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Exotropia is one of the most common forms of strabismus, a condition that refers to any misalignment of the eyes in which one eye deviates outward (away from the nose) while the other fixates normally. Where as Esotropia is the condition where one eye deviates inward (toward the nose).Hence Exotropia and Esotropia are both forms of strabismus but opposite of each other.
Esotropia is the most common type of strabismus in infants, while exotropia often begins between the ages of 2 and 4. About 4 percent of all children in the United States have some form of strabismus. It occurs equally in males and females and is sometimes hereditary. The condition can also develop later in life.
The brain's ability to see three-dimensional objects depends on proper alignment of the eyes. When both eyes are properly aligned and aimed at the same target, the visual portion of the brain fuses the forms into a single image. When one eye turns inward, outward, upward, or downward, two different pictures are sent to the brain. This causes loss of depth perception and binocular vision.
Treatment for intermittent exotropia does not have to occur immediately. As a matter of fact, early surgery has the potential of disturbing the ability of the brain for fusion in the future and can cause a permanent reduction in vision (amblyopia).
Treatment consists of vision therapy, patching, glasses and/or surgery. The most successful form of treatment is vision therapy. In a comparative study using both Optometric and Ophthalmological journals, vision therapy had an overall success rate of 78% as compared to surgery of 48%. Thus, surgery should be reserved only for the large angle intermittent exotropes or when vision therapy is not as successful as expected.
The causes of exotropia are not fully understood. There are six muscles that control eye movement, four that move it up and down and two that move it side to side. All these muscles must be coordinated and working properly in order for the brain to see a single image. When one or more of these muscles doesn't work properly, some form of strabismus may occur. Strabismus is more common in children with disorders that affect the brain such as cerebral palsy, Down syndrome, hydrocephalus, and brain tumors.
The best treatment for convergence insufficiency with or without strabismus is vision therapy which re-establishes the reflexes of convergence. Treatment usually consists of both in office and home exercises. Recent home computerized therapy programs have become effective in eliminating the symptoms associated with convergence insufficiency. This mode of treatment is very successful.
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