Intermittent exotropia: Current concepts in management

Abstract:

Intermittent exotropia (IXT) is one of the most common types of exodeviation encountered in clinical practice. It usually has its onset in childhood and manifests intermittently depending on the fusional control mechanisms, often when binocularity is compromised during states of fatigue, illness, or inattention. Symptoms include headache, eye strain, blurry vision, diplopia and occasionally photophobia. Although rare, suppression scotoma and amblyopia cannot be ruled out when associated with other amblyogenic factors. The treatment of IXT can be nonsurgical and surgical. Nonsurgical options include orthoptic treatment, optical treatment, part-time occlusion, prisms and binocular vision therapy. Surgical options include bilateral recession or unilateral recession-resection/plication. Several modifications of these procedures are available to tackle associated vertical deviations or A-V phenomenon. However, there is a lack of consensus on which treatment is superior, and most surgeons follow a tailored approach to each case based on the age, angle of deviation and fusional control. In this review, both conventional and updated treatment options for IXT have been discussed after a comprehensive literature search across PubMed and Google Scholar.