{"id":3415,"date":"2020-05-20T13:54:19","date_gmt":"2020-05-20T13:54:19","guid":{"rendered":"https:\/\/www.optometrists.org\/wordpress\/?page_id=3415"},"modified":"2021-07-15T07:35:54","modified_gmt":"2021-07-15T07:35:54","slug":"hypertropia-and-hyperphoria","status":"publish","type":"page","link":"https:\/\/www.optometrists.org\/childrens-vision\/a-guide-to-eye-turns\/hypertropia-and-hyperphoria\/","title":{"rendered":"Hypertropia or Hyperphoria?"},"content":{"rendered":"<h2>Hypertropia and hyperphoria are when the eyes are misaligned &#8211; one pointing higher than the other.<\/h2>\n<p>Both these forms of eye turn can be well managed by optical lenses and vision therapy.<\/p>\n<h2>What is hypertropia?<\/h2>\n<p><strong>Hypertropia is a form of vertical <a href=\"https:\/\/www.optometrists.org\/a-guide-to-eye-turns\/strabismus-crossed-eyes\/\">strabismus (eye turn),<\/a> or misalignment of the eyes that occurs when one eye turns upward. When the eye turns downwards it called <i>h<\/i><i>ypo<\/i>tropia.<\/strong><\/p>\n<p><b>Hypertropia<\/b> is usually diagnosed in childhood, though it can also affect adults as a result of an eye injury or eye disease and can be <a href=\"https:\/\/www.optometrists.org\/childrens-vision\/a-guide-to-eye-turns\/strabismus-crossed-eyes\/what-is-intermittent-strabismus\/\">constant or intermittent<\/a>\u2014 only occurring as a result of fatigue or stress.<\/p>\n<p><strong>Hypertropia is uncommon, occurring in only 1 in 400 children.<\/strong><\/p>\n<h2>Symptoms of hypertropia<\/h2>\n<ul>\n<li style=\"font-weight: 400;\">Eye strain<\/li>\n<li style=\"font-weight: 400;\">Headaches<\/li>\n<li style=\"font-weight: 400;\"><a href=\"https:\/\/www.optometrists.org\/vision-therapy\/neuro-optometry\/vision-and-brain-injuries\/double-vision-diplopia\/\">Double vision<\/a><\/li>\n<li style=\"font-weight: 400;\">Tilting head for attempt at clearer vision<\/li>\n<\/ul>\n<h2><b>What causes hypertropia?<\/b><\/h2>\n<p>Hypertropia may be either congenital or acquired, and misalignment is due to imbalance in extraocular muscle function. The superior rectus, inferior rectus, superior oblique, and inferior oblique muscles affect the vertical movement of the eyes. These muscles can be paretic, restrictive (fibrosis) or overactive.<\/p>\n<p>Congenital cases may have developmental abnormality due to abnormal muscle structure, usually muscle atrophy\/hypertrophy or rarely, absence of the muscle and incorrect placement.<\/p>\n<p><b>Specific and common causes include:<\/b><\/p>\n<ul>\n<li style=\"font-weight: 400;\">Fourth cranial nerve palsy<\/li>\n<li style=\"font-weight: 400;\">Brown&#8217;s syndrome<\/li>\n<li style=\"font-weight: 400;\">Duane&#8217;s syndrome<\/li>\n<li style=\"font-weight: 400;\">Inferior oblique overaction<\/li>\n<li style=\"font-weight: 400;\">Fibrosis of rectus muscle in Graves Disease<\/li>\n<li style=\"font-weight: 400;\">Surgical trauma to the vertical muscles<\/li>\n<\/ul>\n<h3><b>1. Fourth cranial nerve palsy<\/b><\/h3>\n<p><b>This is the most common cause of <\/b><b>hypertropia.<\/b><\/p>\n<p>The fourth cranial nerve (IV) sends impulses to the eye muscle that controls the downward movement of the eye. If this nerve is weakened or paralyzed, it cannot properly control the eye muscle, resulting in an upward eye turn.<\/p>\n<p>A child may be born with a weakened or paralyzed nerve, or the never may become damaged following a traumatic brain injury, such as a <a href=\"https:\/\/www.optometrists.org\/vision-therapy\/neuro-optometry\/vision-and-brain-injuries\/traumatic-brain-injury-and-neuro-optometry\/5-essential-tbi-facts-you-may-not-know\/concussion-and-vision\/\">concussion<\/a>.<\/p>\n<p>Other names for fourth nerve palsy include superior oblique palsy and trochlear nerve palsy.<\/p>\n<h3><b>2. Brown syndrome<\/b><\/h3>\n<p>This is a rare condition that causes a tight superior oblique tendon that limits the eye\u2019s movement. Brown syndrome is most commonly seen at birth but can also result from an eye socket injury, or from dental or sinus surgery.