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Abstract: The child was 5 years old and was found to have an outward skew of one eye since the age of 3. In the past 2 years, the exotropia was frequent and the angle of the strabismus increased, affecting the appearance, so he came to the office and was diagnosed with intermittent exotropia. After detailed examination, it was found that the degree of exotropia was relatively large and affected the visual function of both eyes, so surgery was recommended. The child was hospitalized and underwent surgery. After surgery, the child’s eye position was normalized and the visual function of both eyes was partially restored.
Basic information】Male, 5 years old
Disease Type】Intermittent exotropia
Hospital】Jiangxi Provincial People’s Hospital
Date of Consultation】October 2021
Treatment Plan】Surgical treatment (strabismus surgery)
Treatment Period】2 days of hospitalization, 1 week after surgery, and 1.5 months of outpatient follow-up
Results】Eye alignment, partial recovery of visual function in both eyes
I. Initial consultation
The parents reported that the child had occasional exotropia since he was 3 years old, and in the past 2 years, they found that the child had frequent exotropia at distance and near, which affected his appearance, so they came to the clinic. The examination showed that the visual acuity of the right eye was 5.0 and that of the left eye was 5.0, and the intraocular pressure of the right eye was 13 mmHg and that of the left eye was 14 mmHg. The right eye position was measured using the reflective light method with -25 degrees of gaze and alternating masked eye positions outside to mid. Monocular movements were in place in all directions, and binocular movements were +2 in the right eye with hyperfunction of internal upward rotation and +2 in the left eye with an increased angle of external strabismus during upward rotation. Based on the above findings, the diagnosis of intermittent exotropia was made. Considering the frequent occurrence of exotropia, which affects the development of visual function, it is recommended to arrange for surgery to correct exotropia as soon as possible.
II. Treatment history
After admission, a detailed examination of the child’s strabismus and binocular visual function was performed, which, together with fundus photography, revealed external rotation of the right eye and no rotation of the left eye. Based on the comprehensive examination results, the child was recommended to undergo strabismus surgery, which aimed to resolve the external strabismus and the asymmetry of the upper and lower strabismus. The aim of the surgery was to resolve the external strabismus and the asymmetry between the upper and lower strabismus.
III. Treatment results
On the second postoperative day, the child’s exotropia improved, and the reflective point was found to be in the center of the pupil when examined by the reflective light method. The strabismus examination, such as the trigeminal + alternating mask test, showed that seeing 6m far and 33cm near, and the observation of eye movement showed no hyperactivity of the internal rotation muscles during the internal upward rotation of both eyes, the eye position was orthotropic, and the visual function of both eyes was partially restored, and the child was discharged from the hospital. After surgery, topical flumetron eye drops and tobramycin eye drops should be used for 2 weeks continuously. The stitches should be removed 1 week after surgery, and binocular visual function training should be started to establish tertiary stereo visual function.
IV. Notes
We are glad that the child’s symptoms of exotropia have improved after surgery. However, there will be some foreign body sensation and slight pain and discomfort in the eyes after surgery, and the redness of the eye surface will last for half a month to one month, and the eye position will be basically stable after 1.5 months. Pay attention to eye hygiene, try not to enter water, and order hormone and antibiotic eye drops, such as flomylone drops and tobramycin drops, on time, and follow up after 1 week, and again after 1.5 months.
V. Personal insight
Intermittent exotropia has a high prevalence in Chinese children and often leads to impairment of visual function in both eyes, especially when looking at a distance, so it is important to conduct an objective and comprehensive examination of each child seen and decide whether to treat conservatively or surgically. In this case, the child’s symptoms of exotropia worsened, and surgical treatment was given after consultation, which minimized the damage to visual function in both eyes.