Your Hypertropia (Strabismus) Guide Is Here!

Overview | Causes | Symptoms | Diagnosis | Treatment | Prevention |

We all may know about strabismus. If you don’t know, then let me tell you —

Strabismus is an eye condition in which both the eye neither looks similar nor they work together. The eyeballs are either upward, downwards, inside (close to the nose side), or with the outer side (left side) of the eyewall. The prominent types of strabismus are as follows:

  • Hypertropia – upward turn of the eye
  • Hypotropia – downward turn of the eye
  • Esotropia – Inward turn of the eye
  • Exotropia – outward turn of the eye

 We already have an article on strabismus, if you want to know about it, do check it out.

Here, we will tell you, all you need to know about hypertropia.

So let’s begin.

What is hypertropia?

Hypertropia is a type of strabismus, in which one eye turns upward, while the other is incorrect position and direction. This makes the upward or affected eye out of alignment with the other. Although, it can affect one pr both eyes.

Hypertropia can be constant or intermittent, which means the affected eye can be in an upward direction always, or it can be possible that the eye turns upward only for some time or in some condition. Intermittent hypertropia occurs when you feel stressed or fatigue, mostly. This misalignment of the eyes needs treatment and if get diagnosed early, the chances of success of treatment are quite high.

How does hypertropia occur?

Our eyes are having six muscles attached to them. These muscle helps the eyes to move in all directions. But, when all or any of these muscles encounter any type of damage or injury, they become unable to perform their function. This results in strabismus, including hypertropia. Hypertropia occurs mainly due to palsy, or weakness/damage of the third or fourth cranial nerve muscles. This is the most prominent cause of hypertropia.

Causes of hypertropia:

  • Weakness (palsy) of one of the muscle nerves, especially the third or fourth cranial nerves.
  • Eye injury
  • Brown syndrome ( a problem regarding tight eye muscle tendon)
  • Duane syndrome (a problem with the wrong innervation of the eye muscles)
  • Stroke.
  • Thyroid disease
  • Neurological disorders
  • Trauma.
  • Graves’ disease or ophthalmology
  • Surgical trauma (it’s a type of trauma one develops during eye surgery, such as cataract surgery, etc.)
  • Brain tumor
  • Decomposition  of congenital phoria
  • Diabetes (indirect cause)
  • Thyroid dysfunction etc.

Symptoms of hypertropia:

The symptoms of hypertropia vastly dee0nds on its causes. But, some of the prominent symptoms are as follows —

  • Misaligned eye in the upward direction with respect to the other eye
  • Eyestrain
  • The subconscious tilt of the head
  • Headache
  • Diplopia (double vision)
  • Pain above the eyebrows
  • Eye wander  
  • Suppression
  • Vision Confusion

Diagnosis of hypertropia:

You must keep in mind that, the diagnosis and treatment of hypertropia or any eye-related problem must be done by an eye specialist.

To diagnose hypertropia, first of all, you must tell your doctor about all your health history and symptoms you are experiencing.

Then, your doctor can prescribe you some tests to get hypertropia diagnosed. Some of these test can be—

  • MRI test – To figure out if a nerve or muscle problem is the cause of your hypertropia.
  • Cover/Uncover test – This test can be used to diagnose any type of strabismus or tropia. In this, your doctor will briefly cover your one eye, that is fixation, and will observe if there is any refixation movement in the other eye. If you have hypertropia, the non-fixing eye moves downward as it takes up fixation. If there is no refixation takes place, then your doctor will perform this same procedure but with another eye.

It is very important for the cover to be very brief because if the cover is prolonged, it will break binocular fusion and will provoke a possible phoria 

  • Simultaneous prism cover test – This test can be used to estimate the angle of deviation attributed to a tropia. In the case of incomitant strabismus, due to muscle perasis or restrictive syndrome, a prism is placed over the eye with limited ductions to measure the primary deviation; and an another prism is placed in front of the unaffected or ‘good’ eye to measure the secondary deviation. The deviation of affected eye must be bigger than the deviation created by the normal eye, if it is a case of hypertropia.
  • Worth 4 dot test – In this, different light filters,  a green and a red light filter are placed in front of each eye. Then the patient is asked to look at four different dots, 2 green dots on either side, a red dot on the top and a white dot at the bottom, such as it forms a cross.

The green dots can be seen only with the green filter, red dots with the red filter and white dot can be seen with both the filters or eyes. Results of this test can diagnose the eye problem, like this —

  1. Diplopia – if the patient sees 5 lights instead of 4.
  2. Hypertropia – if the light seen by one eye is below the expected position
  3. Suppression – if the patient sees less than 4 lights

Some of the other test that can be used to diagnose hypertropia is:

  • Red filter test
  • Maddox rod test
  • Hirschberg test
  • Imagine test (in case you suspect brain tumour)
  • Krimsky test
  • Bagolini strained test etc.


Hypertropia is not such a condition that gets resolved automatically. You have to consult your doctor for a diagnosis and treatment. Early diagnosis and treatment can highly influence the chances of getting cured.

There are four main treatments for hypertropia. Your doctor may prescribe you a treatment plan, according to your need. Treatment options include —

  • Spectacles (with or without prism)
  • Patching
  • Surgery
  • Vision therapy
  • Eye exercises
  • Botox


Well, honestly hypertropia is not preventable. Some people have hypertropia from their birth and some may develop it after birth due to some injury or damage. One thing you can do is to get an early diagnosis. For this, you or your child should have a screening at the age of 6 months. If you observe any kind of deviation in the eye, you must visit your eye doctor, even if the deviation is slight. Early diagnosis is very important as it can also help you to know about any underlying disease if present.


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