Exotropia

What is exotropia?

Exotropia is a form of strabismus, a misalignment of the eyes. If you have exotropia, one or both of your eyes turn outward (toward your ears). In monocular exotropia, the turning involves one eye. In bilateral exotropia, the turning affects both eyes.

What is the difference between exotropia and esotropia?

Both esotropia and exotropia are forms of strabismus. The main difference is in the way that your eyes are affected. With esotropia, your eyes turn inward toward your nose. With exotropia, your eyes turn outward toward your ears.

What are the types of exotropia?

There are many types of exotropia, even though some researchers narrow it down to only constant (all the time) and intermittent (comes and goes).

Other types include infantile or congenital (present at birth or from infancy), sensory, alternating and consecutive exotropia. Secondary exotropia is another name for consecutive exotropia.

Intermittent exotropia

Intermittent exotropia is the most common form of exotropia. It may affect about 1% of the population.

Intermittent exotropia is not present all the time. Your eye may turn outward when you’re tired, sick or under stress. It is typically more noticeable when looking far away or daydreaming. Because it’s not there all the time, it may be missed and diagnosed later in life.

However, your eyes can develop somewhat more normally because the turning doesn’t happen all the time.

Constant exotropia

In this type of exotropia, your eye or eyes always turn outward away from your nose. It happens at near or far distances. It’s less common than intermittent exotropia.

Sensory exotropia

Sensory exotropia is a term that describes exotropia in an eye that already doesn’t see well. The eye with poor vision isn’t able to work with the other eye to see in a binocular (two eyes) fashion. The eye with poor vision then turns outward. This condition isn’t limited to one age group.

Alternating exotropia

Alternating exotropia refers to exotropia that happens in both eyes at different times. This is different from unilateral exotropia, which means that the misalignment or deviation happens only in the same eye all the time.

Consecutive (secondary) exotropia

Consecutive or secondary exotropia is a misalignment that happens after surgery to treat esotropia. Esotropia is the turning inward of your eyes. This can happen in adults who had treatment as children.

What are the signs and symptoms of exotropia?

The signs and symptoms of exotropia include:

• Eyes turned outward some or all of the time.
• Squinting.
• Eye strain.
• Headaches.
• Double vision (diplopia).
• Closing one eye when you’re in bright sunlight.
• Decreased depth perception.

What causes exotropia?

• Genetics: Strabismus, or misaligned eyes, does run in some families.
• Eye muscle weakness: This refers to your eye muscles’ inability to control eye movements.
• Convergence insufficiency: Convergence insufficiency (CI). Eyes without CI are able to come together to see an object that is near. With CI, your eyes don’t come together at the right point to see the close-up object. If you have CI, you will probably have double vision or blurred vision. About 5% of U.S. children have CI.
• Nervous system conditions: Health conditions like stroke or tumors can cause exotropia.
• Extremely poor vision: Having low vision in your eye can cause exotropia.

Exotropia, especially intermittent exotropia, sometimes has no known cause.

Is exotropia hereditary?

Strabismus can run in families, but just because your family member has exotropia doesn’t mean you’ll have it too. You may have some other type of strabismus if you have any form at all.

How is exotropia diagnosed?

You or your healthcare provider may notice that your child’s eyes are turning outward. (It’s not always obvious to the person who has exotropia.)

Your provider will ask for a family and medical history and will do a physical examination. The exam will cover how the eyes move and focus. Testing may include:

• Visual acuity (reading letters from an eye chart, or examining young children’s visual behavior).
• Refraction (checking the eyes with a series of corrective lenses to measure how they focus light). Children don’t have to be able to give verbal feedback for these tests.
• Tests of alignment and focus.

Examination after dilation (widening) of the pupils to determine the health of internal eye structures.

How is exotropia treated?

Treatment of exotropia varies, depending on the severity of the condition and the desires of the family or person who has it. Sometimes, intermittent exotropia stays mild or goes away on its own. However, other treatments include:

• Eye patching: The stronger eye is covered so the weaker eye gets stronger.
• Eye drops: The medication works like a medical form of patching.
• Corrective lenses: Your provider may prescribe eyeglasses or contact lenses.
• Eye exercises: Eye exercises can help if you have a form of exotropia called convergence insufficiency.
• Surgery: Surgery can be performed to tighten or loosen muscles in one or both eyes. It may also serve to boost your confidence if you feel self-conscious of your eye wandering in social situations.

How can I prevent exotropia?

You can’t prevent exotropia.

What can I expect if I have exotropia?

The outlook for people with exotropia is good in terms of vision and depth perception. However, many people do experience recurrences of exotropia.

If you’ve had treatment for exotropia, you’ll probably need follow-up appointments.

When should I see my healthcare provider?

Always contact your healthcare provider if you have any symptoms that worry you. This includes signs and symptoms like:

• Eye pain.
• Double vision.
• Blurred vision.
• Headaches.
• Motion sickness.

Can exotropia cause blindness?

Untreated exotropia can lead to amblyopia, poor vision in one eye. Without treatment, you may lose your ability to see with both eyes (binocular vision) and have difficulty with your depth perception.

Does exotropia get worse with age?

Exotropia tends to get worse over time if it’s not treated. You can manage it, but it may never go completely away. Some researchers believe that the permanent answer to the problem of intermittent exotropia lies in being able to repair the brain, which is not currently possible.

A note from Cleveland Clinic

Exotropia is a form of strabismus in which one eye or both eyes drift outward away from the nose. If you’re a parent, you might notice the outward turning more when your child is tired or daydreaming. Contact your healthcare provider whenever you have questions about eyesight. Like most conditions, exotropia responds best to treatment when it’s diagnosed early. While you can’t prevent it from happening, you can act quickly to seek treatment.