Hypertropia

What is hypertropia?

Hypertropia is a condition that makes one of your eyes look up all the time. It’s a form of strabismus.

Strabismus is any condition that affects how your eyes align. In other words, one eye is turned in a direction that’s different from the other eye.

You have six muscles in each of your eyes that control your eye movements. Usually, these muscles work together and point both your eyes in the same direction when you look at something. People with strabismus can’t control their eye movements and can’t maintain ocular alignment (eye position).

If you have hypertropia, your affected eye will pull out of alignment with the other. It’s usually most noticeable when you’re trying to look straight ahead. Your affected eye will always look slightly up — away from the center of your face — even if you’re trying to look in a different direction. You might see this referred to as your eye being out of vertical alignment.

It might feel like your eyes are straining and tired. Some people (especially kids) don’t know they have hypertropia or that something is wrong with their eyes. Your child might tilt their head to see out of their affected eye without even noticing they’re doing it.

Hypertropia can make your vision blurry and can cause double vision (diplopia). Kids and adults who have had strabismus for a long time don’t usually experience double vision.

Even if your child has hypertropia (or other forms of strabismus), that doesn’t mean they’ll have other health conditions that affect their brain or body.

Visit an eye care specialist as soon as you notice any changes in your eyes or vision.

Who does hypertropia affect?

Anyone can experience hypertropia. Around 5% of people in the U.S. have some form of strabismus.

Hypertropia often runs in families, but that doesn’t mean your children will definitely develop it if you’ve experienced hypertropia.

What are the symptoms of hypertropia?

The most common symptom of hypertropia is one of your eyes being noticeably out of alignment. Sometimes your eyes will alternate positions. When this happens, your unaffected eye might look like it’s pointing down while your eye while your affected eye looks like it’s pointing straight ahead.

Other symptoms of hypertropia include:

• Double vision (diplopia).
• Blurry vision.
• Eye strain or tired eyes.
• Headaches.

Some people with hypertropia only experience symptoms when they’re stressed or tired. An eye care specialist might refer to this as intermittent hypertropia.

Young children who have hypertropia have an increased risk of developing lazy eye (amblyopia). Visit an eye care specialist as soon as you notice any changes or symptoms in your child’s eyes.

What causes hypertropia?

Two cranial nerves — cranial nerve III (oculomotor nerve) and cranial nerve IV (trochlear nerve) — control the muscles that move your eyes vertically (up and down). Anything that damages these nerves, muscles or your brain can cause hypertropia, including:

• Strokes.
• Eye injuries.
• Damage during or after eye surgery.

Certain health conditions can cause hypertropia, including:

• Graves’ disease.
• Thyroid eye disease.
• Brown syndrome.
• Myasthenia gravis.

You can develop hypertropia if the muscles that move your eyes are too tight or too weak.

Other types of strabismus can cause hypertropia. People with horizontal strabismus sometimes develop hypertropia. Dissociated vertical deviation (DVD) is a special form of hypertropia that makes your one or both of your eyes drift up intermittently (only sometimes). DVD usually affects kids with strabismus.

How is hypertropia diagnosed?

An eye care specialist will diagnose hypertropia with an eye exam. They’ll look at your eye as it moves and while you’re looking straight ahead. They’ll also look inside your eye to rule out other issues that could be affecting it and causing your symptoms.

You might need an MRI or blood tests.

How is hypertropia treated?

How hypertropia is treated depends on what’s causing it. The most common treatments include:

• Eyeglasses: Glasses with special lenses can correct the refractive error that’s causing hypertropia.
• Prisms: Glasses with special prisms help shift the images you see to prevent diplopia (double vision).
• Wearing an eye patch: Children who have amblyopia (lazy eye) may need to wear an eye patch over their strong eye to force their brain to use the weaker eye to see. Adults with diplopia might need an eye patch to block the second image.
• Botulinum toxin: An eye care specialist might inject a dose of botulinum toxin to relax the affected muscles around your eye.
• Surgery: Surgically tightening, weakening or changing the position of your eye muscles can sometimes realign your eyes.

How can I prevent hypertropia?

You probably can’t prevent hypertropia. Because it’s caused by health conditions you can’t control or sudden issues like strokes or eye injuries, there isn’t usually anything you can to prevent it.

In general, make sure you always wear protective eyewear and proper safety equipment while working with tools or doing any activity that could injure your eyes.

What can I expect if I have hypertropia?

Your vision and eye alignment should return to normal after the hypertropia is treated and your eyes are correctly aligned.

Most causes of hypertropia won’t impact your vision long term. However, some people who experience a stroke or eye injury have low vision even after hypertropia is treated.

An eye care specialist will tell you what to expect and how long it will take your eyes to recover.

When should I have my eyes examined?

Having your eyes and vision checked regularly can help an eye care specialist identify problems right away. How often you should get your eyes checked usually depends on your age:

• Kids: A pediatrician should check your child’s eyes at every well-child visit until they’re old enough to start school, and then every one to two years.
• Adults younger than 40: Every five to 10 years.
• Adults between 40 and 54: Every two to four years.
• Adults older than 55: Every one to three years.

You might need your eyes checked more often than this if you wear glasses, contacts or need another type of visual aid. People with diabetes need their eyes checked more often than what’s listed here.

Ask an eye care specialist how often you need an eye exam.

When should I see my healthcare provider?

See a healthcare provider or eye care specialist as soon as you notice any changes in your eyes or vision.

Go to the emergency room if you have any of the following symptoms:

• A sudden loss of vision.
• Severe eye pain.
• You can’t move one or both of your eyes.
• You see new flashes or floaters in your eyes.

What questions should I ask my doctor?

• Do I have hypertropia or another type of strabismus?
• What’s causing the hypertropia?
• Which treatments will I need?
• How long will it take to recover?

A note from Cleveland Clinic

Hypertropia makes one of your eyes drift or look up, even if you’re not trying to. It’s scary not to be in control of a part of your body you usually are — but hypertropia is very treatable. Hypertropia usually won’t have long-term impacts on your vision.

Depending on what’s causing the hypertropia (and which symptoms you’re having), an eye care specialist will find a treatment that can restore your eyes’ alignment or help with your double vision.

If you notice your child tilting their head, they might have hypertropia. Visit an eye care specialist as soon as you notice any symptoms in their eyes. Young children with untreated hypertropia have an increased risk of developing lazy eye.