Heterophoria is an eye condition in which the directions that the eyes are pointing at rest position, when "not" performing binocular fusion, are not the same as each other, or, "not straight". There can be esophoria, where the eyes tend to cross inward in the absence of fusion; exophoria, in which they diverge; or hyperphoria, in which one eye points up or down relative to the other. Phorias are known as 'latent squint' because the tendency of the eyes to deviate is kept latent by fusion. A person with two normal eyes has single vision (usually) because of the combined use of the sensory and motor systems. The motor system acts to point both eyes at the target of interest; any offset is detected visually (and the motor system corrects it). Heterophoria only occurs during dissociation of the left eye and right eye, when fusion of the eyes is absent. If you cover one eye (e.g. with your hand) you remove the sensory information about the eye's position in the orbit. Without this, there is no stimulus to binocular fusion, and the eye will move to a position of "rest". The difference between this position, and where it would be were the eye uncovered, is the heterophoria. The opposite of heterophoria, where the eyes are straight when relaxed and not fusing, is called orthophoria.

In contrast, fixation disparity is a very small deviation of the pointing directions of the eyes that is present while performing binocular fusion.

Heterophoria is usually asymptomatic. This is when it is said to be "compensated". When fusional reserve is used to compensate for heterophoria, it is known as compensating vergence. In severe cases, when the heterophoria is not overcome by fusional vergence, sign and symptoms appear. This is called decompensated heterophoria.

Heterophoria may lead to squint or also known as strabismus.

When the fusional vergence system can no longer hold back heterophoria, the phoria manifests. In this condition, the eyes deviate from the fixating position.

Fixation disparity exists when there is a small misalignment of the eyes when viewing with binocular vision. The misaligment may be vertical, horizontal or both. The misalignment (a few minutes of arc) is much smaller than that of strabismus, which prevents binocular vision, although it may reduce a patient's level of stereopsis. A patient may or may not have fixation disparity and a patient may have a different fixation disparity at distance than near.

When observing a person with strabismus, the misalignment of the eyes may be quite apparent. A patient with a constant eye turn of significant magnitude is very easy to notice. However, a small magnitude or intermittent strabismus can easily be missed upon casual observation. In any case, an eye care professional can conduct various tests, such as cover testing, to determine the full extent of the strabismus.

Symptoms of strabismus include double vision and/or eye strain. To avoid double vision, the brain may adapt by ignoring one eye. In this case, often no noticeable symptoms are seen other than a minor loss of depth perception. This deficit may not be noticeable in someone who has had strabismus since birth or early childhood, as they have likely learned to judge depth and distances using monocular cues. However, a constant unilateral strabismus causing constant suppression is a risk for amblyopia in children. Small-angle and intermittent strabismus are more likely to cause disruptive visual symptoms. In addition to headaches and eye strain, symptoms may include an inability to read comfortably, fatigue when reading, and unstable or "jittery" vision.

Strabismus may also be classified based on time of onset, either congenital, acquired, or secondary to another pathological process. Many infants are born with their eyes slightly misaligned, and this is typically outgrown by six to 12 months of age. Acquired and secondary strabismus develop later. The onset of accommodative esotropia, an overconvergence of the eyes due to the effort of accommodation, is mostly in early childhood. Acquired non-accommodative strabismus and secondary strabismus are developed after normal binocular vision has developed. In adults with previously normal alignment, the onset of strabismus usually results in double vision.

Any disease that causes vision loss may also cause strabismus, but it can also result from any severe and/or traumatic injury to the affected eye. Sensory strabismus is strabismus due to vision loss or impairment, leading to horizontal, vertical or torsional misalignment or to a combination thereof, with the eye with poorer vision drifting slightly over time. Most often, the outcome is horizontal misalignment. Its direction depends on the patient age at which the damage occurs: patients whose vision is lost or impaired at birth are more likely to develop esotropia, whereas patients with acquired vision loss or impairment mostly develop exotropia. In the extreme, complete blindness in one eye generally leads to the blind eye reverting to an anatomical position of rest.

