Neuro-Ophthalmic
Divergence Insufficiency
Also known as: divergence insufficiency, distance diplopia, distance esophoria, comitant distance esotropia, distance worse horizontal diplopia
Filed as: Routine
Source-cited from the record's own evidence list. Clinical content programme led by Dr Ankit Mathur, PhD, Grad Cert Ocu Thera, B.S. Optom. How the clinical content is governed
Clinical decision support only
Overview
An esodeviation larger at distance than at near, producing horizontal double vision that troubles driving and distance viewing while near work stays comfortable. Abduction is full, the deviation is comitant, and the pupils and neurological examination are unremarkable. A comitant distance esodeviation in an older adult still merits care, since a sixth nerve palsy can present with a similar complaint.
Recognition
Symptoms: what patients report
- Horizontal binocular diplopia at distance or distance-worse diplopia.
- Near vision is typically comfortable or less affected.
- Symptoms may be intermittent initially and worse when tired.
Signs: what the examination shows
- Comitant esodeviation greater at distance than near.
- Full abduction and no clear gaze-dependent limitation in a typical routine comitant pattern.
- Normal pupils and no neurologic or orbital signs.
What OptoGuide™ covers for divergence insufficiency
- Pattern reasoning: what this combination of findings points to, and its differentiators
- Don't-miss risks and escalation triggers
- Management tiers with linked Australian therapeutics
- Referral urgency, specialty, and letter drafting
Sources
- Sagging Eye Syndrome (Divergence Insufficiency) — EyeWiki
- The Neuro-Ophthalmology Survival Guide (Pane, Miller & Burdon) — standard reference text
Standard texts: Kanski's Clinical Ophthalmology: A Systematic Approach, Oxford Handbook of Ophthalmology, Oxford American Handbook of Ophthalmology, Signs in Ophthalmology: Causes & Differential Diagnosis.