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Divergence insufficiency
Strabismus
Key Points
- •Divergence insufficiency produces esotropia at distance with orthophoria at near and full abduction - the critical differentiator from bilateral sixth nerve palsy (which has limited abduction).
- •DI is a diagnosis of exclusion - acute onset mandates MRI brain and fundoscopy to rule out raised ICP, posterior fossa lesion, or brainstem pathology.
- •Most common in the elderly as a benign age-related decompensation; base-out prism glasses are first-line treatment.
- •Always check for papilloedema - its presence means this is NOT benign DI but bilateral VI nerve palsy from raised ICP.
- •Surgical options for refractory cases include bilateral LR resection (4–6 mm) or bilateral MR recession (3–4 mm); adjustable sutures are recommended.
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Keep reading Divergence insufficiency
17 more sections are included with the Clinical plan.
- Definition
- Epidemiology
- Aetiology and causes
- Pathogenesis
- Classification
- Risk factors and associations