V-Pattern Esotropia and Exotropia Clinical Presentation

Updated: Dec 09, 2021
  • Author: Neepa Thacker, MBBS, MS, DNB, FRCS; Chief Editor: Donny W Suh, MD, MBA, FAAP, FACS  more...
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The most common presenting signs of V-pattern strabismus are as follows:

  • Inward or outward deviation of the eyes

  • Abnormal eye movements in different gazes

  • Asthenopia (eyestrain)

  • Abnormal head posture, chin down in V-pattern exotropia and chin up in V-pattern esotropia

  • Diplopia in older children and adults



The physical examination includes a general eye examination combined with a detailed ocular motility examination. The ocular motility examination, performed with the refractive error corrected, consists of the following:

  • Note any abnormal head position.

  • Perform cover tests with prisms in the primary position, 30° upgaze and 30° downgaze at near and at distance.

  • With ocular rotations, look for associated underaction or overaction of oblique muscles.

  • Perform a head tilt test if V-pattern strabismus is noted in patients with suspected bilateral superior oblique palsy.

  • Measure torsion in patients with suspected inferior oblique muscle overaction to check for excyclotorsion.

  • When required, perform sensory testing, including distance and near stereoacuity, and other tests.



See Pathophysiology.