Exotropia is a type of strabismus characterised by outward deviation of an eye. Management for this form of strabismus includes observation, medical therapy orthoptics, overminus spectacles, and alternate patching, and surgical intervention. He says its about 70% success rate in babies with patching alone. To characterize eye movements made by patients with intermittent exotropia when fusion loss occurs spontaneously and to compare them with those induced by covering 1 eye and with strategies used to. Although intermittent exotropia may deteriorate with time, there are no widely accepted criteria for measuring progression in this disorder.
Of all the exotropia intermittent exotropia comprises. There is possibility of complications after surgery as well. Surgical treatment of childhood intermittent exotropia xt is associated with high recurrence rates. Intermittent exotropia xt is one of the most common types of childhood strabismus, occurring in. Intermittent exotropia is an exodeviation that is controlled part of the time by fusional convergence but becomes manifest some of the time. Esotropia and exotropia reference guide for clinicians prepared by the american optometric association consensus panel. Sewing an eye patch for lazy eye strabismus amblyopia. A squint, sometimes called strabismus, is a condition in which the eyes. Contrary to the earlier practice of patching one eye for 24 hrs, it is now. Exotropia is a type of strabismus, which is a misalignment of the eyes. A randomized trial comparing parttime patching with. Most common form of divergent strabismus onset before 5 years of age manifest during visual inattention fatigue illness. One or both eyes turn out toward the ear occasionally.
The pathogenesis of intermittent exotropia is unknown. Basein prisms may aid control and relieve asthenopic symptoms in small comitant exodeviations of up to approximately 20 pd. Prevalence exodeviations are much more common in latent or intermittent form than are esodeviations. Exotropia american association for pediatric ophthalmology and. Exotropia pictures,symptoms,causes,complications and. Your child has been diagnosed with intermittent exotropia divergent squint. Know the causes, symptoms, treatment, prognosis and complications of exotropia. Participants were assigned randomly to either observation no treatment for 6 months or patching prescribed for 3 hours daily for 5 months, followed by 1 month of no patching. Surgical management of intermittent exotropia with high aca. Xt is the most common form of divergent strabismus.
T1 an officebased scale for assessing control in intermittent exotropia. Values of near stereoacuity in xt are within agerelated norms, 45 47 making near stereoacuity a poor measure of severity. Intermittent exotropia ixt is the most common form of childhood exotropia 1, 2 with an incidence of 32. History of intermittent squint when child sick, tired, bright light, daydreaming. One of my patients, robert, was diagnosed with intermittent exotropia at his initial examination fig 1. Patching the dominant eye or alternate patching of either eye is performed to interrupt and reduce the progression of the exotropia. But everywhere i read about it, it says patching doesnt help.
Intermittent exotropia american academy of ophthalmology. Remember that lazy eye is not a diagnosis and is a very imprecise term since the following medical terms are sometimes called a lazy eye. Intermittent exotropia causes the eye to sometimes move outward, often when youre tired, sick, daydreaming, or looking in the distance. Does patching ever helps treat intermittent exotropia. Jun 21, 2016 trial of overminus spectacle therapy for intermittent exotropia ixt5 the safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Pdf standard strabismus surgery by perilimbal conjunctival opening causes postoperative ocular irritation and scarring.
Unlike a pure phoria, intermittent exotropia spontaneously breaks down into a manifest exotropia. Information on strabismus crossed eyes intermittent exotropia. What you need to know about car, home and travel insurance cbc marketplace duration. The different types of acquired exotropia are intermittent exotropia, sensory exotropia, exotropia with neurologic causes and field defects, and consecutive exotropia.
He would often complain about his eyes going crazy while he reads. This study will highlight the importance of patching ixt patients and assist to approach the proper use of occlusion therapy. Observation versus occlusion therapy for intermittent. Intermittent exodeviation usually occurs between 2 and 8 years of age, but may present any time between infancy and adulthood. Both parttime patching and observation are appropriate choices for the treatment of intermittent exotropia ixt in children aged 3 to 10 years, researchers conclude in a study published online. I am an eye surgeon but i have a small to medium exophoria.
Exotropia is a type of eye misalignment known as strabismus that occurs when one or both of the eyes turn outward. It is not an eye muscle problem but rather a result of abnormal vision fusion in the brain. Listing a study does not mean it has been evaluated by the u. Fig 1 initial examination using cover test reveals intermittent exotropia at distance and near. Part time patching of the nondeviating eye may convert an intermittent exotropia to a phoria by treating supression and amblyopia. Exotropia also known as walleye or divergent strabismus differs from its opposite form, esotropia eye turns in toward nose, in that exotropic eyes point outward or away from the nose. Nonsurgical treatment may include glasses and in some instances, patching. Intermittent exotropia is a fairly common condition. Intermittent exotropia is the most common form of strabismus. It is the opposite of esotropia and usually involves more severe axis deviation than exophoria. Although exotropia can occur at any age, younger children are majorly targeted. In addition, the natural history of intermittent xt has not been rigorously studied and, anecdotally, some cases resolve without surgery. Nov 14, 2014 intermittent exotropia xt is one of the most common types of childhood strabismus, occurring in. Convergence insufficiency ci is also the leading cause of eyestrain, blurry.
