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A 33-year-old woman was referred for evaluation of intermittent esotropia. When playing video games at a distance or when reading, she developed oscillopsia with eyestrain and noted that her right eye turned up and in. She had undergone strabismus surgery for crossed eyes as a young child and more recently had laser in situ keratomileusis performed. She was medically healthy and neurodevelopmentally normal but had been born 4½ weeks premature. There was no family history of strabismus, and she denied diplopia.
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Dissociated horizontal deviation
C. Reversed fixation test
The term dissociated horizontal deviation (DHD) was originally used to describe a unique form of intermittent exotropia in which the measured exodeviation was larger with 1 eye fixating than the other.1- 4 In some cases, the exodeviation resolves or converts to a large esodeviation when the patient fixates with the nonpreferred eye. Associated clinical findings include latent nystagmus, dissociated vertical divergence, and sensorial suppression of the nonfixating eye, indicating that DHD develops only when binocular visual input is preempted early in life.3- 6 Some cases arise spontaneously, but most patients have undergone previous bimedial recessions.5
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Corresponding Author: Michael C. Brodsky, MD, Department of Ophthalmology, Mayo Clinic, 200 First St SW, Rochester, MN 55905 (email@example.com).
Published Online: April 15, 2021. doi:10.1001/jamaophthalmol.2020.4929
Conflict of Interest Disclosures: None reported.
Additional Contributions: We thank the patient for granting permission to publish this information.
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