How to properly understand exotropia?
Exotropia is the most common type of strabismus, commonly known as “squint”. Parents often say, “Our child’s eyes don’t look right sometimes, is something wrong? We have summarized here the common questions asked by patients and families with exotropia, hoping that it will be beneficial for patients to understand exotropia correctly.
What is exotropia?
Exotropia is the outward deviation of the eye. It is the opposite of internal strabismus. Exotropia can occur from time to time (intermittent exotropia) or can be constant, and can be seen in all age groups.
As shown in the figure.
What are the types of exotropia?
Exotropia can be congenital (present after birth) or acquired. The types of acquired exotropia include intermittent exotropia, perceptual exotropia, and secondary exotropia.
What is congenital exotropia?
Congenital or infantile exotropia is the outward deviation of the eye after birth or in early infancy. Internal strabismus (inward slanting of the eye) is much more common in newborns than exotropia. Constant exotropia in infants should be evaluated by a pediatric ophthalmologist to exclude other medical conditions that may be associated with it.
What is intermittent exotropia?
Many normal people have a tendency for the eye to drift outward when the eye is fully relaxed, such as when staring into an open space or daydreaming. This tendency to drift outward, which occurs only inadvertently, is called episcleral obliquity and can be effectively controlled when attention is restored. Exotropia is less frequent and does not cause symptoms. However, in some patients, exotropia can become more frequent and even progress to constant strabismus.
Is exotropia hereditary?
Strabismus, or misalignment of the eyes, is heritable. All affected family members do not necessarily have the same type of strabismus, i.e., the type of eye position error is not always exotropia. Some relatives can have significant strabismus, while others can have milder strabismus. Many family members may not even have strabismus at all. Children with a family history of strabismus should be examined and evaluated by a pediatric ophthalmologist. In fact, it is not uncommon in our clinical practice for fathers and sons to be treated surgically at the same time.
What are the signs of intermittent external strabismus?
Although they have the ability to regain control, patients with intermittent exotropia may occasionally notice a deviated eye position, for example when they are very tired, ill, or after drinking alcohol. Children may squint in the sunlight or rub their eyes. When the eye position is oblique, vision may become blurred or may feel double vision. Some patients say they can feel the deviation in one eye, even though they see without abnormalities. Others are unaware of the outward slant of the eye and are reminded by someone next to them that they are aware of the eye slanting out.
Why do children with intermittent exotropia often close one eye?
Children with intermittent exotropia often close or squint one eye, especially when they are outside in the sunlight. The exact reason why children with intermittent exotropia close one eye in bright light is not known. In any case, when the eye is closed, the child cannot use both eyes at the same time. Younger children who are unable to wear sunglasses can wear a hat with a brim, such as a baseball cap, to shield their eyes from the sun and thus reduce the need to squint.
Will intermittent exotropia get better when children grow up?
Most exotropia does not go away completely, but sometimes the child can manage it well enough to wear glasses or no glasses at all.
Is there anything I can do to stop intermittent exotropia from getting worse?
Some common sense approaches can help control intermittent exotropia. For example, it is important to get an age-appropriate amount of sleep – many children are sleep deprived! Always staying healthy can also help control it. Illness or fever can cause intermittent episodes of exotropia to occur frequently. Patients often report that my eyes were slanted after an illness when I was a child. As recommended by the doctor, visit the eye doctor as often as possible and keep the glasses at the right prescription in order to keep the child’s visual system receiving timely micro adjustments. Other than that, the progression of intermittent exotropia is not something we can prevent and control.
Can watching too much TV or playing too many video games make exotropia worse? Or do video games help?
Normal visual activity has no effect on exotropia. However, parents support limiting the amount of time children spend watching television, playing video games, and sitting in front of the computer for other health reasons. Recently, 3-D technology has become increasingly popular in the entertainment world. In some cases, exposure to 3-D images can lead to significant eye strain, the latter of which can exacerbate exotropia. Because of this, some manufacturers of 3-D equipment recommend that children under the age of 6 and those with eye conditions not be exposed to 3-D.
What is perceptual exotropia?
Exotropia in the low vision eye is called perceptual exotropia. In such cases, the low vision eye cannot work with the other eye, so the poorly sighted eye has a tendency to skew outward. Perceptual exotropia can occur at any age. Of course, if the visual problem is treatable, it should be treated as soon as possible. In cases of permanent loss of vision, surgery is usually an option to correct the eye position.
How is exotropia treated?
Non-surgical treatment includes glasses or eye muscle training. Occasionally, masking treatment may be recommended. If the eye position is deviated more often than when the eye position is positive, extraocular muscle surgery should be recommended to correct the eye position. Your pediatric ophthalmologist will analyze the best time for surgery based on your condition.
When is exotropia surgery indicated?
The criteria for exotropia surgery can vary to some degree, but in general, surgery is indicated when exotropia is frequent; when the patient has significant symptoms (visual fatigue, diplopia, squinting); or when there is evidence that the patient is losing “binocular vision”. Surgery may not be recommended if emmetropia is well controlled with glasses.
What is binocular vision?
Binocular vision refers to the brain’s ability to see objects with both eyes at the same time. Among other benefits, binocular vision is necessary for normal depth perception, or “3-D stereopsis”.
What is the best age for exotropia surgery?
Age is not a major determinant of exotropia surgery. If the exotropia is present most of the time, surgery is appropriate regardless of age.
Can exotropia be treated with masking?
In young children, if the child prefers to use one eye, or is amblyopic, it is useful to cover the dominant eye part of the time. This will help protect the vision of the eye that is not preferred. Some people recommend alternating the coverage of both eyes every other day to help control exotropia, but this rarely cures the problem.
Can exotropia be treated with glasses?
If the patient is nearsighted, keeping eyeglass prescriptions up to date may help control the eye position.
Can exotropia be treated with trigeminal glasses?
If the exotropia is small, trigeminal lenses can be used to relieve diplopia.
What is the role of training or vision therapy?
Training has been shown to be effective in the treatment of concentration deficits. Training is recommended for some cases of intermittent exotropia where the goal of visual training is to teach the patient to improve control of the eye position. These treatments do not eliminate the eye strabismus; they only hope to help make them appear less frequently. Unfortunately, many patients who undergo these treatments will continue to lose compensations and, eventually, control of the eye position and require surgical treatment.