What is exotropia?
Exotropia, often referred to as “wall-eyed,” is a type of strabismus that causes one or both of the eyes to turn outwards. Exotropia is a common condition, making up nearly 25% of all early childhood ocular misalignments.
There are several subtypes of exotropia, including intermittent, congenital, acquired, sensory and consecutive. The condition can be present at birth, or occur later in life due to secondary health conditions. It can also be present at all times or occur infrequently.
Although exotropia happens more often in childhood, it can occur at any age. Exotropia is treatable, but the form of treatment may vary depending on the type and severity of the condition.
Types of exotropia
Exotropia has several variations: intermittent, congenital, acquired, sensory and consecutive. Causes differ from type to type, and a person affected may have a mild or severe case of the condition regardless of the particular type.
One or both eyes may be impacted by exotropia. Some people also experience alternating exotropia, a condition in which the outward turn deviates between both eyes.
Intermittent exotropia is the most common subtype of the condition. This type of exotropia happens only on occasion, usually as a result of one of the following circumstances:
Gazing into the distance or daydreaming
Focusing on faraway objects
Although intermittent exotropia is typically infrequent, it may happen to some people so often that it becomes a permanent condition. Children with intermittent exotropia often develop myopia (nearsightedness) before adulthood.
Congenital exotropia, sometimes called infantile exotropia, occurs at the time of birth or in the early stages of life. Congenital exotropia is typically first seen between 4 and 6 weeks of age. Some cases are mild enough to resolve on their own, without medical intervention, between 6 and 8 weeks of age.
If you continue to notice misalignment in your child’s eyes after 4 months of age, contact an eye doctor for evaluation.
Exotropia can be acquired as a result of other health conditions — particularly ones that affect the brain, including:
Sensory exotropia occurs due to poor vision or vision loss in one eye, which prevents it from aligning with the other eye to see clearly together. Sensory exotropia can affect children or adults at any age.
Consecutive exotropia is a type of exotropia that develops after a surgery that was performed to correct misaligned eyes — it’s believed that this may have to do with muscles that control eye movement being damaged in some way during the procedure.
One study found that the risk of developing consecutive exotropia is much higher for some people undergoing certain procedures. Speak with your eye doctor about the risks of eye surgery if you have concerns.
One or both eyes turned outward is the most common and apparent indicator of exotropia. However, there are various other symptoms that may occur in addition to this misalignment, including:
Decreased or blurry vision
Light sensitivity (photophobia)
Decreased depth perception
Any exotropia symptom can occur frequently or infrequently. If you experience one or more symptoms, consult an eye doctor for further evaluation.
What causes exotropia?
Exotropia occurs due to a misalignment in the muscles which control eye movement and send visual messages to the brain.
The condition can be inherited or acquired due to another health condition, such as stroke, thyroid disease or cataracts, among several other conditions.
Some cases of exotropia occur without any family history or underlying health conditions present. In these cases, the direct cause is considered unknown.
An eye doctor diagnoses exotropia by evaluating symptoms and family medical history and by performing various vision tests.
Vision tests that are used to help diagnose exotropia may include the following:
Sensory motor evaluation
A cycloplegic refraction may also be performed as part of the vision tests. During a cycloplegic refraction, special eye drops are administered to temporarily relax the eye to prevent it from autofocusing. This process helps an eye doctor evaluate the eye’s refraction more easily.
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Treatment varies depending on the severity of exotropia. Some cases may have relatively simple treatment, while others may require surgery.
Non-surgical exotropia treatment
Intermittent exotropia, which only occurs occasionally, may not require treatment beyond observation. If exotropia is constant, an eye doctor may recommend the following treatment options:
Eyeglasses to correct the refractive error
Eye patching the stronger eye in order to strengthen the weaker eye
Vision therapy, which includes exercises and activities to improve conditions such as exotropia
Some cases of exotropia may require surgery to realign the eye muscles. Surgery is typically recommended early in life for children with congenital exotropia, in order for vision to develop properly and prevent further complications.
Adults may undergo exotropia surgery to improve the appearance of eyes, but the procedure may not necessarily improve vision.
SEE RELATED: Strabismus surgery
Exotropia should be treated promptly
Exotropia is a common eye condition and is relatively easy to treat with corrective lenses, eye patching, vision therapy or surgery.
Though the condition is treatable, it can become more difficult to treat as it progresses. Symptoms should be evaluated to an eye doctor as soon as possible in order to proceed with proper treatment and prevent further complications in childhood or adulthood.
Mild complications such as nearsightedness develop in many children with exotropia (particularly intermittent exotropia), but this is typically corrected easily with eyeglasses or contact lenses.
In general, the best way to ensure the health and proper development of vision and eye health for you and your child is through annual eye exams.
READ MORE: Crossed eyes (esotropia)
Page updated February 2021