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Recognizing Microtropia: When the diagnosis fits and when it doesn’t
Abstract
The ocular deviation found in patients with microtropia can be so miniscule that
detection during routine cover test can prove difficult and in some cases,
impossible. Missing the presence or incorrectly identifying a microtropia has a
dramatic impact on patient care. Overlooking the presence of a microtropia may
cause a patient to be subjected to unnecessary, sometimes extensive, and often
costly neurologic evaluations in attempt to establish the cause of reduced acuity.
Incorrectly labeling an unexplained reduction in acuity as microtropia can result in
insidious etiologies such as a tumor to be missed.
Learning Objectives
1. To review the definition of microtropia and findings associated with the
condition.
2. To understand how to diagnose microtropia.
3. To recognize when the diagnosis may not be appropriate.
4. To be able to create a treatment plan for the condition.
Outline
I.
Microtropia
a. Terminology – microtropia, flick, microesotropia, microsquint,
microstrabismus, small angle strabismus, minitropia, monofixation
syndrome
b. Historical Review and definitions
i. Irvine
ii. Parks
iii. Lang
iv. Helveston and vonNoorden
c. Current definitions
d. Prevalence
II.
Diagnosis of Microtropia
a. Cover test
b. 4 prism base-out test
c. Worth dot test
d. Stereopsis – Global and Local
e. Correspondence test
f. Monocular Fixation test
III.
Associated Conditions
a. Amblyopia
b. Anisometropia
c. Suppression
d. Anomalous correspondence
e. Eccentric Fixation
f. Horror Fusionis
IV.
Conditions mistaken for Microtropia
a. Corneal conditions
b. Retinal disease
c. Optic Nerve Head Anomalies
d. Neurological conditions
V.
Treatment of Microtropia
a. Amblyopia treatment?
b. Surgery?
c. Anti-suppression?
VI.
Case Studies
VII.
References
a. Caloroso EE, Rouse MW. Clinical Management of Strabismus.
Massachusetts; Butterworth-Heinemann; 1993
b. von Noorden GK, Campos EC. Binocular Vision and Ocular Motility.
Missouri; Mosby; 2002