Exotropia

Overview

Exotropia refers to an outward deviation of the eyes. In children, it commonly begins around age 2 to 4 years, although it may begin at any age. Initially, this form of strabismus may only be seen when your child is tired or not feeling well. Typically, the deviation is noted more when the child looks in the distance and not so much when viewing close objects. Your child may be seen squinting or rubbing one of the eyes. A child with exotropia may close one eye in bright sunlit environments. Few children will complain of double vision.

Treatment

Eye muscle surgery to establish good ocular alignment is generally recommended if one or more of the following criteria are present:

• If the exotropia is present for more than 50% of each day.
• If the frequency of the exotropia is definitely increasing over time, even if it is not yet apparent for half of the day.
• If there is a significant exotropia when your child intently views objects at near.
• If there is evidence that your child is losing "binocular vision". This refers to the brain's ability to use both eyes together as a single unit. Among other benefits, binocular vision affords optimal depth perception.

If none of these criteria are met, surgical intervention is generally not recommended and simple observation with or without some form of eyeglass is then warranted. If amblyopia is present, a patch may be prescribed to be worn over the stronger eye to force the child to use and strengthen the eye with poorer vision.