Left eye (LE) is covered and right eye (RE) is observed for movement that would indicate a heterotropia; no movement of the RE in this case. Cover is removed from the LE; some practitioners advise that the LE should now be observed for any heterophoria recovery movement. We advocate that the cover-uncover test should only be used to assess for heterotropia in the uncovered eye and that alternating cover test should be used for heterophoria detection. The RE is now covered and the LE observed for any heterotropia movement; there is none. The cover is removed from the RE and reintroduced to the RE to begin the alternating cover test.
Cover remains over RE for 2-3 seconds and quickly moved across the bridge of the nose to cover LE. As the cover leaves RE, this eye is observed for any heterophoria. LE is occluded for 2-3 seconds and the occluder is quickly moved across the nose to cover RE with the uncovered LE observed for any...
This patient has a fully accommodative alternating esotropia. Without glasses, a cover-uncover test at distance and near reveals an alternating esotropia. With a hyperopic prescription in place a small (approximately 4Δ) esophoria with good recovery is observed at distance and near.
With the patient looking to left the right eye palpebral aperture narrows due to globe retraction. There is also slight to moderate limitation of right eye on adduction. Globe retraction is even more obvious when looking from the side.
