Acquired Exotropia 

  • Author: Neepa Thacker, MBBS, MS, FRCS, DNB; Chief Editor: Hampton Roy Sr, MD   more...
 
Updated: Dec 10, 2009
 

Background

Exodeviation is a horizontal form of strabismus characterized by visual axes that form a divergent angle. The different types of acquired exotropia are intermittent exotropia, sensory exotropia, exotropia with neurologic causes and field defects, and consecutive exotropia.

Certain conditions, such as third nerve palsy, thyroid ophthalmopathy, and iatrogenic trauma following retinal detachment surgery or endoscopic sinus surgery, could cause acquired exotropia; however, these conditions are not discussed in this article.

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Pathophysiology

The deviation usually begins as an exophoria. Exophoria is a condition in which the alignment of the eye is straight when both eyes are open, but either eye drifts outward when covered. During this phase, the patient has bifoveal fixation. This deviation may later progress to intermittent exotropia, during which the deviation may be manifest (exotropia) or latent (exophoria).

When intermittent exotropia develops in a child whose visual system is still immature, bitemporal suppression develops, and the child does not perceive 2 separate images (diplopia). As suppression increases, intermittent exotropia may finally progress to constant exotropia. If acquired exotropia develops in adults, the patient experiences periods of diplopia during the tropic (manifest) phase.

Patient with intermittent exotropia at distance onPatient with intermittent exotropia at distance only. Patient is fixing with the left eye. Note the outward deviation of the right eye. Patient with intermittent exotropia at distance onPatient with intermittent exotropia at distance only. Patient is now fixing with the right eye, showing that he can alternate well. Patient with intermittent exotropia at both distanPatient with intermittent exotropia at both distance and near. Patient is fixing with the left eye. Note the outward deviation of the right eye. Patient with intermittent exotropia at both distanPatient with intermittent exotropia at both distance and near. Patient is now fixing with the right eye, showing that she can alternate well.
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Epidemiology

Frequency

International

Esodeviations are more frequent than exodeviations, with a ratio of 3:1.

Acquired exotropia is more common in the Middle East, Africa, and Asia and in those latitudes with higher levels of sunlight. It is less common in the United States and Europe.

Mortality/Morbidity

Diplopia and eyestrain associated with acquired exotropia can affect daily activities, such as driving and reading.

Race

No racial predilection exists.

Sex

Acquired exotropia is more common in females than in males, with a female preponderance of 63-70%.

Age

Contrary to a previous belief, intermittent exotropia can have an early onset, with 25-40% of cases occurring before the second year of life.

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Contributor Information and Disclosures
Author

Neepa Thacker, MBBS, MS, FRCS, DNB  Consulting Staff, Department of Pediatric Ophthalmology and Strabismus, Breach Candy Hospital, India

Disclosure: Nothing to disclose.

Coauthor(s)

Federico G Velez, MD  Assistant Clinical Professor, Department of Ophthalmology, Division of Pediatric Ophthalmology and Strabismus, University of California at Los Angeles School of Medicine

Federico G Velez, MD is a member of the following medical societies: American Academy of Ophthalmology and American Association for Pediatric Ophthalmology and Strabismus

Disclosure: Nothing to disclose.

Arthur L Rosenbaum, MD  Chief, Division of Pediatric Ophthalmology, Professor, Vice Chairman, Department of Ophthalmology, University of California at Los Angeles School of Medicine

Arthur L Rosenbaum, MD is a member of the following medical societies: American Academy of Ophthalmology, American College of Surgeons, and American Medical Association

Disclosure: Nothing to disclose.

Specialty Editor Board

Michael J Bartiss, OD, MD  Medical Director, Ophthalmology, Family Eye Care of the Carolinas

Michael J Bartiss, OD, MD is a member of the following medical societies: American Academy of Ophthalmology, American Academy of Pediatrics, American Association for Pediatric Ophthalmology and Strabismus, and North Carolina Medical Society

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Senior Pharmacy Editor, eMedicine

Disclosure: eMedicine Salary Employment

J James Rowsey, MD  Former Director of Corneal Services, St Luke's Cataract and Laser Institute, Florida

J James Rowsey, MD is a member of the following medical societies: American Academy of Ophthalmology, American Association for the Advancement of Science, American Medical Association, Association for Research in Vision and Ophthalmology, Florida Medical Association, Pan-American Association of Ophthalmology, Sigma Xi, and Southern Medical Association

Disclosure: Nothing to disclose.

Lance L Brown, OD, MD  Ophthalmologist, Affiliated With Freeman Hospital and St John's Hospital, Regional Eye Center, Joplin, Missouri

Disclosure: Nothing to disclose.

Chief Editor

Hampton Roy Sr, MD  Associate Clinical Professor, Department of Ophthalmology, University of Arkansas for Medical Sciences

Hampton Roy Sr, MD is a member of the following medical societies: American Academy of Ophthalmology, American College of Surgeons, and Pan-American Association of Ophthalmology

Disclosure: Nothing to disclose.

References

  1. Watts P, Tippings E, Al-Madfai H. Intermittent exotropia, overcorrecting minus lenses, and the Newcastle scoring system. J AAPOS. Oct 2005;9(5):460-4. [Medline].

