Cover Tests Explained | Squint Simplified for Medical Students

This is a detailed lecture on how to perform Cover - Uncover and Alternate cover test during squint examination. We start with an introduction to tropias & phorias, followed by a detailed discussion on how to perform these tests with the help of appropriate clinical examples. We also discuss how to grade the fixation behaviour of the eye. In the end, we have a short discussion on Dissociated Vertical Deviation & Latent nystagmus.
---- Chapters-----------
0.00 - Intro
0.09 - Heterotropia vs Heterophoria
1.45 - Preparation for cover tests
3.31 - Cover Test
8.13 - Pseudostrabismus
11.05 - prerequisites for cover tests
15.40 - Uncover Test
18.52 - Grading of fixation behaviour
21.32 - Incomitant Squint
23.48 - Alternate cover test
27.25 - DVD & Latent nystagmus
#squint #ophthalmology #covertest

[@user-kilrilirrlri]

0:00Intro 0:09Heterotropia vs Heterophoria 1:45Preparation for cover tests 3:31Cover-Uncover Test -Step1 Cover test 8:13Pseudostrabismus 11:05prerequisites to avoid False negative 15:40Step2 Uncover Test 18:52Grading of fixation behaviour 21:32Incomitant Squint 23:48Alternate cover test 27:25DVD & Latent nystagmus

[@user-kilrilirrlri]

*Preparation for cover tests:* 1.Fixation target 2.Occluder 3. Best refractive correction 4.Head posture 5.Done in all 9 diagnostic gaze positions *False negatives of cover-uncover test:* 1.pseudosquint 2.poor vision in fixating eye less than 6/60 3.eccentric fixation (check using visuoscope or fixation star mode of direct ophthalmoscope) 4.Gross restriction of extraocular movmts

[@TarisaiNBunda]

This is the most comprehensive video I’ve seen on Squint assessment! Thank you for sharing! Watching from Zambia 🇿🇲

[@eyecarewithdrbabita]

Thanks for watching.. I'm glad you liked it! 🙏❤️

[@hazelpetrick8340]

Best video ever on strabismus. so easy to follow along with ur teaching. you are a very good teacher, hats off to you!! please continue to uploaddd more

[@shizamushtaq2718]

So easy, elaborated and clinically helpful!

[@ahmedfaahim3787]

This is an amazing and comprehensive video ever seen in my life. Thanks for your hard work.

[@miyarqureshi399]

A very easy way of explaining the basic of squint.excellent

[@meopai3]

Brilliant, My understanding of the eye exam has improved 10 fold. Thank you

[@zamuelito8266]

The best video about eterotrophia on the internet. Thank you

[@hannahray6120]

Excellent way of explaining… really worth the time. U just gained a subscriber ma’am… thanks so much..

[@tzvirubin9708]

i would love an intermittent tropia video! thank you!

[@HindiOphthalmology]

From an article on measuring deviation in a group of patients: The grading system used in this study was originally proposed by Zipf and further developed by Wright et al.3 Fixation prefer- ence was classified into 5 categories: (0) no fixation - will not hold fixation with the nonpreferred eye after the oc- cluder is removed from the preferred eye with immediate fixation to the preferred eye; (1) holds with difficulty - fixates with the nonpreferred eye momentarily but loses fixation instantly; (2) holds fixation briefly - holds 2 to 3 seconds with the nonpreferred eye when the cover is re- moved from the sound eye; (3) holds well - holds fixation almost all throughout a blink time before refixation to the dominant eye; and (4) freely alternates fixation with no preferred fixation with either eye.

[@Aditya_Prabhune]

This was absolutely amazing. I don't think I have gotten such knowledge even in Prepladder subscription. Thank you!

[@eyecarewithdrbabita]

😊 Thank you! I'm glad the content is being appreciated by its target audience.

[@omeshnichat8120]

What an explanation ma'am. Thank you !!

[@aandbproductions999]

Perfect Video on Cover and Un-cover Test!!!

[@thogaiezhili9935]

You teached really awesome and very clearly

[@joshjunnoju7626]

Very useful video with simple explanation.i understand very well.keep such videos in future also

[@devthakkar6536]

Best video on the topic ever. Thank you,🙌🙌🙏🏼

[@shreyaagrawal4590]

Amazing,y explained one of the most confusion topic well done

[@cf9496]

Thanks for the amazing video! Please make a video on intermittent Exotropia!

[@dionmoris4916]

Best video on squint! Please talk about everything contact lens.