<\/p>\n<h3><b>3. Duane syndrome<\/b><\/h3>\n<p>This is a congenital rare type of eye turn most commonly characterized by the inability of the eye to move outwards.<\/p>\n<p>The syndrome was first described by ophthalmologists Dr. Jakob Stilling (1887) and Dr. Siegmund T\u00fcrk (1896), and subsequently named after Alexander Duane, who discussed the disorder in more detail in 1905.<\/p>\n<p>Other names for this condition include: Duane&#8217;s retraction syndrome, eye retraction syndrome, retraction syndrome, congenital retraction syndrome and Stilling-T\u00fcrk-Duane syndrome.<\/p>\n<h2><b>How is <\/b><b>hypertropia<\/b><b> diagnosed?<\/b><\/h2>\n<p>Through a comprehensive <a href=\"https:\/\/www.optometrists.org\/childrens-vision\/pediatric-eye-exams-2\/\">eye exam<\/a>, your eye doctor can determine the presence of hypertropia through a series of specialized tests.<\/p>\n<p><b>It is important for <\/b><b>hypertropia<\/b><b> to be diagnosed when a child is still young, to avoid the development of a <a href=\"https:\/\/www.optometrists.org\/vision-therapy-for-lazy-eye\/amblyopia-lazy-eye\/\">lazy eye<\/a>.\u00a0<\/b><\/p>\n<p>A lazy eye may develop as a result of <i>suppression<\/i>, when the brain \u2018shuts off\u2019 vision from the affected eye to avoid double vision. Suppression occurs as the brain cannot process two different visual signals, one from the straight eye and one from the upturned eye. Consequently, the misaligned eye becomes weaker, and the \u2018good\u2019 eye becomes stronger\u2014 affecting 3D vision, or depth perception.<\/p>\n<p><a href=\"http:\/\/www.optometrists.org\/practice-search\/\"><strong>Contact an eye doctor<\/strong><\/a> near you that are experienced in treating hypertropia.<\/p>\n<p><strong>SEE RELATED:<\/strong> <a href=\"https:\/\/www.optometrists.org\/childrens-vision\/a-guide-to-eye-turns\/eye-conditions-causing-strabismus\/\">Eye Conditions That Cause Strabismus<\/a><\/p>\n\n\t<div class=\"practice-search-widget\">\n\t\t<h3>Find an eye doctor for children near you<\/h3>\n\t\t\n\t<form class=\"practice-search-form practice-search-form-widget\" action=\"https:\/\/www.optometrists.org\/practice-search\/results\/\" method=\"get\">\n\n\t\t<input type=\"hidden\" name=\"distance\" value=\"100\" class=\"practice-search-distance\">\n\t\t<input type=\"hidden\" name=\"page\" class=\"practice-search-page\">\n\t\t<input type=\"hidden\" name=\"address_latitude\"><input type=\"hidden\" name=\"address_longitude\">\n\n\t\t<input type=\"text\" name=\"address\" class=\"practice-search-address\" placeholder=\"City, Surburb or Address\" value=\"\">\n\n\t\t\n\t\t\t<input type=\"hidden\" name=\"distance\" value=\"100\" class=\"practice-search-distance\">\n\n\t\t\n\n\t\t<button type=\"submit\" class=\"practice-search-button\">\n\t\t\t\t\t\t\t\t\t<svg width=\"19\" height=\"19\" viewBox=\"0 0 19 19\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"><path fill-rule=\"evenodd\" clip-rule=\"evenodd\" d=\"M10.6796 0.130005C9.15708 0.130059 7.66615 0.5646 6.38198 1.38258C5.09781 2.20057 4.07373 3.36803 3.43004 4.74783C2.78634 6.12763 2.54976 7.66246 2.74808 9.17205C2.9464 10.6816 3.57139 12.1033 4.54964 13.27L0.729639 17.08C0.6364 17.1732 0.562439 17.2839 0.511979 17.4058C0.461519 17.5276 0.435547 17.6581 0.435547 17.79C0.435547 17.9219 0.461519 18.0524 0.511979 18.1743C0.562439 18.2961 0.6364 18.4068 0.729639 18.5C0.917942 18.6883 1.17334 18.7941 1.43964 18.7941C1.5715 18.7941 1.70207 18.7681 1.82389 18.7177C1.94571 18.6672 2.0564 18.5932 2.14964 18.5L5.99964 14.62C7.35406 15.6038 8.98566 16.1324 10.6596 16.13C12.7814 16.13 14.8162 15.2871 16.3165 13.7869C17.8168 12.2866 18.6596 10.2517 18.6596 8.13C18.6596 6.00827 17.8168 3.97344 16.3165 2.47315C14.8162 0.97286 12.7814 0.130005 10.6596 0.130005H10.6796ZM10.6796 14.13C9.49295 14.13 8.33291 13.7781 7.34622 13.1188C6.35952 12.4595 5.59049 11.5225 5.13636 10.4261C4.68224 9.32975 4.56342 8.12335 4.79493 6.95946C5.02644 