Other Forms of Incomitant Strabismus



Some other forms of Incomitant strabismus can be congenital (Duanes, Browns, DVD) or acquired (Blow out fracture). They share the unifying feature of different deviation in different direction of gaze but also have various characteristic associated findings. This chapter describes the clinical features of other common forms of incomitant strabismus along with investigation modalities and treatment options.


Browns Duanes Blow out Dissociated vertical deviation 

Supplementary material

Video 11.4

A 78 year old man with a right sided blow out fracture. Note the frosted superior half of the lens in the right eye. He has no manifest strabismus in primary gaze but has prominent limitation of upgaze in the right eye leading to a right hypotropia in upgaze (MP4 67030 kb)

Video 11.5

A 10 year old girl with a small left hypotropia in primary position associated with a pseudoptosis. When she fixates with the left eye, the right eye elevates significantly behind the cover. This is due to the secondary deviation being more pronounced due to the extra innervation flowing to the right elevators when the left eye fixates. There is limitation of elevation of the left eye, more marked in adduction that abduction (MOV 133888 kb)

Video 11.8

A 16 year old boy with left exotropia and hypertropia in primary position. He has dense amblyopia in the left eye which does not take up fixation when the right is covered. On attempted dextroversion, the left eye elevates and retracts into the orbit due the miswiring of the MR and the SR (MOV 28809 kb)

Video 11.9

A 29 year old man with alternating hypertropia. The eye behind the cover elevates and then returns slowly to fixation when the cover is removed (MOV 6532 kb)


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Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  1. 1.Royal Free London NHS Foundation TrustLondonUK

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