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Treatment modalities used to realign the eyes include spectacles (sometimes with prism or bifocal), patching, strabismus surgery (eye muscle surgery), and botulinum toxin (less frequently utilized) Updated 10/19 #ConditionsThe increased accommodative demand in children with intermittent exotropia may be another factor 27 Chua and associates have shown that the reduction of accommodation with atropine eye drops slowed the progression of moderate myopia and axial elongation in Asian children 28 However, additional investigations have shown an increase inA nonrandomized, casecontrolled study among children from ages 3 to 144 months with intermittent exotropia showed results similar to surgical intervention These children received 25 units of Botox injection into each lateral rectus muscle

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Exotropia treatment for child-Iacobucci IL, Archer SM, Giles CL Children with exotropia responsive to spectacle correction of hyperopia Am J Ophthalmol 1993; Caltreider M, Jampolsky A Overcorrecting minus lens therapy for treatment of intermittent exotropia Ophthalmology 19;Children with hyperopia >350 D of spherical equivalent are at risk for refractive amblyopia 1 Glasses are usually prescribed to allow for normal visual development Most children who have hyperopia >4 D are either orthotropic or have an esotropia 1 Rarely, children with ≥4 D of hyperopia present with an exotropia 2 Spectacle correction in children with hyperopia and exotropia

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Intermittent distance exotropia is a specific type of squint (strabismus) With this type of squint when an individual looks beyond 3 meters, one eye turns outwards towards the ear The squint may be constant or intermittent on distance viewing You may find it is more noticeable when your child is tired, unwell or daydreamingPrisms may be used to improve fusional control – Orthoptic treatment Fusional convergence exercises may be employed in patients with symptoms of convergence insufficiency type of intermittent exotropia Active antisuppression and diplopia awareness techniques may be used in cases of suppressionIntermittent strabismus the exotropia occurs when the child is tired or daydreaming Patient may squint one eye Good stereopsis and binocular fusion when the eyes are aligned Treatment is usually strabismus surgery if the deviation is poorly controlled A phoria is a tendency for the eyes to drift apart, but alignment is maintained by

However, the studies involved either children only or a mix of adults and children1 Unfortunately, there has been little discussion on the benefits of adult strabismus treatment through VT, with the exception of adult VT for convergence insufficiency6,8,9 The above two cases illustrate that VT improves eye alignment, binocularity, andTreatment for hypertropia aims to ensure proper vision in both eyes and aligning the eyes At Children's National Hospital, our treatment options include Glasses to correct vision problems such as nearsightedness, farsightedness or astigmatism that may be contributing to the hypertropiaSpecial glasses with prisms can be used to decrease double vision in patients with constant exotropia In moderate to severe cases in children, an eye patch may be recommended Typically, eye patches are used for strabismic children who also have amblyopia (decreased vision in

Among the treatment options for esotropia are Glasses to correct vision problems such as nearsightedness, farsightedness or astigmatism;23 Wallace D, Chandler DL, Beck RW, et al Treatment of bilateral refractive amblyopia in children three to <10 years of age Am J Ophthalmol 07;144(4) 24 Pediatric Eye Disease Investigator Group Effect of age on response to amblyopia treatment in children Arch Ophthalmol 11;129(11) 25Eye exercises, properly called orthoptic therapy, may be indicated in certain cases of exotropia Orthoptic therapy is often used in children who cannot turn their eyes inward normally while looking at close objects Orthoptic therapy may also be used in

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Exotropia can be constant or intermittent, severe or mild If left untreated, exotropia can worsen, and it is more difficult to treat in adults An optometrist may advise children with exotropia to wear glasses to correct their vision Exotropia can be difficult to detect, since it is not visible when a child is looking at a nearby objectThe use of glasses or contact lenses is usually prescribed to people with exotropia who have, in turn, myopia or another refractive defect When the exophoria is moderate, it is recommended to place the child a patch in one eye to stimulate the alignment and correct the deviation This treatment is used to correct exotropia combined with amblyopiaExotropia Control Assessment Procedure eTable 2 Definition of Deterioration by a Given Time Point eTable 3 Clinical Characteristics According to Study Completion eTable 4 Spectacle Adherence by Treatment Group eTable 5 Child Assessment of IXT Symptoms Over Time eTable 6 Parental Assessment of Spectacle Symptoms and Issues Over Time

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Treatment of associated amblyopia;If the condition is mild, it may go away on its own within 6 to 8 weeks of birth In other cases of exotropia, it is not common to find a complete resolution of the condition While patching, glasses, or vision therapy can help, exotropia may remain presentBoth of these may appear as an eye turn, and can be successfully treated with eyeglasses and/or vision therapy

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If a child's eye only turns outward occasionally, no treatment may be necessary It is important to notice how often the child's eyes turn out If this outward turning begins to occur more frequently (more than 50% of the waking hours), surgery is indicated Surgery Many children with intermittent exotropia will eventually require surgeryTreatment of Intermittent Exotropia What is Intermittent Exotropia?Parents may begin to notice their child's eye turns out, especially when the child is tired, daydreaming, or sick Parents may also notice their child closes or squints one eye when outside in bright sunshine Treatment The treatment for intermittent exotropia can range from observation, conservative management, to surgery

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Treatments include Glasses Glasses that help correct near or farsightedness will help keep the eyes aligned Patching People with exotropia tend to favor the aligned eye, so vision in the eye turned outward can weaken, resulting Exercises Your doctor may suggest aCommon sense approaches may help to control intermittent exotropia For example, getting the recommended amount of sleep for age is important—many children don't!Has your child been diagnosed with exophoria or esophoria?

