Strabismus: from theory to practice, from concepts to its operational attainment

Some particular points concerning the study of strabismus are analyzed, specially, the difficulties for definitions and the different ways it can be conceived, besides the relativity of binocular positions interpretation, and the necessary referential elements for circumscribing such questions. Then, the concept of primary position of gaze is discussed as well as the conditions for its operational attainment, leading to the conclusion that it is materially impossible to achieve this "zero" point, from which all other measurements of strabismus or ocular movements should be done. In sequence, the construction of multiple referential systems applying the quantification of strabismus are examined. The lack of consensual agreement about which should be used as the standard system causes elementary practical implications, as the lack of agreement about how to superimpose orthogonal prisms for the measurement of associated horizontal and vertical deviations. The functional asymmetry of ocular rotations and its exceptions are commented. The accuracy that the measurements of strabismus can be performed is analyzed, leading to the conclusion that fractional figures using the commonest angular unities are improper. At last, some technical problems related to such evaluations are also commented, as operational difficulties related to prism-diopter unity, concerning the use of prisms, and prismatic effects due to the use of conventional optical glasses.