Which symptom is most characteristic of divergence excess?

• A. Intermittent diplopia
• B. Constant diplopia
• C. Pain with eye movement
• D. Redness with blinking

Answer: (A)

Divergence excess is a type of exotropia where the outward deviation is larger when looking at distant targets than at near. Because the far-angle deviation challenges the eyes’ ability to diverge, some patients experience diplopia at distance, but near fusion is often better, so the diplopia is not constant. This makes intermittent diplopia the most characteristic symptom.

Pain with eye movement and redness with blinking aren’t typical features of divergence excess, and constant diplopia would suggest a more persistent misalignment that isn’t as typical when near fixation can usually be fused.