Pediatric Hypertropia

Hypertropia is a type of strabismus, also known as misalignment of the eyes. Hypertropia happens when either eye drifts or looks upward.

Infants' eyes usually align by the age of 2 to 3 months, even if the eyes seem to wander in newborns. Hypertropia that continues or develops after that age can cause:

• "Lazy eye" (amblyopia): Inability of the eye to see well, in spite of optical correction
• Loss of depth perception or 3-dimensional vision 

Learn more about our Ophthalmology program at Children's National.

The most common cause of hypertropia is palsy (weakness) in one of the cranial nerves, the third or fourth nerve. Hypertropia may also co-exist with infantile strabismus, esotropia or exotropia. Other causes of hypertropia include problems that may be congenital (present at birth) or develop later:

• 3rd or 4th cranial nerve palsy
• Brown syndrome: Problem with a tight eye muscle tendon
• Duane syndrome: Problem with wrong innervation of the eye muscles

Hypertropia may be intermittent (happening occasionally) or constant and the symptoms may be barely noticeable. The most common symptoms are:

• One or both eyes wandering upward
• Head tilt to compensate for the eye misalignment

You or your child's pediatrician may notice that your child's eyes or head are not straight.

At Children's National Hospital, we emphasize the need for a pediatrician's vision and ocular alignment screening at regular well-baby visits. When in doubt, your pediatrician will refer your child to an ophthalmologist for a comprehensive eye evaluation. If there is family history of pediatric eye diseases, we recommend an early comprehensive eye examination.

Your child's pediatrician may recommend further testing as follows:

• Diagnostic imaging, including MRI scans, to determine whether the eye misalignment is being caused by nerve, rather than muscle, problems

Treatment for hypertropia aims to ensure proper vision in both eyes and aligning the eyes. At Children's National Hospital, our treatment options include:

• Glasses to correct vision problems such as nearsightedness, farsightedness or astigmatism that may be contributing to the hypertropia
• Eye patch over the strong eye to improve the vision in the weak eye
• Surgery on the eye muscles to realign the eyes