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Case of the week 10 ( November 2011 )
Large positive angle Kappa : Apparent Exotropia

This 25 years old man was referred from a colleague reporting : " XT of both eyes " which is also the complaint of the patient     

   He is otherwise healthy and there is no family history of strabismus.

The eye examination shows bilateral normal fundi 

VA is    6/6 OD    6/6  OS        cycloplegic refraction is insignificant

   Observing the corneal light reflex , it is at the edge of the pupil in both eyes , using the  Krimsky Test this out deviation measures 8 PD in both eyes

Motility exanination : No change in the angle allover the 9 cardinal directions

   Cover uncover test shows : no shift






First we have to know the causes of decentered corneal reflex without eye shift on cover - uncover test
 
 Strabismus course : Examination of strabismus patient

By ophthalmoscopy it is easy to differentiate between ectopic macula and eccenteric fixation

My experience : the screen of the autorefractometer is a fair estimator of the angle Kappa , in this patient the corneal light reflex is shifted nasally near the pupillary edge , named large positive angle Kappa giving the appearance of pseudostrabismus or apparent exotropia
I know all of you have examined many patients having apparent esotropia which is encountered daily , while cases of apparent exotropia due to large positive angle Kappa are rarely seen   



Strabismus course : Examination of strabismus patient

الموقع المصري للحول وامراض الجهاز الحركي للعين

The Egyptian Site of Strabismus & Oculomotor Disorders