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1 Divergence insufficiency in cerebellar ataxiaThis is a 65-yo woman with complaints of imbalance (progressive over years) and horizontal diplopia at distance. On her exam, there was a small symptomatic esotropia at distance, but only a small esophoria at near. There were no obvious abduction deficits, and the 6 prism diopter ET at distance was...Abnormal Alignment, Divergence Insufficiency, OMS Cerebellar
2 Measuring Divergence AmplitudeDivergence insufficiency should be suspected in patients with binocular horizontal diplopia at distance (but not near) who lack abduction deficits. There should be an esodeviation greater at distance, and in older patients with levator dehiscence (or previous ptosis surgery) and prominent superior s...Insufficient Divergence
3 Sagging Eye Syndrome and Cerebellar Disease in Divergence InsufficiencyThis is a 70-year-old woman who presented with diplopia at distance. Her exam demonstrated orthophoria at near with a fairly comitant 8-10 PD esotropia at distance without abduction paresis, consistent with divergence insufficiency (DI). With age, patients may develop an esodeviation greater at dist...Abnormal Alignment; OMS Cerebellar; Jerk Nystagmus; Gaze Evoked Nystagmus; Divergence Insufficiency
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