By Dr. Charles J. Bock

Exotropia

Strabismus is a term used to describe any misalignment of the eyes. Exotropia describes a type of strabismus in which one (or either eye alternately) turns outward, away from the nose.

When to be concerned about exotropia

Many newborn children will have episodes of exotropia during the first few months of life. The eyes of a newborn child may not appear to work well together. This is normal. Constant exotropia in a child younger than four months old or evidence that one or both eyes do not move fully in all directions should be evaluated promptly. Additionally, any exotropia occurring after age four months requires attention.

For most people with exotropia, the problem does not develop until age 18 months or later. For many people, exotropia may not be present until adulthood.

Categories of exotropia

There are several ways to categorize exotropia. The first is to determine if the exotropia is constant or intermittent (present only some of the time). It is also important to measure the exotropia (when possible) with the patient looking at a distant object and then at a near one. Most patients have basic exotropia, which means the amount of outward deviation of the eyes is roughly the same at distance and at near. Exotropia may also be greater at distance than at near or greater at near than at distance.

Diagnosing and managing exotropia

You will be asked some questions about the exotropia during your (or your child's) first examination. These will include your best estimation of how much of the time the exotropia is present, as well as how variable the amount of exotropia seems to be from day to day. You will be asked about conditions commonly associated with a greater likelihood of the development of exotropia, such as prenatal complications and prematurity, presence of cerebral palsy or any congenital or genetic syndrome, any history of head trauma, and family history of relatives with exotropia.

A complete eye examination will help determine if there are any eye problems which may be contributing to the exotropia. The most common of these is myopia (nearsightedness). Dr. Bock will also measure the amount of deviation of the eyes using prisms.

Eye exercises for exotropia

If you are diagnosed with a type of exotropia called convergence insufficiency, there are exercises that can effectively treat this problem in many patients. For the vast majority of patients with exotropia, however, there are not effective eye exercises.

Patching treatment for exotropia

Some children with exotropia have amblyopia (lazy eye) in the eye that is turning out. Patching the good eye will usually help improve the vision in the eye with amblyopia, which may help improve the exotropia. Patching treatment may even help improve the child's control over the exotropia if amblyopia is not present. Dr. Bock will discuss patching with you at length if he feels it would be helpful.

Glasses for exotropia

As already mentioned, glasses may be needed to improve the vision. Additionally, some children who do not need glasses to improve their vision may benefit from wearing glasses to control the exotropia. Dr. Bock will tell you if this seems possible in your child. Usually, this only helps for a short while.

Following patients with exotropia

Patients with exotropia must be followed at regular intervals. At each visit, Dr. Bock will ask you about the exotropia. You may find it helpful to keep a diary or make notes on a calendar to help you remember how often the exotropia is present. Young children with exotropia are usually followed every three to four months.

Surgery for Exotropia

Surgical treatment of exotropia is considered when the exotropia is present much of the time, especially if the patient's control over the exotropia seems to be worsening. In general, Dr. Bock will often try to delay surgical intervention for children under the age of four. There is some evidence that the long-term result may be better if surgery can be delayed until age four. However, there are some patients who need surgery sooner. This is particularly true if the exotropia is constant or very poorly controlled. In these children, delaying surgery is not recommended.

If you have questions

Gaining a complete understanding of the complexities of exotropia takes time. Every patient is different, so the general information above may not cover all of the important issues regarding you or your child. We expect that you may need to call us after your visit, once you have had a chance to think of additional questions.

Please feel free to call our office at any time with any questions you have.