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.

Exotropia (pronounced “ek-suh-TROH-pee-uh”) is the opposite of esotropia, the turning inward of your eyes. While it’s commonly seen in babies and children, it can also affect adults.

If you notice your child’s eye turning out, it’s important to seek treatment right away. The eye with exotropia can have vision problems and the appearance of the condition can lead to low self-esteem and issues with social development. The sooner your child receives a diagnosis, the sooner they can begin treatment to correct the alignment of their eyes.

Types of exotropia

There are many types of exotropia, including:

• Intermittent exotropia: Intermittent exotropia is the most common form. It’s not present all the time — it comes and goes. Your eye may turn outward when you’re tired, sick or under stress.
• 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.
• Infantile or congenital exotropia: Infantile or congenital exotropia means the condition was present at birth or from early infancy.
• Sensory exotropia: This type occurs in an eye that already doesn’t see well. The eye with poor vision turns outward because it isn’t able to work with the other eye.
• Alternating exotropia: This kind happens in each eye at different times. This is different from unilateral exotropia, which means the deviation happens only in the same eye all the time.
• Consecutive (secondary) exotropia: This type is a misalignment that happens after surgery to treat esotropia.

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?

Exotropia has many possible causes, including:

• Genetics: Strabismus runs in some biological families.
• Eye muscle weakness: This occurs when your eye muscles can’t control your eye movements.
• Convergence insufficiency (CI): With CI, your eyes don’t come together at the right point to see an object nearby.
• 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.

What are the risk factors for exotropia?

The risk factors for developing exotropia include:

• Neurologic disorders.
• Preterm birth.
• Substance and alcohol use during pregnancy.
• Genetic variations.
• Uncorrected refractive errors.
• Biological family history of strabismus.

What are the complications of exotropia?

Left untreated, intermittent exotropia can progress to constant exotropia. As the condition progresses at a young age, your child may experience amblyopia or the loss of binocular vision (both eyes working together to see).

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.) They may refer you to an ophthalmologist or optometrist.

Your child’s provider will ask for a family and medical history and will perform an eye exam. The exam will cover how your child’s eyes move and focus. Testing may include:

• Visual acuity test: Reading letters from an eye chart or examining young children’s visual behavior.
• Refraction test: Checking your child’s 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. These tests will check how well your child’s eyes line up and how clearly they can see.
• Examination after dilation (widening) of your child’s pupils to determine the health of their internal eye structures.

How is exotropia treated?

Treatment of exotropia varies depending on the severity of the condition. Sometimes, intermittent exotropia stays mild or goes away on its own. Treatment options include:

• Eye patching: Your child wears a patch over their stronger eye so their weaker eye gets stronger.
• Eye drops: Eye drops work like a medical form of patching.
• Corrective lenses: Your child’s provider may prescribe eyeglasses or contact lenses.
• Visual therapy: Eye exercises can help if your child has convergence insufficiency.
• Botulinum toxin (Botox®): Botox injections into your child’s eye muscles may help with realignment.
• Surgery: Your child’s provider can perform surgery to tighten or loosen the muscles in one or both eyes.

Can exotropia be prevented?

You can’t prevent exotropia. If you’re pregnant or planning to become pregnant, you may wish to speak with a genetic counselor about your risk of passing on the condition to your child.

What is the outlook (prognosis) for people with exotropia?

Exotropia may become less frequent over time, but most types don’t resolve completely. Treatment with nonsurgical measures may help control the condition, but many people still experience recurrences.

When should my child see their healthcare provider?

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

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

What questions should I ask my child’s healthcare provider?

Questions you may want to ask your child’s provider include:

• What type of exotropia does my child have?
• What treatment options do you recommend?
• Does my child need surgery?
• What are the benefits and risks of surgery?

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 isn’t currently possible.