I recently witnessed an individual with an interesting set of eyes. When he looked straight at you, they were perfectly aligned, no sign of strabismus (sometimes referred to as “lazy eye”). When he looked to the right, they were well aligned - that is, they didn’t go in all goofy directions. No sign of strabismus.
However, when he looked to the left, one eye pointed more upwards, while another pointed downwards. I have included this highly detailed image to illustrate what I am talking about.
What might have afflicted this individual? Is it strabismus?
Damage to the extraocular muscles (the muscles that allow for eye movements) or the nerves providing input to those muscles will lead to a pattern like what you describe – a strabismus that varies based on position of gaze.
The pattern you’ve drawn could result from either a left superior oblique palsy (most likely) or right superior rectus palsy. But this person would have to be tested in all positions of gaze to be sure.
(By the way, I’m assuming the way you drew the picture is the way this person looked. You say his eyes were aligned when looking to the right, but in the picture you drew, he’s looking to his left. So I assumed by “right” and “left” you’re referring to your right and left as an observer, and not your friend’s right and left, since that’s how you drew it.)
