Intermittent exotropia can be difficult to treat as its source may not always be evident. Eye exercises and prism glasses are among the best non-surgical treatment options.
JT, an African American 5-year-old boy living with exotropia intermittently reported by his foster mother as turning his head right from time to time during the day.
Symptoms
This condition involves eyes not aligning correctly, leading to double vision or lack of depth perception. It may occur regularly or come and go. It can be caused by genetics, neurological issues such as cerebral palsy or environmental stresses like prolonged reading or computer use – or it can even be worsened by visual stressors.
Exotropia is most often classified as intermittent, meaning its misalignment occurs only occasionally. People living with this form can typically fuse their eyes at a single distance or focus on nearby objects without dissociating (depart from alignment) during stressful situations or when physically or emotionally fatigued – leading to eye strain and headaches and inhibiting the development of binocular vision and depth perception.
Children suffering from alternating exotropia may develop amblyopia (lazy eye), whereby their brain ignores any image coming from the outwardly turned eye. To ensure children with exotropia don’t succumb to amblyopia it is crucial that they receive treatment immediately in order to prevent further problems with vision.
When frequent and pronounced eye turns are present, a child may experience difficulty in school – particularly with learning to read. Furthermore, social situations could become difficult as well as having difficulties with balance and coordination.
An eye examination can provide vital insights into whether or not a child’s eyes are well-aligning, with either eye being dominant. An exam with dilation of pupil can ensure the internal structures of each eye remain healthy.
Vision therapy can be an effective way to strengthen weaker eyes and increase depth perception by realigning muscles that control eye movement. Your provider may recommend patching for several hours each day in order to encourage weaker ones to work harder, as well as active orthoptic exercises designed to promote eye fusion and heighten depth perception. In extreme cases, surgery may even be recommended in order to correct abnormal muscle tone and improve eye-brain connections.
Diagnosis
Eye doctors can accurately diagnose strabismus when their patient’s eyes do not align correctly, using various criteria to diagnose it such as symptoms, family medical history and vision tests like cycloplegic refraction which involves using drops to widen pupils for measurement of exotropia (extropia).
Intermittent strabismus (when one eye turns out only intermittently) can be difficult to identify and can often only become evident after becoming very tired or sick. As it causes depth perception issues that make reading and driving difficult, and may eventually progress into nystagmus or double vision conditions, its cause remains difficult to ascertain.
Your type of strabismus will determine what treatments are necessary. If it involves constant exotropia, surgery may be required to correct misalignments and enhance depth perception and visual coordination – this procedure typically occurs under general or local anesthesia for children and with local anesthesia for adults.
If the squint is intermittent, vision therapy and regular follow-up may provide effective solutions. This process will include determining how much of a squint exists between both eyes, assessing frequency of episodes, as well as any triggers such as fatigue, health conditions, bright light exposure or daydreaming or drowsiness that contribute to them.
Vision therapy typically entails exercises designed to strengthen and train weaker eyes to focus properly, or patching one eye for several hours each day in order to encourage use of misaligning eye. Sometimes doctors will suggest glasses with prism lenses in order to aid alignment; either way, for optimal results it’s vital that patients adhere to their treatment plans to get optimal results; otherwise they risk experiencing recurrent diplopia and less success with vision therapy over time. At PES Adult Strabismus Center we offer several treatment options designed to manage misalignments while improving overall quality of life and quality of life!
Treatment
Eyes that turn out can lead to blurred or double vision and cause difficulties with social situations as people may misidentify which eye they’re speaking into when speaking out loud. If your child shows any sign of their eye turning out, it is crucial that they get tested immediately so treatment can start early on.
Depending on its severity, intermittent eye turn problems may only require intermittently corrective vision therapy exercises and eyeglasses for correction. Vision therapy exercises have proven highly successful at eliminating such eye turns as they don’t involve surgery while improving both distance visual acuity as well as stereopsis.
The 2024 study on intermittent exotropia revealed that vision therapy significantly improved distance and near office control scores as well as decreasing mean exodeviation magnitude, with benefits being seen among both adults and children. Researchers recommend more comprehensive randomized controlled trial studies with longer follow-ups in order to accurately evaluate its efficacy for intermittent exotropia cases.
Eyeglasses may help patients suffering from intermittent exotropia to enhance their vision by enabling the weaker eye to focus more efficiently. This approach can be especially helpful for large angle intermittent exotropia patients as patching or occlusion treatments often fail to provide sufficient visual acuity.
Strabismus symptoms vary between patients, making it essential for your child to visit an optometrist as soon as possible for an examination of their eyes. A comprehensive eye exam will include tests designed to measure how well their eyes line up while also testing visual acuity and ocular motility – an optometrist can then recommend treatment that may include eyeglasses or surgery to address the issue.
JT was 5-years-old when he experienced sudden intermittent exotropia in which his left eye turned outward intermittently. According to his foster mother, this only occurred when tired, sick or stressed – no history of trauma or family history for such deviation was identified; on examination he wore overminus glasses and scored 3 on both distance Snellen chart and near office control test; optometrist recommended vision therapy treatment to correct his alignment and alleviate his symptoms.
Follow-up
Intermittent exotropia presents optometrists with an unusual challenge. This form of strabismus affects individuals of any age and results from an imbalance in the visual system, impairing binocular vision and depth perception. Although only temporary in nature, intermittent exotropia negatively impacts quality of life. Therefore, an evaluation to ascertain its cause must take place as well as vision therapy which enhances eye-brain connections and retrains visual skills necessary for binocular vision.
First step to treating strabismus is identifying whether it is intermittent or constant in nature. Patients with consistent deviation should visit an orthoptist or ophthalmologist for surgical intervention; procedures available include recession and resection surgeries to correct misalignments by weakening or strengthening eye muscle structures responsible. Vision therapy should also be pursued prior to surgical interventions as strengthening these weaker muscle can improve their alignment ability and help ensure better outcomes for treatment.
Intermittent Exotropia may occur when eyes become fatigued, feeling sick or stressed, or when focused on distant objects. It’s more common among young children as their eye-hand coordination continues to develop.
A three-year-old girl presented with an intermittent right eye turn while reading and playing video games, with uncorrected Snellen acuities of 20/20 both for distance and near. A cover test revealed intermittent exotropia at distance with 18PD intermittent exotropia and 8PD exophoria for near vision respectively; her KBB test and random dot stereopsis tests were all negative.
After conducting an in-depth evaluation, we initiated her in-office treatment program consisting of vergence/accommodative therapy with home reinforcement. She received these therapies every other week for 60 minutes at our offices and 15 minutes per day for reinforcement at home. Once her regimen had concluded, we conducted another evaluation to compare her initial control score with data collected during therapy sessions.
His office control score showed remarkable improvement from her initial baseline. She was able to more effectively manage his ocular deviation and restore her ability to fuse and suppress each eye’s image independently. Furthermore, Hering-Bielschowsky afterimage test results also confirmed an increase in his fusional reserve.
