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Dr. Donahue, who is also the protocol chair and a member of the Pediatric Eye Disease Investigator Group (PEDIG) executive committee, described two studies on intermittent exotropia that are underway. The first study will explore the natural history of intermittent exotropia by comparing patching against no treatment.
What is the pediatric eye disease group doing about intermittent exotropia?
If there is suspicion of exotropia, it is essential to seek an eye care specialist. An eye doctor can perform a comprehensive eye exam and differential diagnosis to rule out other possible conditions. What Causes Exotropia?
Should I see an eye doctor for exotropia?
The 2 classic surgical procedures for intermittent exotropia are bilateral lateral rectus muscle recessions, or a unilateral medial rectus muscle resection combined with a lateral rectus muscle recession.
What are the classic surgical procedures for intermittent exotropia?
1 College of Optometry, Pacific University, Portland, Oregon. Clinical opinions regarding treatment of intermittent exotropia (IXT) vary widely and there is controversy as to which treatment modality is most successful.
What are the clinical opinions on treatment of intermittent exotropia (IXT)?
Can you fix intermittent exotropia?
IS IT POSSIBLE TO OUTGROW INTERMITTENT EXOTROPIA? While it is possible for exotropia to become less frequent with age, most forms of exotropia do not resolve completely. However, some people may be able to adequately control the drifting with glasses or other non-surgical means.
Who treats exotropia?
It may also occur in association with a 3rd cranial nerve palsy or previous eye muscle surgery for strabismus. But, most often, childhood intermittent exotropia has no known cause so, if outward wandering of the eyes is suspected and persistent, your child should be evaluated by an ophthalmologist or orthoptist.
What is treatment for intermittent exotropia?
Non-surgical treatment of IXT includes patch therapy, prism therapy, orthoptic sessions, and overcorrecting minus lens therapy. The objective of these treatments is to reduce the symptoms and the frequency of manifest deviation by decreasing the angle of deviation or enhancing the ability to control it.
Does vision therapy work for intermittent exotropia?
Intermittent exotropia should be treated immediately, as any misalignment indicates that the eye-brain connection is not working effectively. The most successful treatment for strabismus is vision therapy, usually with other means such as eye patching, eyeglasses, and surgery.
How do you fix eye exotropia?
How is exotropia treated?Glasses: Glasses that help correct near- or farsightedness will help keep the eyes aligned.Patching: People with exotropia tend to favor the aligned eye, so vision in the eye turned outward can weaken, resulting in amblyopia (lazy eye).More items...
Can too much screen time cause exotropia?
Normal visual activities do not affect exotropia. However, for other health reasons, parents are encouraged to limit the time their children spend watching TV, playing video games, and sitting at their computers.
How rare is intermittent exotropia?
Prevalence - Exodeviations are much more common in latent or intermittent form than are esodeviations. Of all the exotropia intermittent exotropia comprises about 50-90% of the cases and is usually preceded by a stage of exophoria (4,5). It usually affects about 1% of the general population.
How common is intermittent exotropia?
An annual incidence of 64.1 of 100,000 patients was found among children lesser than 19 years of age. [14] Among these, 86% had either an intermittent exotropia, or an underlying convergence insufficiency, or a central nervous system pathology with an exotropia.
Is exotropia neurological?
Conclusion: Intermittent exotropia increasing with near fixation is associated with neurological disease in children.
How do glasses help exotropia?
Intermittent exotropia is often treated using glasses with special lenses (overminus glasses). These glasses are like those prescribed for near-sighted people. These glasses make the eyes work harder in order to see clearly. The extra work is thought to help make the eye drift out less frequently.
Can exotropia be cured in adults?
Treatment for exotropia depends on how often you have symptoms and on how severe they are. Prism in your glasses may be prescribed to help with double vision. Eye muscle surgery is also an option, especially if your exotropia is Page 2 Kellogg Eye Center Exotropia 2 constant or is causing double vision.
Is exotropia the same as lazy eye?