[@karemoptom]

Easy understanding video, thanks a lots mam😊🙏

[@saipriyaneelam4843]

Great explanation, easy to understand thank you mam ❤

[@anjalimiglani506]

Absolutely amazing🎉

[@fatimazahrachammout3642]

Thank you very much ! Very helpful vidéo !

[@saigagankamarushi1684]

Very Good Explanation

[@thewarrior9508]

Thankew for this lecture ma'am,it really helped me understanding these topics , Stay Blessed

[@Wordlesspine]

Nice examination video... Can u make a video regarding checking ECCENTRIC FIXATION and ABNORMAL RETINAL CORRESPONDENCE.

[@peaceful865]

Ty so much. Its litl more clear now. Squint 🙄 time was long bt worth taking to clear tht concept.

[@ZahidKhan-df6sx]

Thank you so much ❤️ very will explaining

[@aryanpandey2576]

That's impressive keep making more videos ma'am tysm I was struggling reading Parsons alot

[@eyecarewithdrbabita]

You're welcome 😊

[@sagardeepdatta8330]

Maam, ist time such a nice video on cover and uncover tesr

[@AbdulAhad-di2ec]

one question---at 22;44 , if there 6th cranial palsy on the left side and the eye is already deviated nasally, when you do the cover test and occlude the right eye, which muscle pulls the left eye to midline ?

[@hellassynke3279]

Brilliant video

[@chitradalokesh]

Please make a video for removing of squint in exercise type of way

[@neenuskitchenhub1508]

Really helpful video❤

[@user-mh1wu9ku4g]

great explanation👍

[@shahabe1349]

Thank you, awesome!

[@JN-kk4nk]

great video thank you !

[@m.saeedopridai9990]

Thank you so much ma'am

[@vijayalakshmikv5916]

in the books its given do alternate cover test after cover and uncover test , and alternate cover test is to detect total deviation - doesn't distinguish between phoria and tropia..

[@ashashyam4757]

Thank you so much maam such a good class❤

[@shizamushtaq2718]

Best video ever!

[@rakeshbali7209]

Good... Very good..... We wants more video from Dr. Babita chanel.... On different topics

[@meenasalve6265]

Plzzz make video on krimsky corneal reflex test

[@anu3286]

Very very wonderful lecture ma'am..I have never seen like this explanation before...thank u so much ma'am..plss make more videos on squint

[@eyecarewithdrbabita]

Thanks for watching and supporting this channel. I will post more videos 💕

[@fancyworld2077]

i switched from prepladder to you channel, thank you mam for this much help

[@eyecarewithdrbabita]

Glad I could help!

[@HMS20th]

22:40 The secondary deviation can only be assessed when the fixation behavior is grade 0, right ?

[@stephenenajite1504]

Thank you sooooo much❤

[@ikelivictoria2379]

Pls how do you determine when a patient is using eccentric fixation and is also having gross restrictions of eom?

[@hamzamasood5628]

Maam how to check whether eye having eccentric fixation or Abnormal retinal correspondence ARC through worth 4 . Test? And for palsy and contracture?

[@ZahidKhan-df6sx]

Please one video of Acc and non Acc Esotropia

[@memoonasaeed4408]

Hi can this be done without translucent occluder?

[@rajakumarim970]

Kindly do a video on intermittent oesotropia

[@afreenshaikh384]

Wonderful

[@zarifanurinnisa4780]

Love your videos

[@opthamgeetha1179]

Super mam .....explanation

[@memoonasaeed4408]

Mam agr pt ko left eye mai exotropia h and on alternate cover test agar both eyes out to in arai h and right eye up to down then kia ye alternate exotropia h with left dominance and right eye mai hyperphoria hga ya hypertropia????

[@trendheart2165]

Thank you 😊 make more videos

[@damodarpudasaini3685]

Why do we need fixation target for near and distant ?

[@theoptometrist265]

Thank youiui❤❤❤❤

[@vickyyadav1331]

Osm lecture mam

[@anupamgoswami4934]

awesome teaching

[@eyecarewithdrbabita]

Thank you!

[@wongleongyang4637]

I LIKE THIS VIDEO , AWESOME ! I HOPE GOT MORE VIDEO FOR THIS ~~~

[@kirubelgetahun2739]

Thank you

[@HMS20th]

How to exclude eccentric fixation?

[@drsurendranayak2461]

nice presentation madam

[@NIRMALKUMAR-nn4tq]

Thank you mam

[@abidkhan3391]

Just wow.

[@lakshmipriyakarthi7265]

Wonderful lecture yet again Dr Babita. Can you please make a video on refractive errors and also another video on intermittent squints also?

