HomeAnswersOphthalmology (Eye Care)decompensated heterophoriaI am diagnosed with decompensated heterophoria. Please help.

Is there anything I can do about decompensated heterophoria?


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Published At June 23, 2018
Reviewed AtFebruary 17, 2024

Patient's Query

Hello doctor,

I have had binocular, horizontal esotropia for two years now, worse on distant gaze. My ophthalmologist diagnosed it to be decompensated heterophoria. Is there anything I can do about it? I spend a lot of time writing and reading on my computer, could that make it worse?


Welcome to icliniq.com.

Decompensated heterophoria, can result from a variety of decompensating factors. The most notable few are refractive error and recent fever or stressful events like dieting or sleep deprivation. Refractive errors are easy to detect and correct. You can do a simple test called pinhole test at home to check if you do have a refractive error. Just take any piece of paper and poke a hole in it with a pen. Then try looking at things at least 6 meters away. If you feel things look sharper or better in any way that means that you need glasses, or if you already wear glasses, then the power has changed. The sure shot way to diagnose refractive errors of-course is to get a cycloplegic refraction done by an ophthalmologist. Cases who do not respond may need an orthoptic referral for prismatic lenses. Now coming to your question on writing or reading, there are numerous reports that say near work (reading and writing) are tasks that cause progression of myopia. If there has been any change in your working hours or intensity, this can also cause a decompensation. I suggest that you follow the 20-20-20 rule of taking a 20-second break every 20 minutes and looking 20 feet away while working on the computer, also take study breaks while reading or writing. Glasses with anti-reflective coating and lubricants may also help you work for longer periods with minimum strain on your eyes. With glasses of appropriate power and avoiding overexertion whilst reading or writing, your weakened fusional reflexes should make up some ground. Surgical treatments are considered only for cases not responding to the above measures. In case the problem persists or if you start to have problems like double vision, headache or increasing severity of symptoms, please consult your ophthalmologist.

Probable diagnosis

Partially accommodative esotropia with decompensation.

Treatment plan

Cycloplegic refraction.

Regarding follow up

For more information consult an eye care ophthalmologist online.--->https://www.icliniq.com/ask-a-doctor-online/eye-care-ophthalmologist

Patient's Query

Hi doctor,

Thank you for your reply. It was very helpful.

I forgot to mention that I have had diplopia for the last two years as well. It varies in intensity, worst on distant. I wear contact-lenses (left eye: -3.75, right eye: -4.25). But I feel like the power has changed lately, could that be the cause for decompensated phoria? The wrong strength for a long time?


Welcome back to icliniq.com.

The wrong power could definitely be a cause. I suggest that you go to an ophthalmologist to check your power. The presence of diplopia would suggest a squint that is difficult to treat and may need prismatic lenses or surgery. The diplopia and squint more for distance simply suggest that your fusional reflexes are at fault than your accomodative convergence. I feel that your unequal refractive errors and wearing of contact lenses are not causative factors. The past is past and what is left now is to take good care from here on. Try to attend follow-ups regularly. Although you have been having these problems for two years, I know from experience that we can never predict the treatment outcome of a patient with 100 % accuracy. The fact that you are still quite young and are putting in efforts to get things right will solve most if not all of the problems.

Patient's Query

Thank you doctor,

I can understand. What do you think can be the cause for this? I am a writer, sitting at the computer about eight hours a day. Could that be the cause for the diplopia or decompensated phoria?


Welcome back to icliniq.com.

It could probably be. Can you please send me a copy of your glass power and also a copy of the new power. If the power is more myopic, then probably writing is to blame. Although I would not be sure unless you got your refraction done after installation of cycloplegics. Kindly get your power re-evaluation done and send it to me. I will advise you further then.

Same symptoms don't mean you have the same problem. Consult a doctor now!

Dr. Manjunath Natarajan
Dr. Manjunath Natarajan

Ophthalmology (Eye Care)

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