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 heterophoria. It should not be necessary to repeat this process more than 4 times. It is imperative the patient never views the fixation target with both eyes simultaneously during the alternating cover test; maximum heterophoric eye movements will be elicited with full dissociation. The view from the side shows the cover should be held in front of the lashes to ensure occlusion and prevent peripheral fusion from reducing heterophoric or heterotropic movements. A translucent occluder allows easier observation of the eye under the cover
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.
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...
