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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 may be either paretic, restrictive (fibrosis) or overactive effect of the muscles.
Impairment of cranial nerve IV, which can be congenital, causes the associated eye to drift up and perhaps slightly inward. Sixth nerve palsy causes the associated eye to deviate inward and has many causes due to the relatively long path of the nerve. Increased cranial pressure can compress the nerve as it runs between the clivus and brain stem.
The optic nerve can be damaged when exposed to direct or indirect injury. Direct optic nerve injuries are caused by trauma to the head or orbit that crosses normal tissue planes and disrupts the anatomy and function of the optic nerve; e.g., a bullet or forceps that physically injures the optic nerve.
The fibers from the retina run along the optic nerve to nine primary visual nuclei in the brain, from which a major relay inputs into the primary visual cortex. A fundus photograph showing the back of the retina. The white circle is the beginning of the optic nerve. The optic nerve is composed of retinal ganglion cell axons and glia.
The optic tract is a continuation of the optic nerve that relays information from the optic chiasm to the ipsilateral lateral geniculate nucleus (LGN), pretectal nuclei, and superior colliculus. [14] The optic tract represents the first stage in the visual pathway in which visual information is transferred in a homonymous nature. [ 15 ]
Heterophoria is the misalignment of the visual axis such that one or both eyes are not properly fixated to an object of interest. When the visual axis is misaligned in such a way, it is corrected by the fusional vergence system.
Amblyopia, also called lazy eye, is a disorder of sight in which the brain fails to fully process input from one eye and over time favors the other eye. [1] It results in decreased vision in an eye that typically appears normal in other aspects. [1]
Diplopia is the simultaneous perception of two images of a single object that may be displaced horizontally or vertically in relation to each other. [1] Also called double vision, it is a loss of visual focus under regular conditions, and is often voluntary.