Congenital Exotropia Clinical Presentation

  • Author: Mounir Bashour, MD, CM, FRCS(C), PhD, FACS; Chief Editor: Hampton Roy Sr, MD   more...
 
Updated: Dec 1, 2011
 

History

By definition, children present when they are younger than 12 months with a constant outward deviation of the eyes.

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Physical

  • Unlike other neurologic forms of exotropia, there should be no pupillary or lid involvement. Although craniofacial syndromes can be seen with congenital exotropia, there should be no ptosis or pupillary mydriasis (see Oculomotor Nerve Palsy).
  • The eyes should appear diverging with no limitation of adduction.
  • Over time, a preference may occur with one eye used consistently for fixation; then, the other eye will develop amblyopia.
  • As many as 60% of patients may develop oblique muscle dysfunction, dissociated vertical deviation, and amblyopia. Nystagmus is rare.
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Causes

There is a familial predisposition suggestive of an autosomal dominant pattern with incomplete penetrance.

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Contributor Information and Disclosures
Author

Mounir Bashour, MD, CM, FRCS(C), PhD, FACS  Assistant Professor of Ophthalmology, McGill University; Clinical Assistant Professor of Ophthalmology, Sherbrooke University; Medical Director, Cornea Laser and Lasik MD

Mounir Bashour, MD, CM, FRCS(C), PhD, FACS is a member of the following medical societies: American Academy of Ophthalmology, American Association for Pediatric Ophthalmology and Strabismus, American College of International Physicians, American College of Surgeons, American Medical Association, American Society of Cataract and Refractive Surgery, American Society of Mechanical Engineers, American Society of Ophthalmic Plastic and Reconstructive Surgery, Biomedical Engineering Society, Canadian Medical Association, Canadian Ophthalmological Society, Contact Lens Association of Ophthalmologists, International College of Surgeons US Section, Ontario Medical Association, Quebec Medical Association, and Royal College of Physicians and Surgeons of Canada

Disclosure: Nothing to disclose.

Coauthor(s)

C Corina Gerontis, MD  Consulting Staff, Departments of Pediatrics and Ophthalmology, Schneider Children's Hospital/Long Island Jewish Medical Center

C Corina Gerontis, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Ophthalmology, American Association for Pediatric Ophthalmology and Strabismus, and American Medical Association

Disclosure: Nothing to disclose.

Specialty Editor Board

Gerhard W Cibis, MD  Clinical Professor, Director of Pediatric Ophthalmology Service, Department of Ophthalmology, University of Kansas School of Medicine

Gerhard W Cibis, MD is a member of the following medical societies: American Academy of Ophthalmology, American Association for Pediatric Ophthalmology and Strabismus, and American Ophthalmological Society

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

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

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. Hunter DG, Kelly JB, Buffenn AN, et al. Long-term outcome of uncomplicated infantile exotropia. J AAPOS. Dec 2001;5(6):352-6. [Medline].

  2. Saunders RA, Trivedi RH. Sensory results after lateral rectus muscle recession for intermittent exotropia operated before two years of age. J AAPOS. Apr 2008;12(2):132-5. [Medline].

  3. Biglan AW, Davis JS, Cheng KP, et al. Infantile exotropia. J Pediatr Ophthalmol Strabismus. Mar-Apr 1996;33(2):79-84. [Medline].

  4. Brodsky MC, Baker RS, Hamed LM. Pediatric Neuro-ophthalmology. 1996.

  5. Hunter DG, Ellis FJ. Prevalence of systemic and ocular disease in infantile exotropia: comparison with infantile esotropia. Ophthalmology. Oct 1999;106(10):1951-6. [Medline].

  6. Matsuo T, Yamane T, Ohtsuki H. Heredity versus abnormalities in pregnancy and delivery as risk factors for different types of comitant strabismus. J Pediatr Ophthalmol Strabismus. Mar-Apr 2001;38(2):78-82. [Medline].

  7. Mohney BG, Huffaker RK. Common forms of childhood exotropia. Ophthalmology. Nov 2003;110(11):2093-6. [Medline].

  8. von Noorden GK. Binocular Vision and Binocular Motility: Theory and Management of Strabismus. 1996.

  9. Wright KW, Buckley EG, Del Monte MA. Pediatric Ophthalmology and Strabismus. 1995.

 
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