(Disclaimer: This article is for scientific purposes only, and the information in the following content has been processed to protect the privacy of the child)
Abstract: A 5-year-old male child whose parents noticed occasional outward drifting of the left eye and physical examination suggested the presence of exotropia, so he sought medical examination. The diagnosis of intermittent exotropia was confirmed after completion of the outpatient examination, and the exotropia correction surgery was performed under general anesthesia. After the surgery, the child felt significantly easier to see and the outward drift of the left eye disappeared. After the surgery, the child was given bilateral visual function training according to his condition, and all the visual function indicators returned to normal after 3 months of review.
Basic information】Male, 5 years old
Disease Type】Intermittent exotropia
Hospital】The First Affiliated Hospital of Zhengzhou University
Date of Consultation】April 2020
Treatment plan]: Left eye exotropia correction + binocular visual function training (simultaneous visual function training, fusion function training and stereopsis function training)
Treatment Period】5 days in hospital, 3 weeks after surgery and 3 months after outpatient follow-up
Treatment effect】Strabismus completely corrected, binocular vision function restored
I. Initial consultation
The parents found that the child’s left eye drifted outward when watching TV, listening to stories, being sleepy and inattentive, but when focused, the eye could maintain its normal position. At first, they didn’t pay attention to it, but when the kindergarten took a group photo, they found that the child’s eyes were obviously skewed in the photo, which seriously affected his beauty.
The child’s physical examination revealed no significant abnormalities in the external eyes, OD 0.8, OS 0.8, anterior segment and fundus of both eyes. IOP R14mmHg, L15mmHg. primary optometry: OD+0.50DS/+1.00DCx10=1.0, OS+0.75DS/+1.25DCx10=1.0. synoptic machine: I(-14)°, II(-5)°-(+10)°, III none, Worth four-point light: near 4 lights, far 2 red lights. The preliminary diagnosis of intermittent exotropia was made by combining the above examination results.
II. Treatment history
After the child was admitted, a detailed consultation was conducted, and the results of the simultaneous vision examination indicated that the child had a small fusion range and no stereopsis. Based on the parents’ complaints and the examination results, the final diagnosis of intermittent exotropia was clear.
Therefore, the child was given a monocular mask for 40 minutes to break the fusion by disrupting binocular vision and fully exposing the hidden set-controlled exotropia. Later, the results of the combined trigeminal masking method showed 33cm-60△ and 6m-40△.
Considering that the child was already 5 years old and had a large strabismus with significantly impaired visual function in both eyes, there were objective clinical manifestations. In a comprehensive judgment, surgery was given to correct the strabismus. The left external strabismus was corrected under general anesthesia, and the external rectus muscle of the left eye was posteriorly migrated by 5 mm and the internal rectus muscle was shortened by 5.5 mm during the operation.
III. Treatment results
After the operation, the child said he had no discomfort and the strabismus disappeared, so he was discharged after 5 days of hospitalization. The child complained of mild hyperopia when looking at a distance, which disappeared after a little autonomic control. The examination showed mild conjunctival congestion in the left eye and neat healing of the conjunctival incision, VaOD 0.8, OS 0.8, and orthoptic position of both eyes. Synoptic machine: I (+3)°, II (-2)°-(+13)°, III none, Worth four-point light near 4 lights, far 5 lights. The examination results showed positive eye position and no significant abnormalities in all directions of eye movements. However, binocular vision was still abnormal, and there were still significant defects in fusion range and stereopsis. Therefore, bilateral visual function training was given for 3 months, including simultaneous visual function training (capture training, flicker training), fusion function training and stereopsis function training.
At the review after 3 months, the child felt that the diplopia disappeared, both eyes were no longer fatigued, and he could concentrate more easily when studying. Synoptic machine I (0)°, II (-5)°-(+30)°, Worth four-point light near 4 lights, far 4 lights. Showed significant recovery of visual function in both eyes.
IV. Notes
We are glad that the child has recovered significantly after surgery and visual function training, and the intermittent exotropia has disappeared. However, parents still need to observe the child’s behavior carefully and remember not to rub the eye in the early postoperative period to avoid slipping or cracking of the muscle or conjunctival incision. In case of refractive abnormalities and other eye problems, the child should be seen by a professional pediatric ophthalmologist as soon as possible, and regular training and periodic review are required after surgery. In addition, parents should actively correct their children’s eye use norms, use their eyes correctly, and wear sunglasses when they go out.
V. Personal insight
Intermittent exotropia is a common type of strabismus in clinical practice. Early detection and treatment is the basis for restoration of binocular vision, and unsightly appearance and poor binocular vision are important indications for surgical treatment, and rapid recovery and examination of binocular vision after surgery is the key to successful treatment. The fact that the child was able to achieve good results within 3 months is inseparable from the required examination, active surgery, adherence to post-operative training and timely review by the child and parents. We remind parents that if they find their children have strabismus or other eye discomfort symptoms, they must seek medical examination early to avoid delaying treatment and increasing the treatment difficulty or treatment period.