Further Outpatient Care
Although regimens vary among surgeons, regular follow-up visits are necessary to determine if the eyes are well aligned and if fusional abilities are present and stable.
Further Inpatient Care
Surgery for the patient with strabismus usually is performed as an outpatient procedure.
Complications
If left untreated, loss of fusion and stereopsis could occur. If the patient freely alternates, the chance of amblyopia is reduced.
Complications associated with surgery include undercorrection and overcorrection and/or residual or new oblique muscle dysfunction.
Postoperative complications include residual A- or V-pattern strabismus, diplopia, and undercorrection or overcorrection of the horizontal deviation.
Prognosis
The prognosis for patients with this condition is good. Only one surgery is required to correct the deviation in 80% to 85% of patients; 10% to 15% of patients may need a second or third procedure for good alignment.
Success for binocularity depends on the patient's age, the time of presentation, and any previous amblyopia. Failure to detect and appropriately treat this condition could result in loss of binocularity and possibly amblyopia
Postoperative drift in patients with comitant exotropia alone and patients with intermittent exotropia with coexistent A or V pattern has been studied, and it has been seen that patients with a coexistent V or A pattern have a reduced risk of postoperative recurrence. [13]
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V-pattern exotropia.
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V-pattern esotropia.
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Esotropia and exotropia, V-pattern. In Image 3a, lateral rectus muscle insertion moved toward the open end of V. In Image 3b, medial rectus muscle insertion moved toward the closed end of V.
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Esotropia and exotropia, V-pattern. In Image 4a, half tendon width vertical shift of muscle insertion. In Image 4b, full tendon width vertical shift of muscle insertion.
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Esotropia and exotropia, V-pattern. In Image 5a, slanting of rectus muscle insertion. In Image 5b, recession and slanting of rectus muscle insertion.
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Esotropia and exotropia, V-pattern. Recess-resect procedure in same eye.
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Patient with V-pattern exotropia and inferior oblique muscle overaction.
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Patient with V-pattern esotropia and inferior oblique muscle overaction.
