Cover test

A cover test or cover-uncover test is an objective determination of the presence and amount of ocular deviation. It is typically performed by orthoptists, ophthalmologists and optometrists during eye examinations. The two primary types of cover tests are: the alternating cover test the unilateral cover test (or the cover-uncover test). The test involves having the patient focusing on both a distance as well as near object at different times during the examination. A cover is placed over an eye for a short moment then removed while observing both eyes for movement. The misaligned eye will deviate inwards or outwards. The process is repeated on both eyes and then with the child focusing on a distant object. The cover test is used to determine both the type of ocular deviation and measure the amount of deviation. The two primary types of ocular deviations are the tropia and the phoria. A tropia is a misalignment of the two eyes when a patient is looking with both eyes uncovered. A phoria (or latent deviation) only appears when binocular viewing is broken and the two eyes are no longer looking at the same object. The unilateral cover test is performed by having the patient focus on an object then covering the fixating eye and observing the movement of the other eye. If the eye was exotropic, covering the fixating eye will cause an inwards movement; and if esotropic, covering the fixating eye will cause an outwards movement. The alternating cover test, or cross cover test is used to detect total deviation (tropia + phoria). The cover test is regarded as an essential examination in investigating strabismus. It is simple to undertake, does not require great amounts of skill by the examiner and is objective in nature. To ensure that the test is executed accurately and that the maximal amount of information is obtained, it is paramount that the appropriate fixation targets are used for near (approximately ), distance () and far distance (>) and also that a cover consisting of a black 'paddle' is used.