Early Onset Exodeviations

Abstract

Forty-nine consecutive patients with intermittent or constant exotropia were examined by twenty-six months of age. No exophoria patients or patients with incomitant strabismus were included. Thirty-eight patients had intermittent exotropia and eleven had constant exotropia.

The intermittent group exhibited a mean angle size of thirty-one prism diopters and poor fusional control. These patients were unresponsive to occlusion therapy with only one improvement in sixteen patients who underwent an adequate trial.

Almost all intermittent exotropia patients were eligible for surgery based on angle size, fusional control and poor response to occlusion. Nineteen intermittents received bilateral lateral rectus muscle recessions. Seventy-two percent of these patients achieved orthophoria or esophoria less than ten prism diopters with glasses. Three patients or sixteen percent were converted to monofixational esotropia.

The constant group also presented with large angle exotropia with a mean of forty-two prism diopters. This group was more variable in their findings and less likely to have nonsurgical therapy attempted. Eighty percent of the five patients that underwent surgery were aligned to within ten prism diopters.

Both groups exhibited neurologic disease. This was present in twenty-four percent of intermittent patients and fifty-five percent of the constant group. Atypical refractions were also present with myopia, astigmatism and anisometropia present in both groups although higher in the constant exotropia patients.

• exotropia
• constant exotropia
• intermittent exotropia
• occlusion therapy