Binocular Alignment

Binocular alignment is evaluated with a cover test. The examiner holds a point light source beneath his or her own eyes and observes the light reflections in the patient's corneas in the near field (40 cm) and at a distance (5 m). The reflections are normally in the center of each pupil. If the corneal reflection is not in the center of the pupil in one eye, then a tropia is present in that eye. Then the examiner covers one eye with a hand or an occluder (Fig. 1.6) and tests whether the uncovered eye makes a compensatory movement. Compensatory movement of the eye indicates the presence of tropia. However, there will also be a lack of compensatory movement if the eye is blind. The cover test is then repeated with the other eye.

If tropia is present in a newborn with extremely poor vision, the baby will not tolerate the good eye being covered.

Evaluation of binocular alignment.

Evaluation of binocular alignment.

Cover Test Eye Exam
Fig. 1.6 The examiner covers one eye of the patient with the hand to test if the uncovered eye makes a compensatory movement indicating presence of tropia.

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