5.79558 5.59788 4.72648 6.437 3.88736C7.27611 3.04825 8.34521 2.4768 9.5091 2.24529C10.673 2.01378 11.8794 2.1326 12.9757 2.58673C14.0721 3.04085 15.0092 3.80989 15.6685 4.79658C16.3277 5.78328 16.6796 6.94332 16.6796 8.13C16.6796 9.7213 16.0475 11.2474 14.9223 12.3726C13.7971 13.4979 12.2709 14.13 10.6796 14.13Z\" fill=\"#fff\"\/><\/svg>\n\t\t\t\t\t<\/button>\n\n\t\t<button type=\"button\" class=\"practice-search-use-my-location\">\n\t\t\tSearch near me\n\t\t<\/button>\n\n\n\t<\/form>\n\n\n\n\t\t<\/div>\n\n\t\n<h2><b>Complications from hypertropia<\/b><\/h2>\n<p>Vertical misalignment may lead to:<\/p>\n<ul>\n<li style=\"font-weight: 400;\">Strabismic amblyopia (lazy eye)<\/li>\n<li style=\"font-weight: 400;\">Cosmetic defect<\/li>\n<li style=\"font-weight: 400;\">Face turn<\/li>\n<li style=\"font-weight: 400;\">Diplopia or double vision<\/li>\n<li style=\"font-weight: 400;\">Suppression of one eye<\/li>\n<li style=\"font-weight: 400;\">Cyclotropia (a deviation of the eyes)<\/li>\n<\/ul>\n<h2><b>How is <\/b><b>hypertropia<\/b><b> treated?<\/b><\/h2>\n<p>In general, hypertropia can be approached and treated with a variety of procedures. Depending on the individual case, treatment options include:<\/p>\n<ul>\n<li style=\"font-weight: 400;\"><a href=\"https:\/\/www.optometrists.org\/eye-care-for-children\/glasses-for-children\/\">Eyeglasses<\/a><\/li>\n<li style=\"font-weight: 400;\"><a href=\"https:\/\/www.optometrists.org\/vision-therapy\/neuro-optometry\/what-are-prism-lenses\/how-are-prisms-used-in-vision-therapy\/\">Prism therapy<\/a> (for diplopia)<\/li>\n<li style=\"font-weight: 400;\"><a href=\"https:\/\/www.optometrists.org\/vision-therapy\/what-is-vision-therapy\/\">Vision therapy<\/a><\/li>\n<li style=\"font-weight: 400;\">Patching<\/li>\n<li style=\"font-weight: 400;\">Botulinum toxin injection<\/li>\n<li style=\"font-weight: 400;\"><a href=\"https:\/\/www.optometrists.org\/childrens-vision\/a-guide-to-eye-turns\/strabismus-crossed-eyes\/strabismus-surgery\/\">Surgical correction<\/a><\/li>\n<\/ul>\n<h3><b>Eyeglasses<\/b><\/h3>\n<p>Corrective lenses for near or farsightedness can improve eye misalignment. A prism may be added to the lenses for increased improvement.<\/p>\n<h3><b>Patching<\/b><\/h3>\n<p>Placing a patch over the \u2018good\u2019 eye for a few hours each day will force the weaker eye to become stronger.<\/p>\n<h3><b>Vision therapy<\/b><\/h3>\n<p>Vision therapy works to improve the eye-brain connection and improve vision in the affected eye. Vision therapy may be prescribed in combination with eye glasses, patching or surgery.<\/p>\n<p><a href=\"https:\/\/www.optometrists.org\/practice-search\/\"><strong>Schedule an appointment<\/strong><\/a> with a vision therapy eye doctor to start a treatment program.<\/p>\n<h3><b>Surgery<\/b><\/h3>\n<p>Surgery may help to align the eyes, however it cannot treat the underlying problem, and therefore may not achieve long lasting results\u2014 requiring the child to undergo multiple surgeries.<\/p>\n<p>Specialty fellowship trained pediatric ophthalmologists and strabismus surgeons are best equipped to deal with these complex procedures.<\/p>\n<p>Vision therapy, before or after surgery will facilitate the improved neural connections necessary for improved vision and correction of the vertical eye turn.<\/p>\n<h2><b>What is hyper<em>phoria<\/em>?<\/b><\/h2>\n<p>Hyperphoria is an eye condition in which the eye points upwards, but not permanently. This usually occurs when the child is tired, stressed, or with the onset of an illness.<\/p>\n<h3><b>Symptoms\u00a0<\/b><\/h3>\n<p><strong>The most common symptom of hyperphoria is an upward eye turn that is not present all the time, and only occurs intermittently.