What pattern would indicate incomitancy in strabismus?

What pattern would indicate incomitancy in strabismus?

• A. A deviation that changes with gaze direction, indicating incomitant strabismus; often due to a paretic or restrictive muscle.
• B. A deviation that remains perfectly the same in all gazes.
• C. No diplopia in any gaze.
• D. A deviation that only occurs in primary gaze.

Answer: (A)

Incomitancy is shown when the misalignment changes as the eyes look in different directions. That changing pattern points to a problem with a specific extraocular muscle being weak (paretic) or mechanically restricted (restrictive), so the angle of deviation isn’t the same in all gaze positions. When you test motility, you’d see the deviation vary — for example, it may widen in certain gazes if a muscle is weak or restricted, reflecting the nonuniform control of eye movement. If the deviation stayed the same no matter where the patient gazed, that would be a comitant pattern, not incomitant. Other options describe scenarios like no diplopia or a deviation limited to primary gaze, which don’t demonstrate the gaze-dependent change that defines incomitancy.

Incomitancy is shown when the misalignment changes as the eyes look in different directions. That changing pattern points to a problem with a specific extraocular muscle being weak (paretic) or mechanically restricted (restrictive), so the angle of deviation isn’t the same in all gaze positions. When you test motility, you’d see the deviation vary — for example, it may widen in certain gazes if a muscle is weak or restricted, reflecting the nonuniform control of eye movement. If the deviation stayed the same no matter where the patient gazed, that would be a comitant pattern, not incomitant. Other options describe scenarios like no diplopia or a deviation limited to primary gaze, which don’t demonstrate the gaze-dependent change that defines incomitancy.