Which deviation is suggested by a nasal displacement of the corneal reflex on Hirschberg or angle lambda?

• A. Exo deviation
• B. Eso deviation
• C. Normal
• D. Indeterminate

Answer: (A)

In assessing eye alignment with the corneal light reflex, the reflection should fall near the center of each pupil when both eyes are looking straight ahead. If an eye drifts outward, its line of sight shifts and the light reflection moves toward the nose of that eye. This nasal shift of the corneal reflex indicates an exodeviation (exo) of that eye relative to the fellow eye. Conversely, a reflection displaced toward the temple would suggest an esodeviation. So a nasal displacement on Hirschberg or when evaluating the reflection relative to the angle lambda points to exotropia.