secondary position
A secondary position is any position the eye reaches by moving straight horizontally or straight vertically from primary position.1 The adducted, abducted, elevated and depressed positions of the globe are the secondary positions, and primary position is the straight-ahead gaze with the body and head erect.1
Each secondary position is reached by rotation about a single axis of Fick, the vertical axis for gaze right and left or the horizontal axis for upgaze and downgaze.2 The oblique positions, such as up and right, combine the two rotations and are called tertiary positions instead.1,2
Primary position, the four secondary positions and the four tertiary positions make up the nine diagnostic positions of gaze.3 A deviation measured in each of them shows incomitance and identifies the muscle involved in a paralytic deviation.3 Some texts still call all eight secondary and tertiary positions cardinal positions, but in the physiology of ocular motility that term covers only the secondary positions, reached by the cardinal movements.3
Sources (8)
- von Noorden and Campos, Binocular Vision and Ocular Motility, ch. 4
- Kanski, Clinical Ophthalmology (2024), ch. 18
- von Noorden and Campos, Binocular Vision and Ocular Motility, ch. 12
- Ansons, A.M. and Davis, H. eds. 2014. Diagnosis and management of ocular motility disorders. 4th ed. Oxford: Wiley-Blackwell.
- Noorden, G.K. and Campos, E.C. 2002. Binocular vision and ocular motility: theory and management of strabismus. 6th ed. St. Louis: Mosby.
- Rutstein, R. and Daum, K. 1997. Anomalies of Binocular Vision: Diagnosis & Management. St. Louis: Mosby.
- Rowe, F.J. 2012. Clinical orthoptics. 3rd ed. Oxford: Wiley-Blackwell.
- Von Noorden, G.K. and Campos, E.C. 2002. Binocular vision and ocular motility: theory and management of strabismus. 6th ed. St. Louis: Mosby
Reviewed October 2026