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Hyper Hypo Cyclo Strabismus


Hyper/hypotropia is a strabismus characterized by the upward/downward deviation of the line of sight of deviating eye relative to the fixating eye. Cyclotropia is a meridional deviation around the antero-posterior axis of the deviating eye relative to the fixating eye.



The signs and symptoms associated with vertical heterophoria may include, but are not limited to, the following:

  1. eye turn, deviation (ICD:H51.9); sensation of monocular viewing; head turn/tilt
  2. defective stereopsis and inaccurate/inconsistent depth judgment
  3. general fatigue/motion sickness/dizziness after sustained task
  4. diplopia (ICD: 2)
  5. inaccurate eye-hand coordination
  6. reduced efficiency and productivity/diminished accuracy/inconsistent work product
  7. asthenopia
  8. diminished performance with increased task time
  9. inconsistent visual attention/concentration and/or distractibility while performing visually demanding tasks
  10. abnormal postural adaptation/abnormal working distance (ICD: 3)
  11. spatial disorientation/incoordination/clumsiness (ICD: 8)
  12. inaccurate spatial judgements



Hyper/hypo/cyclo strabismus is typically characterized by one or more of the following diagnostic findings:

  1. amblyopia and/or suppression (both of monocular and binocular vision)
  2. reduced stereopsis
  3. absence of fusion
  4. non-comitancy
  5. inaccurate visual-motor coordination



The doctor of optometry determines appropriate diagnostic and therapeutic modalities, and frequency of evaluation and follow-up, based on the urgency and nature of the patient’s conditions and unique needs. Vision disorders that are not totally cured through vision therapy may still be ameliorated with significant improvement in visual function and quality of life. The management of the case and duration of treatment would be affected by:

  1. the severity of symptoms and diagnostic factors, including onset and duration of the problem
  2. the complications of associated visual conditions
  3. implications of patient’s general health, cognitive development, physical development, and effects of medications taken
  4. etiological factors
  5. extent of visual demands placed upon the individual
  6. patient compliance and involvement in the prescribed therapy regimen
  7. type, scope, and results of prior interventions


Some cases are successfully managed by the prescription of therapeutic lenses and/or prisms. Most dissociated vertical deviation cases require optometric vision therapy, which incorporates the prescription of specific treatments in order to:

  1. develop adequate fusional vergence ranges and stability in all positions of gaze at distance and near
  2. enhance accommodative/convergence relationships
  3. enhance depth judgments and/or stereopsis
  4. integrate binocular function with information processing
  5. enhance fusional vergence facility and flexibility
  6. integrate binocular skills with accurate motor responses
  7. integrate binocular skills with other sensory skills (vestibular, kinesthetic, tactile, and auditory)
  8. increase visual stamina/integrate newly established skills with information processing


The following treatment ranges are provided as a guide. Treatment duration will depend upon the particular patient’s condition and associated factors. When duration of treatment beyond these ranges is required, documentation of the medical necessity for additional treatment services may be warranted for third-party claims processing and review purposes.

  1. Full treatment requires resolution of associated visual
  2. The most commonly encountered vertical/cyclo strabismus usually requires 36 to 48 hours of office therapy.
  3. Vertical/cyclo strabismus therapy may be complicated by an associated horizontal deviation and or associated factors such as prior eye muscle surgery, cerebral vascular accident, head trauma, and/or systemic conditions. This may warrant an increase in treatment


At the conclusion of the active treatment regimen, periodic follow-up evaluation is required. Should signs, symptoms, or other diagnostic factors recur, further therapy may be medically necessary.

Therapeutic lenses may be prescribed during or at the conclusion of active vision therapy to assist in the maintenance of long-term stability.