  2. Dawson EL, Sainani A, Lee JP. Does botulinum toxin have a role in the treatment of secondary strabismus?. Strabismus. Jun 2005;13(2):71-3. [Medline].

  3. Choi MY, Hyung SM, Hwang JM. Unilateral recession-resection in children with exotropia of the convergence insufficiency type. Eye. Dec 2 2005;[Medline].

  4. Figueira EC, Hing S. Intermittent exotropia: comparison of treatments. Clin Experiment Ophthalmol. Apr 2006;34(3):245-51. [Medline].

  5. Kim C, Hwang JM. 'Largest angle to target' in surgery for intermittent exotropia. Eye. Jun 2005;19(6):637-42. [Medline].

  6. Burian HM. Exodeviations: Their classifications, diagnosis, and treatment. Am J Ophthalmol. 1996;62:1161.

  7. Burian HM, Franceschetti AT. Evaluation of diagnostic methods for the classifications of exodeviations. Am J Ophthalmol. 1971;71:34.

  8. Burke MJ. Intermittent exotropia. Int Ophthalmol Clin. Winter 1985;25(4):53-68. [Medline].

  9. Caltrider N, Jampolsky A. Overcorrecting minus lens therapy for treatment of intermittent exotropia. Ophthalmology. Oct 1983;90(10):1160-5. [Medline].

  10. Choi DG, Rosenbaum AL. Medial rectus resection(s) with adjustable suture for intermittent exotropia of the convergence insufficiency type. J AAPOS. Feb 2001;5(1):13-7. [Medline].

  11. Cooper E. The surgical management of secondary exotropia. Trans Am Acad Ophthalmol Otolaryngol. 1961;65:595.

  12. Duane A. A new classification of the motor anomalies based upon physiological principles together with their symptoms, diagnosis, and treatment. Am Ophthalmol Otolaryngol. 1897;6:84.

  13. Eustace P, Wesson ME, Drury DJ. The effect of illumination of intermittent divergent squint of the divergence excess type. Trans Ophthalmol Soc U K. 1973;93(0):559-70. [Medline].

  14. Friedman Z, Neumann E, Hyams SW, Peleg B. Ophthalmic screening of 38,000 children, age 1 to 2 1/2 years, in child welfare clinics. J Pediatr Ophthalmol Strabismus. Jul-Aug 1980;17(4):261-7. [Medline].

  15. Jampolsky A. Ocular divergence mechanisms. Trans Am Ophthalmol Soc. 1970;68:730-822. [Medline].

  16. Jampolsky A. Strabismus reoperation techniques. Trans Am Acad Ophthalmol Otolaryngol. Sep-Oct 1975;79(5):704-17. [Medline].

  17. Jampolsky A. Treatment of exodeviations. Trans New Orleans Acad Ophthalmol. 1986;34:201-34. [Medline].

  18. Jenkins R. Demographics: Geographic variations in the prevalence and management of exotropia. Am Orthopt J. 1992;42:82.

  19. Kushner BJ. Exotropic deviations. A functional classification and approach to treatment. Am J Orthop. 1988;38:81.

  20. Kushner BJ. Selective surgery for intermittent exotropia based on distance/near differences. Arch Ophthalmol. Mar 1998;116(3):324-8. [Medline].

  21. Kushner BJ. The distance angle to target in surgery for intermittent exotropia. Arch Ophthalmol. Feb 1998;116(2):189-94. [Medline].

  22. Parks MM. Concomitant exodeviations. In: Ocular Motility and Strabismus. Hagerstown, Md:. Harper & Row;1975:113.

  23. Rosenbaum AL. Exodeviations. In: Current Concepts in Pediatric Ophthalmology and Strabismus. Ann Arbor:. University of Michigan;1993:41.

  24. Rosenbaum AL, Stathacopoulus RA. Subjective and objective criteria for recommending surgery on intermittent exotropia. Am Orthopt J. 1992;42:46.

  25. Santiago AP, Ing MR, Kushner BJ, Rosenbaum AL. Intermittent exotropia. In: Clinical Strabismus Management: Principles and Surgical Techniques. WB Saunders Co;1999.

  26. Von Noorden GK. Exodeviations. In: Binocular Vision and Ocular Motility: Theory and Management of Strabismus. 5th ed. St Louis:. Mosby Year Book;1996:341.

  27. Wiggins RE, von Noorden GK. Monocular eye closure in sunlight. J Pediatr Ophthalmol Strabismus. Jan-Feb 1990;27(1):16-20; discussion 21-2. [Medline].

  28. Wirtschafter JD, Bourassa CM. Binocular facilitation of discomfort with high luminances. Arch Ophthalmol. May 1966;75(5):683-8. [Medline].

 
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Patient with intermittent exotropia at distance only. Patient is fixing with the left eye. Note the outward deviation of the right eye.
Patient with intermittent exotropia at distance only. Patient is now fixing with the right eye, showing that he can alternate well.
Patient with intermittent exotropia at both distance and near. Patient is fixing with the left eye. Note the outward deviation of the right eye.
Patient with intermittent exotropia at both distance and near. Patient is now fixing with the right eye, showing that she can alternate well.
Kushner classification of intermittent exotropia.
Management options for various types of intermittent exotropia.
 
 
 
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