Exotropia

Dr. Burke is one of Cincinnati's most trusted resources concerning exotropia in children.

A child whose eye turns outwardly is said to have a wandering eye or “wall-eye.” If the eye is turned out all the time, it is called exotropia. Children with intermittent exotropia have a strong tendency to let the eye turn out, but it does not turn out all the time. When the child does control the eye alignment, the eyes are straight and function normally together.

Exotropia occurs in about 1 out of 100 children. The most common age of onset in children is between 2 and 5 years of age. The eye will drift or wander outwardly when the child looks at things far way, especially if the child is tired, ill, or daydreaming. Children do not do this “on purpose.” Sometimes in sunlight the child will squint or close one eye. When the eye is turning out, the brain “turns off” or suppresses the central vision causing a loss of binocular or 3-D vision.

Surgical realignment is ultimately necessary in over 90% of cases because the amount and duration of the drifting increases. When surgery is done, there is an excellent chance of the eyes will be straight and that there will be normal vision and good binocularity.

Whenever an eye misalignment is suspected, your child should have a complete evaluation by a pediatric ophthalmology specialist.

What is exotropia?

A child whose eye turns outwardly is said to have a wandering eye or be “wall-eyed”. Exotropia refers to an outwardly drifting eye. About one percent of children have an outwardly wandering eye. The most common presentation in a child is where the eye drifts only part of the time. This is called intermittent exotropia.

What is infantile exotropia?

Congenital or infantile exotropia describes a constantly outwardly deviated eye in an infant less than 12 months old. This type of exotropia is very uncommon. Although it may be no more worrisome than the much more common infantile esotropia (crossed eyes), many with infantile exotropia have some type of neurological insult with developmental delay.

What is intermittent exotropia?

Children with intermittent exotropia have a strong tendency to let an eye turn out, but the eye does not turn outwardly all the time. When the child does control the alignment, the eyes are straight and functional normally together. The most common age of onset is between 2 and 5 years of age. During the early stages, the child has straight eyes looking at anything closer than 3 to 4 feet. The eye will drift or wander outwardly when the child looks at things far away and is especially noticeable when the child is tired, ill, or daydreaming. Parents often notice that the child squints or tries to close one eye in bright sunlight. As time passes, control is gradually lost and the eye will begin to wander more frequently and stay in the outwardly deviated position for a longer period of time. Surgical realignment of the eye muscles will ultimately be necessary in over 90% of patients with intermittent exotropia.

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