<\/strong><\/p>\n<p>Common signs of hyperphoria include:<\/p>\n<ul>\n<li style=\"font-weight: 400;\">Double vision<\/li>\n<li style=\"font-weight: 400;\">Blurred vision<\/li>\n<li style=\"font-weight: 400;\">Words appear to move on a page<\/li>\n<li style=\"font-weight: 400;\">Eyestrain<\/li>\n<li style=\"font-weight: 400;\">Headaches<\/li>\n<li style=\"font-weight: 400;\">Difficulty concentrating<\/li>\n<li style=\"font-weight: 400;\">Difficulty with reading fluency<\/li>\n<li style=\"font-weight: 400;\">Reduced comprehension<\/li>\n<\/ul>\n<p>If you experience any of these symptoms <a href=\"https:\/\/www.optometrists.org\/practice-search\/\"><strong>contact an eye doctor near you,<\/strong><\/a> to diagnose and treat your child&#8217;s hyperphoria.<\/p>\n<h2><b>How is hyperphoria treated?<\/b><\/h2>\n<h3><b>Eyeglasses<\/b><\/h3>\n<p>Eyeglasses can impact the position of the eye, especially if the child has a high optical prescription or a significant difference of prescription between the two eyes. Eyeglasses may include a <a href=\"https:\/\/www.optometrists.org\/vision-therapy\/neuro-optometry\/what-are-prism-lenses\/\">prism<\/a> to allow for the eye turn.<\/p>\n<p><strong>However, while eyeglasses are prescribed to correct the presenting refractive error, they generally cannot treat the cause of the hyperphoria<\/strong>.<\/p>\n<h3><b>Vision therapy<\/b><\/h3>\n<p><b>Vision therapy is essential for the treatment of hyperphoria.<\/b><\/p>\n<p>Vision therapy may involve the use of specialized tools such as prisms, a series of vision therapy exercises, computer or virtual reality games and vectograms.<\/p>\n<p>Vision therapy will aim to improve the eye position by strengthening:<\/p>\n<ul>\n<li style=\"font-weight: 400;\">Eye coordination<\/li>\n<li style=\"font-weight: 400;\">Convergence ability<\/li>\n<li style=\"font-weight: 400;\">Divergence ability<\/li>\n<li style=\"font-weight: 400;\">Ability to rapidly switch from convergence to divergence<\/li>\n<\/ul>\n<p><strong>If untreated, hyperphoria may lead to a permanent <a href=\"https:\/\/www.optometrists.org\/a-guide-to-eye-turns\/strabismus-crossed-eyes\/\">eye turn<\/a> or a <a href=\"https:\/\/www.optometrists.org\/vision-therapy-for-lazy-eye\/lazy-eye-faqs\/\">lazy eye<\/a>.<\/strong><\/p>\n<p><strong>LEARN MORE:\u00a0<\/strong><a href=\"https:\/\/www.optometrists.org\/childrens-vision\/a-guide-to-eye-turns\/\">Guide to Eye Turns<\/a><\/p>\n<p><b>If your child is showing signs of an eye turn, or complains of eye strain or difficulties in reading and learning, <a href=\"https:\/\/www.optometrists.org\/practice-search\/\">schedule an eye exam<\/a> for a comprehensive evaluation of your child\u2019s vision and ocular health.\u00a0<\/b><\/p>\n<p>The earlier a vision problem is detected, the sooner your child will achieve clear and comfortable vision\u2014 necessary tools for academic success!<\/p>\n","protected":false},"excerpt":{"rendered":"<p>Hypertropia and hyperphoria are when the eyes are misaligned &#8211; one pointing higher than the other. Both these forms of eye turn can be well managed by optical lenses and vision therapy, often avoiding eye surgery.<\/p>\n","protected":false},"author":4,"featured_media":3430,"parent":991,"menu_order":119,"comment_status":"closed","ping_status":"closed","template":"template-article.php","meta":{"footnotes":""},"categories":[],"tags":[89,285,198,230,217,286,113,115,83],"class_list":["post-3415","page","type-page","status-publish","has-post-thumbnail","hentry","tag-brain-injury","tag-esophoria","tag-esotropia","tag-eyeglasses","tag-hyperopia","tag-hyperphoria","tag-lazy-eye","tag-strabismus","tag-vision-therapy"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v23.9 - https:\/\/yoast.com\/wordpress\/plugins\/seo\/ -->\n<title>Hypertropia or Hyperphoria? - Optometrists.org<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/www.optometrists.org\/childrens-vision\/a-guide-to-eye-turns\/hypertropia-and-hyperphoria\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Hypertropia or Hyperphoria? - Optometrists.org\" \/>\n<meta property=\"og:description\" content=\"Hypertropia and hyperphoria are when the eyes are misaligned - one pointing higher than the other. 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