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

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

Answer: (B)

Interpreting where the corneal light reflex lands helps us infer the direction of a deviation. In a normally aligned eye, the reflection sits near the center of the pupil. If an eye is turning inward (an esodeviation), the eye’s optical axis shifts so the light reflex appears displaced toward the temple side of that cornea. So a temporal displacement of the reflex indicates that the eye is deviating inward, i.e., an esotropia. By contrast, a reflex displaced nasally would suggest exotropia (eye turning outward). If the reflex stays centered, alignment is normal. If the reflex position is unclear, the deviation may be indeterminable. The concept also aligns with angle lambda, where a temporal shift of the reflex reflects an inward (esotropic) deviation of the eye.