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Microtopia

 
Author: Alexey Portnov, family doctor
Date created: 12.05.2012
Last reviewed: 27.10.2025

Microtropia (monofixation syndrome) can be primary or occur as a result of surgical intervention after correction of a large angle of deviation.

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Symptoms of microtropia

  1. Anisometropia occurs in almost 90% of all cases and is often accompanied by hypermetropia or hypermetropic astigmatism.
  2. A very small angle of deviation (8 D or less) may or may not be detected by the cover test.
  3. Central suppression scotoma in the deviated eye prevents the phenomenon of confusion and can be detected by:
  • Bagolinu striped glasses. Observe the interruption of the oblique line in the figure of the cross at the point of intersection, visible to the microtropic eye with suppressive scotoma.
  • test with a 4D prism with the base facing outwards
    • When a 4 D prism is placed base outward in front of a normal eye, an unexpected shift of the image occurs from the fovea and parafoveal region, the temporal side of the retina, which provokes a refixation movement.
    • There are no adjustment movements in the microtropic eye, since the image shift occurs within the eupression scotoma.
    • According to Hering's law, the fellow eye deviates outward when the eye under the prism refixes, followed by a fusional movement in the opposite direction to correct the image displacement.
    • If the central scotoma affects the function of the fovea, then the adjustment movement does not occur.
  1. Other features: ACS, normal or near-normal peripheral fusion amplitude, and decreased stereopsis.

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Treatment of microtropia

Spectacle correction of anisometropia and occlusion is performed to treat amblyopia, but restoration of bifoveal fixation is almost impossible.