Patient: Occasional exotropia was noticed at the age of 2. He was diagnosed with intermittent exotropia at the hospital. He squinted when he was outdoors, especially in sunny weather, and showed exotropia when he looked at a distance, but he could see well at close range. He squinted about 50% of the time during the day. My child is 5 years old today and has had the disease for 3 years. He has not had surgery yet. I would like to hear Dr. Luo’s advice on when is the best time to operate? We are also waiting for the child’s visual development to mature before we dare to operate. But the later the surgery, the more it will affect the establishment of stereo vision in the future? I am also worried about the impact on my child’s vision in the future. When my child starts school next year, he will be using his eyes more and the fatigue will aggravate his strabismus, right? I would like to hear your advice on whether it is better to operate now or to wait for a few years, thank you. Luo Zhaowen, Ophthalmology Department, The First Hospital of Dalian Medical University: Hello! Intermittent exotropia is characterized by intermittency, so surgery depends mainly on the frequency and duration of the strabismus. If the strabismus is present only a small part of the day and can be maintained in a good eye position most of the time, then the child’s visual function is good in both eyes and there is no need to rush the surgery. However, if the child’s condition progresses and the strabismus lengthens in duration, surgery can generally be considered at about 50% of the time. Another issue that needs to be considered is anesthesia. The main types of anesthesia for strabismus surgery are general anesthesia and local anesthesia. General anesthesia is suitable for young children who cannot cooperate and is basically painless. However, because the child is unconscious during surgery, it is impossible to immediately observe the surgical results and make appropriate adjustments. No strabismus surgeon can guarantee orthotropia after general anesthesia based only on the results of the preoperative examination. The advantage of surgery under local anesthesia is that the child is awake during the surgery, and the result can be observed immediately after the surgery, and the amount of surgery can be adjusted if necessary, increasing the chance of a successful surgery. However, surgery under local anesthesia can be a little painful, so the child needs to be old enough to cooperate. This would generally need to be at the age of 8-9 years. In conclusion, the timing of surgery for intermittent exotropia needs to be considered in the context of all aspects of the situation. In addition, the trigeminal + masking test is usually used to check the degree of strabismus before surgery to determine the amount of surgery. If you don’t need surgery for the time being, you don’t have to rush to check. Welcome to visit us again when you have time.