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Microtropia: The Subtle Misalignment You Might Be Overlooking


4 min


Squinting could be a sign of microtropia.

In the world of vision and eye health, there are a number of conditions that can affect our eyesight. Some are well-known, like nearsightedness or astigmatism, while others are relatively obscure.

One such condition that frequently goes unnoticed is microtropia. Despite its subtle nature, microtropia can have a significant impact on one’s vision and quality of life. In this blog post, we will explore what microtropia is, its causes, symptoms, and potential treatments.

What is Microtropia?

Microtropia is a term that might not be familiar to some people. It refers to a subtle form of strabismus, also known as an eye turn or squint. In such condition, one eye deviates slightly from its normal alignment.

What is Strabismus?

Strabismus is a condition in which the eyes do not align properly and point in different directions. Under this condition, eyes cannot work together as a team.

Why is Microtropia often overlooked or misdiagnosed?

Microtropia, as the name suggests, is characterized by a very small or subtle misalignment of the eyes. This small-angle strabismus is measuring less than 5 degrees. Unlike more noticeable forms of strabismus, microtropia may not be immediately obvious, making it easy to overlook.

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Microtropia is a subtle form of strabismus, also known as eye turn or squint.

Causes of Microtropia

Microtropia can have various underlying causes, including:

1. Congenital: Some individuals are born with microtropia due to a developmental issue in the eye muscles or nerves responsible for eye movement.

2. Result of previous strabismus treatment: Microtropia can be also a result of a surgery for a larger squint.

3. Injury or trauma: A head injury or trauma to the eye can lead to microtropia by damaging the eye muscles or nerves.

4. Eye conditions: Certain eye conditions, such as cataracts or retinal disorders, can disrupt the alignment of the eyes and contribute to developing this condition.

5. Neurological conditions: Neurological disorders like cerebral palsy or stroke can affect the control of eye muscles, resulting in microtropia.

Symptoms of Microtropia

While microtropia may not be immediately obvious to the affected individual or others, there are some subtle signs and symptoms to watch out for:

1. Difficulty with depth perception: The condition can make it challenging to judge distances accurately.

2. Headaches: Individuals with microtropia often experience headaches, especially after prolonged visual tasks, as the brain struggles to fuse the misaligned images from each eye.

3. Inaccurate eye-hand coordination: It can make tasks that require precise eye-hand coordination, such as catching a ball or threading a needle, more challenging due to the subtle misalignment of the eyes.

4. Double vision: One of the most common symptoms of microtropia is double vision, especially when looking at objects up close.

5. Eye strain: People with microtropia often experience eye strain, which can lead to discomfort and headaches.

People with microtropia often experience eye strain, which can lead to discomfort and headaches.


The diagnosis relies on a variety of test results.

  1. Cover Test: During this test, one eye is covered, and the doctor observes the movement of the uncovered eye. The test helps detect any misalignment or subtle eye turn. This test looks for manifest strabismus.
  2. Visual Acuity Test: The eye care professional will start by assessing your visual acuity using an eye chart. This test helps determine how well each eye can see and whether there are any significant differences in visual acuity between the eyes. In case of microtropia, there is a reduced visual acuity in the eye that has it.
  3. Alternating Cover Test: This test involves alternately covering and uncovering each eye to assess their alignment and the presence of any deviation.
  4. Refraction Test: Refraction is done to determine if a prescription for eyeglasses is needed to correct any refractive errors, such as nearsightedness or farsightedness, which can contribute to microtropia symptoms.
  5. Cycloplegic Refraction: In some cases, a cycloplegic refraction may be performed, which involves using eye drops to temporarily paralyze the eye’s focusing muscles.

Treatment Options

  1. Lenses and Prisms: Some cases are successfully managed with the use of lenses or prisms.

  2. Vision Therapy: The majority of microtropia cases require vision therapy. Vision therapy exercises may be prescribed to help improve eye coordination and reduce the deviation in some cases. These exercises are often performed under the guidance of a vision therapist.

Potential Complications of Untreated Microtropia

If left untreated, it can lead to several potential complications, including:

a. Amblyopia (Lazy Eye): Microtropia can result in amblyopia, a condition in which one eye does not develop normal visual acuity. This can lead to permanent vision impairment in the affected eye.

b. Strabismus-related Vision Problems: Persistent double vision or visual disturbances can impact daily life and make tasks such as reading or driving difficult.

c. Psychosocial and Quality of Life Issues: Strabismus, including microtropia, can affect self-esteem and quality of life, especially in social and professional settings, due to the appearance of misaligned eyes.


Microtropia may be subtle, but it can significantly impact an individual’s vision, overall quality of life, and daily activities. If you or someone you know is experiencing symptoms such as double vision, eye strain, headaches, inaccurate eye-hand coordination, or difficulty with depth perception, it’s essential to seek the advice of an eye care professional.

Early and accurate diagnosis, as well as appropriate treatment, can make a world of difference in managing this condition and improving visual comfort and function. Remember, even subtle eye misalignments should not be overlooked when it comes to your eye health.

Frequently Asked Questions

What is microtropia?

Microtropia is a type of strabismus where one eye slightly deviates from its normal alignment, causing mild double vision or visual disturbances. The misalignment is less noticeable than in other forms of strabismus.

What are the synonyms for microtropia?

Microtropia can be also referred to as Microstrabismus and Monofixation Syndrome.

What are the treatment options for microtropia?

Treatment options include corrective lenses (glasses or contacts), vision therapy exercises, and surgery when necessary.

What are the potential complications of untreated microtropia?

Untreated microtropia can lead to amblyopia (lazy eye), persistent double vision, and psychosocial challenges due to the appearance of misaligned eyes. Early treatment is essential to prevent these complications.

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