7, 2000
PubMed
Summary

This study details a case of left-over-right vertical deviation (VD) in a child, which worsened with head tilt and convergence. The findings suggest a congenital supranuclear misinnervation requiring differentiation from other vertical deviations.

Area of Science:

  • Ophthalmology
  • Pediatric Ophthalmology
  • Neuro-ophthalmology

Background:

  • Vertical deviation (VD) is a common condition in pediatric ophthalmology.
  • Understanding the etiology and clinical presentation of VD is crucial for accurate diagnosis and management.

Observation:

  • A 7-year-old boy presented with a small left-over-right vertical deviation (-VD).
  • The -VD significantly increased with leftward head tilt and during near convergence.
  • Cover test measurements revealed a marked increase in vertical phoria at near fixation and with contralateral head tilt.

Findings:

  • The vertical deviation was exacerbated by left head tilt (up to 18 degrees distance, 26 degrees near) and convergence.
  • Head tilt to the right shoulder decreased the vertical deviation.

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  • The deviation was presumed to be a congenital supranuclear misinnervation, distinct from dissociated vertical deviation.

    • Implications:

    • This case highlights the importance of assessing head position and convergence in evaluating vertical deviations.
    • Accurate differentiation of this specific type of vertical deviation is essential for appropriate treatment planning.
    • Further research into supranuclear misinnervations may elucidate underlying mechanisms of binocular vision disorders.