Esophoria

[Mich1111]

I was just diagnosed with this. My vision is sort of slanted. Not double but the text just appears to slant and slope some. I have no idea if it's related or not to the esophoria. It was diagnosed doing the cover test. Turns inward. Regular test, uncovered, using both eyes together are in sync.  My ophthalmologist wasn't even concerned. He said usually when this finding takes place, they just note it and unless the patient has bad symptoms (which usually never happens, they don't do anything). He also said it's very common. Many people have this. I am 40 years old. Does this mean I've always had it or just developed it now? My eye doctor said he didn't believe there was any CNS involvement. Well, it's not that I didn't trust him, but I do have a neurologist I see for migraines so I explained my weird vision and he ordered an MRA/MRI of the brain. I had that done last night and the tech even did scans of the eyes orbits since I was complaining of vision stuff. Got a call today and my MRI, MRA and orbits, are unchanged from the last time I had this done in 2011. So good news. I am not sure I needed this done but I feel better knowing we are not talking brain tumors, aneurysm, stroke or MS.

So my questions are this:

1. What precisely is esophoria? I was told mine was small.
2. Have I probably had it all my life or maybe it is just coming out now?
3. Could this be causing my slanted vision or not?
4. Given the fact that my brain is fine, are there other causes or is this strictly an eye muscle issue without a bad cause behind it?
5. Is it true that this is a common finding in many people and many eye docs don't even mention it to the patient if the esophoria is small and not causing symptoms?

Thank you kindly.

[Mich1111]

Thank you for the clear, precise, wonderful reply. I will check out the wealth of information on the condition. I do have an astigmatism just diagnosed. Here are my numbers:

Right Eye:
Sphere: - 3.50
Cylinder: +.50
Axis: 75

Left Eye:
Sphere: - 4.75
Cylinder: +.75
Axis: 70

Apparently the ophthalmologist toned down the numbers just a bit since he felt the tech figured out a stronger script than needed or something like that. I know the tech did some corneal testing (or mapping?) and it showed astigmatism.

My doctor assured me he didn't see any signs of macular degeneration or anything on the macular or optic nerve, he said everything looked good. My mom has macular degeneration and even lost her sight in one eye during a treatment for it since she unfortunately developed that rare eye infection after the injection called Endophthalmitis. That was a nightmarish time since we ended up down at Mayo Clinic in Rochester (we live in Minnesota) as they were trying to save her sight. She had surgery but her eye was too far gone, and then she developed a pulmonary embolism. Big nightmare that's thankfully over but my mom's permanently without sight in her left eye.. at least she's alive though.

Anyway, do you believe the astigmatism I have is enough to cause the slanted vision?

I can't thank you enough for your prompt and informative, response. :)

[Houman Vosoghi, MD]

1)  A slight misalignment of the eyes that is only visible when one eye is covered (brain makes them work together under binocular conditions).  There is a lot of good information on it on the web if you google it.
2)  Probably since childhood
3)  Unlikely.  I would want to make sure you are refracted correctly for any astigmatism and checked to make sure you don't have any macular pathology.
4)  see above
5)  Yes

HV