Most people automatically use the term Lazy Eye when an eye crosses or turns outward. As stated above, an eye that moves on its own is a sign of Amblyopia or Lazy Eye, but Strabismus is the condition that one or both eyes turns inwards (esotropia) or out (exotropia).
What is the best treatment for eye drifting?
Eye exercises – Used to help strengthen control of the eyes. Eye exercises work best for smaller amounts of eye drifting. Eye muscle surgery – Used to loosen or tighten eye muscles in one or both eyes to improve eye alignment. Eye muscle surgery is usually a better option when there is a large amount of eye drifting.
What is the abnormal movement of the eye?
Signs and symptoms of intermittent exotropia. Abnormal outward movement of the eye happens most often when the child is focusing on distant targets , such as watching television. It can also occur when focusing on a near target, but this is less noticeable. Sometimes, the eye deviation may happen only when the child is daydreaming, ...
What is eye muscle surgery?
Eye muscle surgery – Used to loosen or tighten eye muscles in one or both eyes to improve eye alignment. Eye muscle surgery is usually a better option when there is a large amount of eye drifting. Patching one or both eyes – The value of eye patching for the purpose of improving eye alignment is unclear.
Why do my eyes turn out?
One or both eyes turn out toward the ear occasionally. Only one eye turns out at a time while the other eye points straight forward. Cause of intermittent exotropia. The cause of this condition is not known. Most experts believe that the brain of affected patients has trouble controlling the position of the eye.
Can a child have double vision?
The eye movement may occur infrequently or can occur throughout the day. A few children will report double vision, but most do not. A few children will report eye strain and/or headaches, but most do not.
Can you have a recurrence of eye drifting?
Regardless of the treatment used, recurrence of the eye drifting is very common. Exercises and over minus lenses often must be continued long term and surgery often must be repeated. Most children with intermittent exotropia will have excellent vision and excellent depth perception.
Who conducted the BJO study?
The BJO study, conducted by Buck et al. in the United Kingdom, 1 supports Dr. Rosenbaum’s premise that intermittent exotropia is not fully understood. This study followed an observational cohort of 460 children with intermittent exotropia who were younger than 11 years old.
Can a child see normal if they have lost stereopsis?
Dr. Epley’s approach is to try conservative measures first, provided that the child is not losing vision, can still see normally, and has not lost stereopsis. “If these are normal, we will recommend exercises or do some patching or even prescribe glasses to exercise the convergence system,” he said.
Is intermittent exotropia a surgical procedure?
Surgical correction of intermittent exotropia is a bread-and-butter procedure for many pediatric ophthalmologists. But a recent study in the British Journal of Ophthalmology ( BJO) 1 and an accompanying editorial 2 call into question the notion that intermittent exotropia is straightforward or fully understood.
How long does it take for intermittent exotropia to go away?
Intermittent exotropia may occur in infants as young as 1 to 2 months of age. If the condition is mild, it may go away on its own within 6 to 8 weeks of birth. In other cases of exotropia, it is not common to find a complete resolution of the condition. While patching, glasses, or vision therapy can help, exotropia may remain present.
What are the risk factors for exotropia?
Additionally, having some of the risk factors below may raise the probability of exotropia: Family history of strabismus, amblyopia, childhood cataract, or glaucoma (increased eye pressure). Some genetic disorders, such as cerebral palsy or Down syndrome. Childhood cataracts or glaucoma.
What is it called when your eyes turn outward?
Exotropia refers to a type of strabismus (eye misalignment) in which either one or both of the eyes turn outward. It is not the same as esotropia, in which either one or both of the eyes turn inward. Exotropia is a common condition. It comprises 25% of all ocular misalignment cases in young children.
What is the name of the condition where the eye has two different refractive errors?
Duane’s syndrome — this is a congenital strabismus syndrome, in which people with the condition could experience diplopia (double vision), anisometropia (the two eyes have different refractive errors), and amblyopia (lazy eye).
What is the condition that impairs the lateral gaze?
