This document discusses various eye examination techniques to evaluate eye alignment and deviations. It describes different types of strabismus or deviations including esotropia, exotropia, hypertropia, and hypotropia. It also classifies deviations based on age of onset, fixation type, and whether the deviation is comitant or incomitant. The Hirschberg test uses light reflection to evaluate corneal alignment. Cover tests including cover-uncover, alternating cover, and prism alternate cover tests are used to determine the type and amount of deviation as well as the strength of fixation in each eye.

1. Pemeriksaan
Kedudukan Bola
Mata dan
Strabismus

2. DEVIASI BOLA MATA
Manifes
(Heterotropia)
Latent
(Heterophoria)

3. JENIS DEVIASI BOLA MATA
Esotropia (ET)
Hypertropia (HT)
Esophoria (E)
Hyperphoria (H) Hypophoria (H0)
Hypotropia (H0T)
Exotropia (XT) Exophoria (X)

4. KLASIFIKASI DEVIASI BOLA MATA
 Usia terjadinya : infantil dan didapat
 Fiksasi : alternating, monokular
 Variasi deviasi berdasarkan posisi gaze atau fiksasi mata
: comitant, incomitant

5. HIRSCHBERG TEST
(CORNEAL REFLEX
TEST)

6. HIRCHBERG TEST (CORNEAL REFLEX )

7. Teknik Pemeriksaan Tes Reflex Kornea (Hirschberg)
Pantulan Cahaya pada kornea

8. INTERPRETASI
A. Mata Normal
B. 15◦ (30 △) Reflex cahaya berada di
margin pupil (2 mm dari tengah
pupil)
C. 30◦ (60 △) Reflex cahaya berada di
iris pertengahan antara tepi pupil
dan limbus
D. 45◦ (90 △) Reflex cahaya berada di
limbus

9. INTERPRETASI
• Mata Normal
• 15◦ (30 △) Esotropia
• 15◦ (30 △) Exotropia
• 15◦ (30 △) Hypertropia
• 15◦ (30 △) Hypotropia

10. COVER TEST

11. TUJUAN
• Berdasarkan kemampuan fiksasi pasien :
• membedakan antara foria dan tropia
• mengetahui derajat deviasi
• mengetahui derajat atau titik fiksasi yang terbaik dari
pasien
• mengetahui kekuatan fiksasi tiap mata
• Dibagi dalam beberapa tes, yaitu :
• Cover test
• Uncover test
• Alternate Cover Test
• Prism (-Alternate) Cover test

12. Equipment
VA Chart
Near Cover Test Target
Occluder
Penlight /
Over head Torch

13. Set Up The Target
For Distance:
An Isolated letter, one line larger than the VA in the patient’s
seeing eyes with best correction.
Suppose patients poor seing eye has 6/9 vision, ask him to
focus any letter of 6/12 optotype. Like the “H”.

14. Set Up The Target
For Near :
An Accomodative target hold at 40 cm.

15. VIDEO

16. COVER - UNCOVER
TEST

17. VIDEO

18. ALTERNATING
COVER TEST

19. ALTERNATING COVER TEST
1. Child fixates on a point (eg small toy, penlight)
2. Cover one eye for 1-2 seconds
3. Rapidly uncover the first eye and cover the second for 1-2
seconds
4. Rapidly uncover the second eye and cover the first again for 1-
2 seconds
5. Observe for refixation (suggests hidden phoria)

20. VIDEO

21. PRISM
ALTERNATE
COVER TEST

22. ALTERNATING COVER TEST
Prism Alternate cover test
• Prisms of varying amount
are held over one eye or
botheyes during alternate
cover testing;
• The amount of prism that
neutralizes the deviation,
such that eye movement
is no longer seen as the
occluder is moved from
one eye to the other,
represents the magnitude
of the deviation

23. PRISM
SILMULTANEOU
S COVER TEST

24. PRISM SIMULTANEOUS COVER TEST
Simultaneous prism and cover test
• Measures the manifest
deviation during binocular
viewing (only the
heterotropia).
• is performed by placing a
prism in front of the
deviating eye and covering
the fixating eye at the same
time. The test is repeated
using increasing prism
powers until the deviated
eye no longer shifts. This
test has special application
in monofixation syndrome.

25. T E R I M A
K A S I H