What is Exotropia?

Published March 26, 2020

Exotropia is a common form of strabismus (wall-eyed), characterized by an outward eye turn, away from the nose.

The eye turn may be noticed while the child is looking at distance objects, near objects or both.

There are two types of exotropia:

  • Constant
  • Intermittent

Constant exotropia occurs when the eye turn is present all of the time, at all distances. This type of strabismus occurs less frequently than the intermittent type.

Treatment for this condition should be prescribed early in order to recover proper binocular vision. Vision therapy, with or without eyeglasses, eye patching, drops, or surgery is the most effective approach in treating constant exotropic strabismus.

Intermittent exotropia, the most common form of exotropia, occurs when the eye turn is only present occasionally. In many cases, the eye turn may only be visible during stressful situations or when the person is tired or ill —this can lead to a late diagnosis since the vision condition is difficult to notice.

On a positive note, when the eye turn is only occasional, the visual system, including the eye-brain connection, can continue to develop and allow for some development of binocular vision and depth perception.

What are the symptoms of exotropia?

Symptoms of exotropia may be exacerbated by prolonged reading, desk work, and computer use.

The most common symptoms of exotropia are:

  • Outward Eye turn
  • Blurred vision
  • Diplopia (double vision)
  • Eyestrain
  • Headaches
  • Avoidance or inability to focus while reading
  • Motion Sickness

Can intermittent exotropia be due to convergence insufficiency?

Yes.

An outward turn of one eye that occurs only when focusing on near objects can be a symptom of Convergence Insufficiency (CI), another common binocular (two-eyed) vision problem.

If left untreated, CI can eventually lead to an eye turn and intermittent exotropia.

Convergence Insufficiency is the most common type of visual-motor problem in children— with a reported 5 to 13% prevalence among children and adults. The condition can cause eyestrain, blurry vision, double vision (diplopia), and/or headaches— which can lead to academic and athletic challenges. According to the National Institutes of Health/National Eye Institute, the best treatment for CI is Vision Therapy.

How is an intermittant eye turn diagnosed? 

Intermittent eye turns can be difficult to detect because of their occasional appearance. Additionally, an outward eye turn typically only appears when the child is fatigued, anxious, or ill. However, with the use of specialized equipment, your doctor will determine the functional integrity of your child’s visual system.

Treatment of 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.  Vision therapy treats the underlying cause and improves the eye-brain connection and retrains visual skills necessary for binocular vision.

Vision therapy or surgery?

In a comparative study using both Optometric and Ophthalmological journals, Vision therapy had an overall success rate of 78% as compared to surgery of 48%.

Vision therapy is also effective in improving the developments of the neural pathways and the eye-brain connection, both before and after surgery.  Surgery should be used as a last resort only for large angle intermittent exotropia. Patients with a significant large angle eye turn can benefit from surgery because the eye will appear aligned —increasing confidence in social situations.  However, surgery does not usually improve visual function, and is therefore typically combined with vision therapy.

Even an occasional eye turn can impact relationships

An early diagnosis of an eye turn, even if it only appears on occasion, is beneficial to your child’s social performance — alleviating social discomfort or low self esteem that can be caused by the condition.  Personal relationships can be significantly impacted, especially if an outsider doesn’t know that the person suffers from an occasional eye turn.

The eye turn can be present only sometimes during a conversation — presenting as lack of eye contact and causing the person to appear as if he is distracted or not interested in the conversation.

If you suspect that your child is suffering from an eye turn, it is important to seek attention to diagnose and treat the condition as early as possible.

The early the condition is diagnosed, the early your child can begin a personalized vision therapy program and be on their way to improved binocular vision.