We noted factors such as a habitual face tilt or the presentation of anatomical dissociation (prominent nasal septum iso- lated or combined with small pupillary distance/endophthalmus) when present. There were, however, no clear trends or patterns providing support that anatomi- cal factors significantly contributed to the problem of working with a tilted gaze. Further investigation of the relation- ship between monocular signs and symp- toms, binocular function and ergonomics within the workplace is clearly needed. Others have proposed different variables to be considered. These include anoma- lies in the ocular sensory system as a pos- sible cause. 23 A loss of clarity of the optical image in one eye could then impact the development of suppression and/or binocular instability. 37 It is likely.