Although many possible causes of strabismus are known, among them severe and/or traumatic injuries to the afflicted eye, in many cases no specific cause can be identified. This last is typically the case when strabismus is present since early childhood.

Results of a U.S. cohort study indicate that the incidence of adult-onset strabismus increases with age, especially after the sixth decade of life, and peaks in the eighth decade of life, and that the lifetime risk of being diagnosed with adult-onset strabismus is approximately 4%.

Exophoria can be caused by several factors, which include:

- Refractive errors - distance and near deviation approximately equal.

- Divergence excess - exodeviation is more than 15 dioptres greater for distance than near deviation.

- Convergence insufficiency - near exodeviation greater than distance deviation.

These can be due to nerve, muscle, or congenital problems, or due to mechanical anomalies. Unlike exotropia, fusion is possible in this condition, causing diplopia to be uncommon.

Exophoria is particularly common in infancy and childhood, and increases with age.

There are several methods to quantify fixation disparity. The Mallett card, the Bernell lantern slide, the Wesson Card and the Disparometer may be used. A patient's associated phoria is the amount of prism needed to reduce their fixation disparity to zero minutes of arc.

The Mallett Fixation Disparity Unit

Instrument used to measure the associated heterophoria (or compensating prism). It consists of a small central fixation letter X surrounded by two letters O, one on each side of X, the three letters being seen binocularly, and two coloured polarized vertical bars in line with the centre of the X which are seen by each eye separately. The instrument can be swung through 90° to measure any vertical fixation disparity. The associated phoria is indicated by the misalignment of the two polarized bars when the subject fixates the X through cross-polarized filters in front of the eyes. The amount of associated phoria is given by the value of the base-in or base-out prism power necessary to produce alignment and the eye. The unit can also be used to detect suppression. See Disparometer; associated heterophoria; uncompensated heterophoria.

Esophoria is an eye condition involving inward deviation of the eye, usually due to extra-ocular muscle imbalance. It is a type of heterophoria.

Causes include:

- Refractive errors

- Divergence insufficiency

- Convergence excess; this can be due to nerve, muscle, congenital or mechanical anomalies.

Unlike esotropia, fusion is possible and therefore diplopia is uncommon.

Eye strain, also known as asthenopia, is an eye condition that manifests through nonspecific symptoms such as fatigue, pain in or around the eyes, blurred vision, headache, and occasional double vision. Symptoms often occur after reading, computer work, or other close activities that involve tedious visual tasks.

When concentrating on a visually intense task, such as continuously focusing on a book or computer monitor, the ciliary muscle tightens. This can cause the eyes to get irritated and uncomfortable. Giving the eyes a chance to focus on a distant object at least once an hour usually alleviates the problem.

A CRT computer monitor with a low refresh rate (<70Hz) or a CRT television can cause similar problems because the image has a visible flicker. Aging CRTs also often go slightly out of focus, and this can cause eye strain. LCDs do not go out of focus but are also susceptible to flicker if the backlight for the LCD uses PWM for dimming. This causes the backlight to turn on and off for shorter intervals as the display becomes dimmer, creating noticeable flickering which causes eye fatigue.

A page or photograph with the same image twice slightly displaced (from a printing mishap, or a camera moving during the shot) can cause eye strain by the brain misinterpreting the image fault as diplopia and trying in vain to adjust the sideways movements of the two eyeballs to fuse the two images into one. The word is from Greek "asthen-opia: ἀσθεν-ωπία" = "weak-eye-condition".

Eye strain can happen with a blurred image (including images deliberately partly blurred for censorship), due to the ciliary muscle tightening trying in vain to focus the blurring out.

Sometimes asthenopia can be due to specific visual problems—for example, uncorrected refraction errors or binocular vision problems such as accommodative insufficiency or heterophoria. It is often caused by the viewing of monitors such as those of computers or phones for prolonged periods of time.