Art of Investigating Binocular Vision Anomalies

Art of Investigating Binocular Vision Anomalies

Demonstrations of cover-uncover and alternating cover tests and examples of comitant and incomitant deviations. Comitant deviations include fully accommodative esotropia, micro-esotropia and A exophoria pattern. Incomitant deviations include Duane’s retraction syndrome, Brown’s syndrome, dysthyroid eye disease, dissociated vertical divergence following extra-ocular muscle surgery, III, IV and VI nerve palsies plus examples of upper lid ptosis.

These videos accompany our book, available on Amazon, "The Art of Investigating Binocular Vision Anomalies" : you will receive a link to purchase it in your email receipt.

Art of Investigating Binocular Vision Anomalies

14 Videos

  • BVA-000a-Cover-uncover test

    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 cove...

  • BVA-000b-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...

  • BVA-001-Fully accommodative alternating esotropia

    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.

  • BVA-002-Duane’s retraction syndrome Type A

    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.

  • BVA-004-Consecutive left esotropia with dissociated vertical divergence (DVD)

    A consecutive left esotropia following left medial rectus recession and right lateral rectus resection, with DVD. The presence of DVD indicates that the age of onset of the infantile esotropia was at or before six months of age. Cover-uncover of the left eye reveals DVD of the left eye (the cover...

  • BVA-005-Right Brown’s syndrome

    This patient has right Brown’s syndrome. There is a left head tilt CHP. On elevation and left-elevation the RE will not elevate as much as the left and the patient experiences discomfort.

  • BVA-006-Dysthyroid eye disease

    This patient has dysthyroid eye disease. The clip shows the patient attempting to look up. There is restricted left elevation and left proptosis. There is mechanical restriction of eye movement with overaction of contralateral synergists. There are no further muscle sequelae, as the deviation is ...

  • BVA-007-Right III nerve palsy

    Recovering right III nerve palsy. Minimal RE ptosis. Patient is looking up and to the right. Cover-uncover of RE, no movement of the LE. Cover-uncover of the LE, upward movement of the RE; right superior rectus underaction. Movement of RE becomes greater, more easily observed with alternating cov...

  • BVA-008-Fully accommodative left to alternating esotropia

    This patient has a fully accommodative left to alternating esotropia. Without the hyperopic prescription in place, the LE moves outwards to take up fixation on cover-uncover indicating a 20Δ left esotropia. When the cover is removed from the LE the RE has moved inwards and there is now a right es...

  • BVA-009-Residual intermittent right distance exotropia (simulated)

    This patient has a residual intermittent right distance exotropia (simulated), following right lateral rectus recession and medial rectus resection. When the LE is covered the RE is seen to move inwards indicating a right exotropia of approximately 12Δ. This can also be seen when the cover is mov...

  • BVA-010-Right esotropia and DVD

    Right esotropia in the primary position. Right corneal reflex is displaced to just beyond the pupil margin indicating a right esotropia of around 35∆. The vertical displacement of both reflexes is a filming artefact and should be ignored. A cover-test of RE reveals no movement of LE. Cover test o...

  • BVA-011-Congenital partial right ptosis and right microesotropia

    This patient has congenital partial right ptosis and right microesotropia. When the RE is covered there is no movement of the LE. When the LE is covered there is a very slight outward movement of the RE, indicating 2Δ right microesotropia. When the cover is removed from the left eye the RE moves ...

  • BVA-012-Exophoria and a V exo pattern

    This patient has an exophoria and a V exo pattern. Alternating cover test with glasses in place reveals an exophoria that increases in size to approximately 10Δ with good recovery. The exophoria increases in size to 20Δ on elevation and decreases to 2Δ on depression. There has to be a difference ...

  • BVA-013-Longstanding right IV nerve palsy

    Patient has longstanding right IV nerve palsy with left head tilt. When RE is covered no movement of LE; when LE is covered no movement of RE (with head tilt). Alternating cover testing right hyperphoria of approximately 8Δ with good recovery. Without head tilt the right hyperphoria becomes more ...