Internuclear ophthalmoplegia — this is an ocular motility disorder that impairs the lateral gaze and causes ophthalmoplegia (paralysis or weakness of the eye muscles). Orbital fibrosis — this rare condition is characterized by an infiltrating orbital mass and thickening of connective tissue.
What is the name of the condition where the eye turns outward?
Alternating Exotropia. As the name suggests, people with an alternating exotropia have an outward eye turn that alternates both eyes. The condition can be constant or intermittent and vary in degree of severity. Intermittent exotropia is the most frequent type of strabismus, impacting as much as 1% of the U.S. population.
Can exotropia be treated with surgery?
Those with exotropia can explore both non-surgical and surgical treatment options. Non-surgical treatment possibilities include: Surgical treatments may be performed to maintain or restore binocular capability. It may also help provide relief for diplopia (double vision) or cosmesis (to enhance physical appearance).
What is intermittent exotropia?
Intermittent exotropia is frequently noted in infancy or early childhood as an outward deviation of one eye typically when viewing a distant object. The tropic phase occurs with greater frequency during periods of inattention, in bright sunlight and when the child is stressed, fatigued or ill. Transient closure of one eye in bright sunlight and photophobia are seen in more than 50% of patients [12]. Diplopia rarely occurs in the younger child as the brain suppresses the eye during the periods of manifest deviation. When intermittent exotropia develops in children beyond age 10, diplopia can be a predominant presenting symptom as they have not developed these sensory adaptations. The incidence of amblyopia has been reported to be 4.5% and 12.8% in children with intermittent exotropia [13,14].
What is overminus lens?
Overminus lens therapy induces accommodative convergence and is sometimes used as temporizing measure in X (T) to promote fusion and delay surgical correction . There have been few studies addressing the treatment of X (T) with overminus lenses. However, a more recent prospective study with 5-year follow-up showed 52% of 21 patients achieved a successful or good outcome with overminus lenses alone [26]. The patients were initially treated with −1.00 to −3.00 lenses and after improvement in the angle of deviation and/or binocular function was noted the power of the lenses was reduced. The study found that in the short term (median 4 months), there was 100% improvement in the angle of deviation and binocular function. In the intermediate term (6–24 months), the lens power could not be reduced without recurrence of the X (T). Some cases required further treatment but others showed a smaller angle of deviation which was cosmetically acceptable with good binocular function. In the long-term (median 2.5 years), five patients achieved exophoria at near and distance fixation with good binocular function and this was maintained for at least 1 year after cessation of the treatment. The study showed no induced myopia from the minus lenses.
What is the most common form of divergent strabismus?
Intermittent exotropia (X (T)), the most common form of divergent strabismus, is seen in 60–70% of normal infants, is transient, and usually resolves in the first few months of life as the attention required to maintain binocularity improves [1]. Small exophorias are found in high frequency in adults.
What is intermittent exotropia?
Intermittent exotropia is the most common form of exotropia and it is estimated that approximately 3% of Chinese teenagers suffer from this condition. 1 The treatment of intermittent exotropia includes watchful observation, 2,3 patching, 2,3 prism, 4,5 overminus lens, 6 vision therapy 7–13 and surgery. 14,15 Currently, there is no consensus regarding which treatment modality is the best approach for this condition. 16 There is a number of randomized clinical trials of occlusion 2,3 and overminus lens 6 that support the use of these approaches. Surgery is a common treatment modality for patients with intermittent exotropia but the evidence supporting its effectiveness is limited. There is a lack of randomized clinical trial data on the comparison between the effect of surgical treatment and observation alone. 17,18 Furthermore, it is often reported that after receiving the surgery, there is still a strong tendency for the condition to recur, 19,20 and a significant portion of patients require reoperation. 14,21–23
Why is vision therapy so short?
36 The major reasons for a short therapy duration included financial reasons, a lack of time by patients or their parents or a lack of any apparent improvement judged by examiner and/or parents.
What is vision therapy?
