Angle Kappa

An angle kappa is caused by failure of the pupillary and visual axes of the eye to coincide.

 The pupillary axis is the line passing through the center of the apparent pupil perpendicular to the cornea. The visual axis (or the line of sight) connects the fovea with the xation point. The angle kappa is formed at the intersection of these two axes at the center of the entrance pupil.

 Visual axis is defined as the line connecting the optical centers of cornea and lens. The visual axis does not always coincide with the optical axis. Visual axis with optical axis forms the angle alpha at the nodal point and the angle gamma at the center or rotation of the eye. All these angles are geometric constructions and only the angle kappa can actually be measured and is of practical importance.

 As a rule, the pupillary axis touches the posterior pole of the globe slightly nasal and inferior to the fovea. As a result, when an eye xates a penlight, the reection from the cornea will not be centered but will be located in a position slightly nasal to the center. This is termed a positive angle kappa.

 A sufciently large positive angle kappa may simulate an exodeviation and produce pseudostrabismus. An existing exodeviation will look worse than it actually is, or it may mask all or part of an esodeviation.

 If the foveas position is nasal to the point at which the optical axis cuts the globes posterior pole, the corneal reection of a light xated by that eye will appear to lie on the temporal side of the pupillary center. In this case the term negative angle kappa is used.

 A negative angle kappa may simulate an esodeviation and again produce a pseudostrabismus, may make an existing esotropia look worse than it actually is, or may mask all or part of an exodeviation. Nasal displacement of the fovea may be caused by high myopia or rarely may be normal.

 In cases of retinopathy of prematurity, a true pathologic ectopia of the macula is accompanied by a positive angle kappa. The macula is pulled in the temporal direction, causing pseudoexotropia. Other causes of ectopic macula include scarring from Toxocara canis retinitis or congenital retinal folds.

 A vertical angle kappa, simulating a hyperdeviation, is usually (but not always) caused by superior or inferior displacement of the macula from a retinal scar.

Measurement of Angle Kappa

For clinical purposes it sufces to observe the position of the corneal light reection while the patient xates monocularly on a penlight.