[@eyecarewithdrbabita]

Thank you Lakshmi! I have a few videos on squint basics lined up next, for undergraduate students. Once I'm done with that, I'll cover IXT 👍

[@lakshmipriyakarthi7265]

@@eyecarewithdrbabita Still waiting for your videos on intermittent squints and refractive errors! thanks!

[@eyecarewithdrbabita]

I wholeheartedly apologize, Lakshmi! I have been super busy lately.. Will see what I can do

[@belsondebbarma6532]

I appreciate your video.... I would like to add one point as per the latest literature whn we perform HBT.... 1 mm of deviation is equal to 11.8 degree.

[@eyecarewithdrbabita]

Thank you for your input!

[@edgardocordova1064]

GREAT

[@ammarbhatti7641]

Mam how to treat Alternate exotropia about 15 degree kindly suggest best way of treatment.

[@bijaysah8951]

Want video on Intermittent Exotropia

[@Medicoboi]

Madam, do both normal and squint eye try to fixate in alternate cover testing and we can say which eye has squint only after repeated alternate cover testing when squint becomes manifested?

[@eyecarewithdrbabita]

In alternate squint with equal dominance, both eyes will have central, steady and maintained fixation. If one eye is dominant, the other eye will not be able to maintain fixation. Although in many cases, both eyes have equal dominance yet one eye has a greater tendency to deviate. In such cases, I personally rely on patient history and my own observation.

[@sufiyan941]

Best

[@maxpayne8953]

On 14:25 , you say that one of the pre requisites for performing cover uncover test is "central fixation in both eyes" .. so how can we determine this before doing the cover uncover test if the eye is centrally fixating or not ? Any test for this ?

[@eyecarewithdrbabita]

Hi.. Fixation can be checked with the help of visuoscope/fixation star mode of direct ophthalmoscope

[@maxpayne8953]

@@eyecarewithdrbabita can u make a video or share one regarding the fixation star mode of ophthalmoscope?

[@eberechidi9071]

Thank you once again for yet another well detailed tutorial. But please how do we correct abnormal posture(if present) before continuing with the cover test, considering that the patient has become accustomed to the position, and will always maintain such position even unconsciously?

[@eyecarewithdrbabita]

Thanks for your comment. We need to manually correct the head posture before performing cover test and keep it corrected till we are done with our examination.

[@eberechidi9071]

@@eyecarewithdrbabita Ok, thanks for that. Which means we have to continuously adjust the head position all through the test

[@eyecarewithdrbabita]

Instead of continously adjusting it, I usually ask someone (a helper or patient's attendant) to maintain patient's head in the corrected position till I'm done with my examination.

[@eberechidi9071]

@@eyecarewithdrbabita Ok, that sounds better

[@anilloat1580]

Hi Mam, Your videos are very helpful I need advice on my son's eyes ...he is going to be 2 year by this Nov... Need urgent help 🙏 Can you suggest if we can connect online? Also I am based in Hyd Me and my Wife will be highly thankful to you for same

[@kummarivenkatsh9607]

Iam completed optometry Which course best madam

[@sandeepmaheshwari5286]

19:04 or before : does Alternating squint appear as Latent squint ?

[@eyecarewithdrbabita]

Intermittent Exotropia with poor control may present as Latent squint

[@sandeepmaheshwari5286]

22:36 1)you said that left eye moves out to take fixation but how is it going to fixing becoz fixing done with the help of left lateral rectus but it is paralyzed in this case then how can left eye moves out ?

[@eyecarewithdrbabita]

Thanks for your comment. You're right. In palsy (total paralysis), the eye cannot move to take fixation. The word paresis should have been used there. However, irrespective of whether it's case of palsy/paresis, one would find secondary deviation>primary deviation.

[@sandeepmaheshwari5286]

@@eyecarewithdrbabita not fully satisfied but ok 👍

[@optitechnoopticianskurunegala]

Dear Doctor , well explained... simply confusing but re watching it will be ok. Are you Orthoptist Doctor? Where do you practice ???

[@eyecarewithdrbabita]

Thank you! 🙏❤️ I'm an ophthalmic surgeon practising in India

[@optitechnoopticianskurunegala]

@@eyecarewithdrbabita 😍

[@sandeepmaheshwari5286]

How fixation works ? means how eye come to centre by its own ?

[@eyecarewithdrbabita]

Eye will come to centre to take fixation if the eye has central (foveal) fixation.

[@sandeepmaheshwari5286]

@@eyecarewithdrbabita Got it !

[@lichh64]

Tysm🫶

[@ebabekele3222]

very helpful video