Unlike surgery, which aims to reduce the size of the deviation, vision therapy is a treatment that mainly focuses on improving the control of exodeviation. Through vision therapy, visual skills that may contribute to the control of exodeviation are trained.
How is the length of vision therapy determined?
The length of vision therapy was determined based on the experience of the first author, patient’s time and financial factors, and patient’s binocular vision test result (e.g., office control score, positive fusional reserve and suppression test).
How often do you have to be reevaluated for vision therapy?
Patients who received vision therapy were re-evaluated after every 5 therapy sessions, and only those who received at least 5 sessions of vision therapy were analyzed. In all patients, visual acuity was needed to be correctable to 20/25 or better in each eye.
Is vision therapy 11 good or bad?
That study classified the control ability as good, moderate or poor control based on the frequency with which exodeviation was decompensated.
Clinical Manifestation of Intermittent Exotropia
Intermittent exodeviation usually occurs between 2 and 8 years of age, but may present any time between infancy and adulthood. Initially, an exotropia may only be seen when the patient is fatigued or ill. Covering one eye will manifest the exotropia.
Treatment of Intermittent Exotropia
In contrast to esotropia, which requires urgent intervention, the treatment of intermittent exotropia is elective. These children have binocular fusion and are well aligned most of the time. Eye muscle surgery is the treatment of choice for most forms of intermittent exotropia.
Types of Exotropia
Causes of Exotropia
Signs and Symptoms of Exotropia
- The earliest telltale sign of exotropia is a noticeable outward divergence of the eye. The degree of deviation may vary from basic-type to divergence-excess type exotropia. Deviation may be intermittent at first, occurring when you are tired, not feeling well, inattentive or daydreaming. It may also be noticeable when you look at something in the distance. Control of exotropia may va…
Risk Factors
- All types of strabismus, including exotropia, are more common in people with handicaps, including Down Syndrome, cerebral palsy and craniofacial dysostosis. They occur in: 1. Nearly 50 percent of people with Down Syndrome 2. 44 percent of people with cerebral palsy 3. 90 percent of people with craniofacial dysostosis Craniofacial dysostosis is a condition characterized by pr…
Diagnosis
- Eye doctors diagnose exotropia through a complete eye exam, including evaluation of anterior and posterior ocular structures and ocular motility (eye movement) evaluation. Other tests an eye doctor may conduct include: 1. Visual acuity test 2. Stereopsis and binocular function evaluations 3. Strabismus measurements 4. Cycloplegic refraction 5. Meas...
Treatment Options
- Glasses, prisms (if the angle of exotropia is small), patching therapy, orthoptic vision therapy, exercises can help reduce or control the outward-facing eye in some children. However, surgery is often required to correct exotropia and other types of strabismus if the condition increases in frequency over time or if its present for prolonged periods. It may also be a viable option if the ot…
Complications If Untreated
- Usually, as exotropia progresses, your eyes begin to face outwards when looking at objects in the distance and close objects. If this condition is left untreated, your eye may face outwards continually, causing stereopsis, loss of binocular vision, and poor depth perception. Also, if unchecked, the vision change, including double vision, impaired depth perception, diplopia, ambl…
FAQs
- Can exotropia be corrected?Exotropia can be corrected, especially if the condition is diagnosed early. Glasses, prisms, vision therapy, can be used to reduce the outward-turning eye. Exotropia surg...
- What is the cause of exotropia?Exotropia occurs when one or more muscles that control eye movement (extraocular muscles) do not function properly. Some genetic disorders that affec…
- Can exotropia be corrected?Exotropia can be corrected, especially if the condition is diagnosed early. Glasses, prisms, vision therapy, can be used to reduce the outward-turning eye. Exotropia surg...
- What is the cause of exotropia?Exotropia occurs when one or more muscles that control eye movement (extraocular muscles) do not function properly. Some genetic disorders that affect the eyes or sku...
- Can exotropia go away on its own?Exotropia can become less frequent as you age. However, most forms of the condition do not resolve completely without treatment. Nonetheless, progression from inter...
