Decompensated phoria

Decompensated Phoria

Decompensated phoria is a condition in which a latent misalignment of the eyes, known as phoria, becomes symptomatic and affects binocular vision. This condition can lead to symptoms such as double vision, eye strain, headaches, and difficulty focusing. It is important for medical students and practitioners to understand the underlying mechanisms, diagnosis, and management of decompensated phoria to effectively treat patients experiencing these symptoms.

Pathophysiology

Phoria is a type of heterophoria, which is a latent deviation of the eyes that is usually compensated by the brain's fusional mechanisms. In normal conditions, the brain can align the eyes properly to maintain single binocular vision. However, when these compensatory mechanisms are overwhelmed or fatigued, the phoria can decompensate, leading to symptomatic misalignment.

Decompensated phoria can be classified into different types based on the direction of the misalignment:

• Exophoria: A tendency for the eyes to drift outward.
• Esophoria: A tendency for the eyes to drift inward.
• Hyperphoria: A vertical misalignment where one eye tends to drift upward.
• Hypophoria: A vertical misalignment where one eye tends to drift downward.

Causes

Several factors can contribute to the decompensation of phoria, including:

• Visual stress: Prolonged periods of near work or screen time can fatigue the eye muscles.
• Illness or fatigue: General physical fatigue or illness can reduce the ability to compensate for phoria.
• Age: As people age, their ability to compensate for phoria may decrease.
• Refractive errors: Uncorrected refractive errors can exacerbate phoria.

Symptoms

Patients with decompensated phoria may experience a variety of symptoms, including:

• Diplopia (double vision)
• Asthenopia (eye strain)
• Headaches
• Blurred vision
• Difficulty concentrating

Diagnosis

The diagnosis of decompensated phoria involves a comprehensive eye examination, including:

• Cover test: To assess the presence and type of phoria.
• Prism cover test: To measure the degree of phoria.
• Fusional vergence testing: To evaluate the patient's ability to compensate for phoria.
• Refraction: To identify any refractive errors that may be contributing to the symptoms.

Management

The management of decompensated phoria may include:

• Optical correction: Prescribing glasses or contact lenses to correct refractive errors.
• Prism lenses: To help align the eyes and reduce symptoms.
• Vision therapy: Exercises to improve the coordination and strength of the eye muscles.
• Lifestyle modifications: Reducing visual stress by taking regular breaks during near work.

Prognosis

With appropriate management, many patients with decompensated phoria can achieve significant symptom relief. However, ongoing management may be necessary to maintain comfortable binocular vision.

Also see

• Strabismus
• Binocular vision
• Diplopia
• Asthenopia
• Vision therapy

External

• Age-Related Macular Degeneration

• Amblyopia (Lazy Eye)

• Anophthalmia and Microphthalmia

• Astigmatism

B

• Behçet's Disease* Bietti's Crystalline Dystrophy

• Blepharitis* Blepharospasm

C

• Cataracts

• Coloboma

• Color Blindness

• Corneal Conditions

D

• Diabetic Retinopathy

• Dry Eye

F

• Floaters

G

• Glaucoma

I

• Idiopathic Intracranial Hypertension

L

• Low Vision

M

• Macular Edema

• Macular Hole

• Macular Pucker

P

• Pink Eye

R

• Rare Diseases

• Refractive Errors

• Retinal Detachment

• Retinitis Pigmentosa

• Retinoblastoma

• Retinopathy of Prematurity

S

• Stargardt Disease

U

• Usher Syndrome

• Uveitis

V

• Vitreous Detachment