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Related Experiment Video

Updated: May 20, 2026

Using an Automated Hirschberg Test App to Evaluate Ocular Alignment

Using an Automated Hirschberg Test App to Evaluate Ocular Alignment

Published on: March 24, 2020

Where the wild things are: when esotropia misbehaves.

Christopher Lyons¹

¹Department of Ophthalmology and Visual Sciences, University of British Colombia, and the Department of Ophthalmology, BC Children's Hospital, Vancouver, British Columbia, Canada.

The American Orthoptic Journal

|August 1, 2012

Summary

Esotropia, a common eye misalignment, can present with complex causes beyond simple accommodation issues. This review details challenging cases requiring thorough testing to diagnose underlying neurological or restrictive conditions.

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Area of Science:

Ophthalmology
Neuro-ophthalmology

Background:

Esotropia is the most frequent strabismus presentation.
Accommodation is a known precipitating factor, often with straightforward management.
This review focuses on complicated esotropia presentations.

Observation:

Reviewed a dozen complex esotropia cases.
Some cases involved elusive fleeting symptoms requiring detailed sensory and motor testing.
Other cases indicated serious underlying pathologies necessitating further investigation.

Findings:

Discussed restrictive conditions misdiagnosed as neurological.
Presented cases including fixation switch diplopia, consecutive esotropia with superior oblique palsy, and over-corrected myopia.
Included acute nonaccommodative esotropia, esotropia with cerebellar tumor, sixth nerve palsy from pontine/cavernous pathology, and thyroid strabismus.

Implications:

Highlights the importance of comprehensive diagnostic approaches for esotropia.
Emphasizes differentiating neurological from restrictive causes.
Underscores the need for further investigation in complex or atypical esotropia presentations.