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Engaging patients (parents/families) in treatment decisions is increasingly recognised as important and beneficial Yet where the evidence base for treatment options is limited, as with intermittent distance exotropia (X (T)), this presents a challenge for families and clinicians The purpose of this study was to explore how decisions are made in the management and treatment of X (T) and what can be done to support decisionmaking for clinicians, parents and childrenBackground Intermittent exotropia (IXT) is a common form of childhood exotropia, accounting for about 50–90% of all the exotropia and affecting about 1% of the general population Objective The purpose of this study was to evaluate difference modalities for treatment of intermittent exotropia either by nonsurgical and surgical methodsPatching of the good eye, to improve vision in the lazy (amblyopic) eye;

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A few children will report eye strain and/or headaches, but most do not Squinting in sunlight is very common Excess blinking is often present Treatment of intermittent exotropia Treatment recommendations depends on the severity of the problem, on the signs and symptoms, and on the patient and family desiresUnilateral recessionresection in children with exotropia of the convergence insufficiency type Eye 05 Dec 2 Figueira EC, Hing S Intermittent exotropia comparison of treatments Clin Experiment Ophthalmol 06 Apr 34(3) Kim C, Hwang JM Largest angle to target' in surgery for intermittent exotropia(binocular depth perception) Early identification and treatment of strabismic children may prevent amblyopia1 The strabismic child with amblyopia has a significantly higher risk of becoming blind by losing vision in the nonamblyopic eye, due to trauma or disease2,3 Normal binocular vision is required for many occupational and

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About a quarter of all children with strabismus have exotropia There are different types of exotropia The condition can be visually noticeable either all the time or just sometimes Exotropia can be present at birth or occur later in life It can usually be managed or treated, but treatment will vary based on type and severityHowever, this treatment was associated with increased myopic shift The beneficial effect of overminus lens therapy on distance exotropia control was not maintained after treatment was tapered off for 3Congenital exotropia Also known as infantile exotropia People with this condition have an outward turning of the eye or eyes from birth or early childhood Sensory exotropia – Poor vision in the eye causes it to turn outward and not work in tandem with the straight eye This type of exotropia can occur at any age

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Staying as healthy as possible may also help Feeling sick or having a fever may cause the intermittent exotropia to temporarily occur more frequentlyEstablishing the Diagnosis Definition and Classification Infantile exotropia is a relatively rare strabismus disorder characterized by outward deviation of one or both eyes Onset is before age 6 months and persists beyond this age (Figure 1) 1,2,3 It is classified as primary infantile exotropia, where patients are healthy with no evidence of systemic or ocular disease (Table 1) 2Main outcome measures The relative proportion of the various forms of childhood exotropia Results Two hundred thirtyfive consecutive children without prior surgical treatment were evaluated for exotropia Of the 235 study children, the specific forms of exotropia diagnosed and numbers were as follows intermittent exotropia, 112 (477%);

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Treatment of intermittent exotropia Intermittent exotropia should be treated immediately, as any misalignment indicates that the eyebrain connection is not working effectively The most successful treatment for strabismus is vision therapy, usually with other means such as eye patching, eyeglasses, and surgeryIntroduction Intermittent exotropia (X(T)) is one of the most common type of strabismus in children as well as adults, especially in the Asian and South Asian populations1–4 In these populations, it has been estimated that the prevalence of exotropia can be up to 7–185 times higher than that of esotropia, out of which the most common type is X(T) accounting for aboutSurgery on the eye muscles to realign the eyes;

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Stereoacuity deterioration or progression to constant exotropia was uncommon among children with intermittent exotropia who did not undergo surgical treatment, according to a study from theEstimated Reading Time 5 minsConclusions and relevance Children 3 to 10 years of age had improved distance exotropia control when assessed wearing overminus spectacles after 12 months of overminus treatment;

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Intermittent exotropia is a condition in which one eye turns outwards (diverges) intermittently, mainly when looking at objects in the distance The outward turn may be more noticeable when the child is tired or daydreamingThis is a handy exercise for exotropia Draw three barrels of progressive size in red lengthwise on one side of a card Draw three barrels of progressive sizeIn Intermittent Exotropia J Ophthalmol Sci ;2(2)14 Jornal o Ophthalmoloical Science Page 3 of 4 Discussion The management of intermittent exotropia is complex The severity and duration of fusion disruptive exo deviated state, usually influences the clinician regarding treatment decisions The natural history of intermittent exotropia

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Treatment options for children with exotropia include GlassesIntermittent exotropia is the most common type of exotropia in children Treatment options are surgical and non surgical Nonsurgical management include Correction of refractive errors, Active orthoptic treatments, Prisms and Occlusion therapy Benefits of patch therapy are limiting suppression, reducing the frequency and amplitude of thePrescribing to 40 diopters of myopic correction to the refraction of children with intermittent exotropia is thought to induce convergence, promote fusion, and decrease the angle of the eye misalignment This can be a useful tool in young children, with hopes of promoting bifoveal fixation, if deferring surgery

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Background Intermittent exotropia (IXT) is the most common form of childhood exotropia 1, 2 with an incidence of 321 per 100,000 in children under 19 years of age 1 The strabismus is characterized by an exodeviation of one eye that is interspersed with periods of ocular alignment 3 Reliable measurement of the deviation is often hindered by the variable nature of the strabismus,

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