Convergence insufficiency ci is also the leading cause of eyestrain, blurry vision, double vision diplopia, andor headaches. Although intermittent exotropia may deteriorate with time, there are no widely accepted criteria for measuring progression in. Only one eye turns out at a time while the other eye points straight forward. In our office, the parents are told of these possible problems following surgery, and that patching, special glasses, and even more than one operation may. Capturing the moment of fusion loss in intermittent exotropia. A squint, sometimes called strabismus, is a condition in which the eyes are misaligned one eye looks straight and the other eye looks outwards.
T1 current nonsurgical management of intermittent exotropia. But a recent study in the british journal of ophthalmology bjo 1 and an accompanying editorial 2 call into question the notion that intermittent exotropia is straightforward or fully understood. Transient intermittent exotropia is sometimes seen in the first 4 6 weeks of life and, if mild, can resolve spontaneously by 6 8 weeks of age. Untreated exotropia can give rise to blurred vision and further increase the risk of permanent loss of vision. Intermittent exophoria and double vision eye care medhelp.
Although the benefit is usually temporary, occlusion can be used to postpone surgical intervention in responsive patients 18. Intermittent exotropia is a condition in which there are times when one eye has drifted outwards, and other times when the eyes are straight. Initially, an exotropia may only be seen when the patient is fatigued or ill. Capturing the moment of fusion loss in intermittent exotropia john r. Treatment options consist of vision therapy, patching, eyeglasses andor, very. When the eye turns outward only some of the time, it is called intermittent exotropia. Of dreamworks animations kung fu panda 2 red carpet in hollywood, ca. Intermittent exophoria is not a clinical diagnosis. N2 three common nonsurgical management strategies for childhood intermittent exotropia are observation alone, parttime patching, and overminus spectacles. Intermittent exotropia is a very common type of eye misalignment.
Sep 27, 2017 exotropia is a type of strabismus, which is a misalignment of the eyes. I initially spoke to james blaha after stumbling on his indiegogo campaign back in 20. Intermittent distance exotropia is a difficult condition to manage because of its variability uncertain natural history, although control scores can facilitate management decisions. Intermittent exotropia is the most prevalent form of childhood exotropia, 1 and is characterized by an acquired, intermittent exodeviation in an otherwisehealthy child. Postoperative outcomes in children with intermittent. Although the benefit is usually temporary, occlusion can be used to postpone surgical intervention in responsive patients. Oct 05, 2015 how to take on strabismus in adults often mislabeled a childhood disease, strabismus can be treated in adults, with visual and psychosocial benefits. Worth 4dot testing revealed diplopia at 6 feet and intermittent fusion at 16 inches. This is a topic that comes up day after day, week after week, month after month.
Sensory exotropia occurs in the presence of poor vision. Indicates that the study sponsor or investigator has submitted summary results information for a clinical study to clinicaltrials. Exotropia, or divergent squint, refers to an eye that turns or diverges outwards. Exotropia is a condition in which one or both eyes turn outward away from the nose. Untreated intermittent exotropia can change into permanent exotropia which finally results in vision loss. Dry eyes causes, ghost images, vision therapy, eye infections, healthy. Part time patching of the nondeviating eye for four to six hours daily may convert an intermittent exotropia to a phoria. Management of intermittent exotropia of the divergence excess. Intermittent exotropia caused by common near vision disorder. In a randomized trial we found parttime patching reduced the 6month risk of intermittent exotropia ixt deterioration, compared with observation. If you missed my last update, back to patching, feel free to catch up. Draw three barrels of progressive size in red lengthwise on one side of a card.
The aim of this study was to evaluate the effectiveness of occlusion therapy in the control of intermittent exotropia ixt in children between 4 and 10 years in saudi arabia. Certain conditions, such as third nerve palsy, thyroid ophthalmopathy, and iatrogenic trauma following retinal detachment surgery or endoscopic sinus surgery, could cause. Unlike a pure phoria, intermittent exotropia spontaneously breaks. Diagnostic occlusion test in intermittent exotropia. This is part 1 of a multipart series on how binocular vision affects reading ability. Some patients or family members notice the exotropia more when the patient is tired or daydreaming. Intermittent divergent squint what is intermittent exotropia.
May 16, 2017 exotropia is a category of strabismus, a defect in which ones eyes deviate outward or away from each other. Pediatrics new research sheds light on intermittent exotropia. Intermittent exotropia is an exodeviation intermittently controlled by fusional mechanisms. How to take on strabismus in adults often mislabeled a childhood disease, strabismus can be treated in adults, with visual and psychosocial benefits.
