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Hypertropia

Medically Reviewed by Whitney Seltman, OD on July 11, 2020

What Is Hypertropia?

When someone has hypertropia, one eye turns up while the other looks in the right direction. It’s not common, and there are treatments to correct it.

Your eyes are a team, working together to see clearly and focus on images near and far. But sometimes eyes move separately. If they turn in different directions from each other, it can cause vision problems. It’s a condition called strabismus. With one type of strabismus, hypertropia, one eye turns up while the other looks in the right direction.

Children mainly have this condition, but adults can also develop it. Hypertropia is the rarest type of strabismus, affecting just 1 in 400 kids.

What Causes Hypertropia?

Hypertropia happens when the eye muscles are imbalanced and don’t work together.

The most common cause is weakness (called palsy) in the nerves in the brain that control eye movement. Some people are born with this eye weakness, but it can also happen later in life. Other common causes in adults include:

Some less common reasons for hypertropia happen at birth or later on. Brown syndrome and Duane syndrome are rare conditions that limit eye movement.

Symptoms of Hypertropia

It can be hard to notice the symptoms of this condition. Sometimes it’s a permanent part of your life, or your eye may only wander from time to time when you’re stressed or tired. The most common symptoms are:

  • Eye wander. One or both of your eyes will drift up toward the ceiling or sky.
  • Double vision. People with this condition often have trouble with eye focus.
  • Head tilt. Your head leans or turns to one side to try to clear your vision.
  • Eyestrain
  • Headaches

How Do Doctors Diagnose Hypertropia?

Eye doctors diagnose hypertropia with an eye exam and other specialized tests.

With kids, you or your child’s doctor may notice that their eyes aren’t straight or they tilt their head. Children should have regular vision screenings during their well-baby checkups, especially if kids in your family have a history of eye disease. It’s important to diagnose the condition early on so your child doesn’t develop a lazy eye. This happens when the brain suppresses, or “shuts off,” vision from the weak eye to avoid double vision.

If your doctor notices anything unusual during a vision screening, they may send your child to visit an ophthalmologist (a doctor who can perform surgery for eye diseases) for a more in-depth eye exam.

Your doctor could also recommend an MRI. This scan will help them to figure out if a nerve or muscle problem is the cause of your hypertropia.

Hypertropia Treatments

Doctors have two goals for hypertropia treatment: make sure you can see well in both eyes, and align them. You may need one or more treatments, including:

  • Glasses. Wearing glasses, sometimes with a special prism, will correct vision problems that cause hypertropia.
  • An eye patch. You’ll wear the patch over your strong eye, which helps to correct the vision in the weak one.
  • Surgery. Your doctor will give you medication to help you sleep and then operate on the muscles attached to the outside of your eyeball. After, you’ll have slight eye pain and redness, but you'll probably go home the same day. You may need more surgery in the future.
  • Vision therapy. These are eye exercises that you’ll do every day for several minutes, along with glasses, patches, or surgery. They work to improve your eye-brain connection and the vision in your weak eye.
  • Botox. First, you’ll get drops to numb your eye. Then with a special needle, your doctor will inject a small dose of Botox into your eye muscle to keep it from contracting for a period of time.

Show Sources

SOURCES:

Optometrists Network: “What Is Strabismus?” “Hypertropia or Hyperphoria?”

Children’s National: “Pediatric Hypertropia.”

University of Michigan Health Center: “Hypertropia in Adults.”

UC San Diego Health: “Eye Movement Disorders.”

American Academy of Ophthalmology: “What is an Ophthalmologist?” “Strabismus: Botox Treatment.”

Medscape: “What is third cranial nerve palsy (oculomotor cranial nerve palsy)?”

National Organization for Rare Disorders: “Brown syndrome,” “Duane syndrome.”

Mayo Clinic: “Convergence insufficiency.”

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