Strabismus, whether it is newonset or a reappearance of childhood strabismus, can usually be successfully treated in adults. Trial of overminus spectacle therapy for intermittent. Surgical correction of intermittent exotropia is a breadandbutter procedure for many pediatric ophthalmologists. I got a second opinion and indeed she has intermittent exotropia. Stereoacuity in intermittent exotropia in xt, the eyes usually remain aligned for near fixation, or are capable of realignment in response to the stimulus of presentation of a stereoscopic image. Surgical management of intermittent exotropia with high ac.
Pdf minimally invasive strabismus surgery video presentations of. If exotropia affects both eyes, as a result of which the individual is unable to align both eyes, the condition is termed as convergence insufficiency or exophoria. Absence of simultaneous contraction of lr anatomic. Although surgery to rotate the fixing eye in the direction of the. Article 4 vision therapy management for intermittent. People with exotropia often experience crossed diplopia. Cause of intermittent exotropia the cause of this condition is not known. Intermittent exotropia outward drifting of either eye interspersed with periods of good alignment fig.
Patching the dominant eye or alternate patching of either eye is suggested to interrupt the process of suppression and to reduce the progression of the exotropia. The longterm ontreatment effect of overminus treatment on distance intermittent exotropia ixt control score. Current nonsurgical management of intermittent exotropia. A common cause of intermittent exotropia intermittent strabismus convergence insufficiency, if untreated, can cause intermittent exotropia an outward eye turn that comes and goes. Information on strabismus crossed eyes intermittent. Exotropia may occur from time to time intermittent exotropia or may be constant. May 16, 20 its been awhile since i blogged about alivias intermittent exotropia. Sometimes, exotropia is not completely treated with surgeries. Rarely, intermittent exotropia can coexist with a high aca ratio, which places the patient at risk for consecutive esotropia at near after surgical correction of the distance deviation. Most common form of divergent strabismus onset before 5 years of age manifest during visual inattention fatigue illness daydreaming drowsiness upon awakening. These types of exotropia usually begin in early childhood. A randomized trial comparing parttime patching with observation for intermittent exotropia in children 12 to 35 months of age. Additionally, i have a page dedicated to all of our intermittent exotropia updates including resources so if you havent checked it out already, have at it.
Its been awhile since i blogged about alivias intermittent exotropia. New research sheds light on intermittent exotropia by marianne doran, contributing writer interviewing michael p. Effect of patching versus observation on intermittent exotropia. Exotropiaor an outward turning of the eyesis a common type of strabismus accounting for up to 25 percent of all ocular misalignment in early childhood. Exotropia 1 exotropia in adults this material will help you understand exotropia and how to manage it. Now esophoria is very common and often asymptomatic. New research sheds light on intermittent exotropia. Intermittent exotropia is the most common exodeviation and is found in 1% of the population. Nov 15, 2018 the different types of acquired exotropia are intermittent exotropia, sensory exotropia, exotropia with neurologic causes and field defects, and consecutive exotropia. Of all the exotropia intermittent exotropia comprises about 5090% of the cases and is usually preceded by a stage of exophoria 4,5. This is a common type of squint that usually develops in the preschool age group. The primary outcome was deterioration, defined as constant exotropia measuring at least 10. Does occlusion therapy improve control in intermittent exotropia. You may only notice one particular eye drifting out, or it may be either eye that deviates, known as an alternating exotropia.
Exotropia is a common type of strabismus that occurs when misaligned eyes deviate outward. An officebased scale for assessing control in intermittent. The main objectives of this randomized trial comparing overminus lens treatment to nonoverminus spectacles without overminus or spectacles with plano lenses are to determine. Mesencephlic reticular formation near oculomotor nucleus in monkeys passive. In many cases, the eye turn might only be visible during stressful situations or. Additionally, i have a page dedicated to all of our intermittent exotropia updates including resources so if you havent checked it out already, have at it considering surgery for intermittent exotropia. Both parttime patching and observation are appropriate choices for the treatment of intermittent exotropia ixt in children aged 3 to 10 years, researchers conclude in.
Exotropia is a form of strabismus where the eyes are deviated outward. Children aged 3 to 10 years with intermittent exotropia saw little deterioration in their condition after 6 months, whether treated with parttime patching or observation. A randomized trial comparing parttime patching with observation for children 3 to 10 years of age with intermittent exotropia. Trial of overminus spectacle therapy for intermittent exotropia ixt5 the safety and scientific validity of this study is the responsibility of the study sponsor and investigators. The risks of exotropia are equal in both male and female. Nov 04, 2015 intermittent exotropia outward drifting of either eye interspersed with periods of good alignment fig.
Parttime patch therapy for treatment of intermittent exotropia full. This is, by far, the most common type of exodeviation. Theories historical theories innervational imbalance between convergence and divergence duane divergence. Exotropia a common type of strabismus is the outward deviation of an eye eye turns away from the nose. Exotropia also known as walleye or divergent strabismus differs from its opposite form, esotropia eye turns in toward nose, in that exotropic eyes point outward or away from the. Many people have a tendency for their eyes to drift out. Management of intermittent exotropia of the divergence.
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