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Classification of Exotropia

From the Department of Ophthalmology, University of Wisconsin, Madison, Wisconsin.

Correspondence: Requests for reprints should be addressed to: Gail V. Morton, C.O., Dept. of Ophthalmology, University of Wisconsin, 2880 University Ave., Madison, WI 53705; e-mail:gmorton{at}uwhealth.org

Background and Purpose: The classification of exotropia has been created to clarify the subsets of exotropia, to identify salient characteristics, and to address treatment options. These subsets were initially defined by comparing distance to near measurements. Now the effects of fusion are also known to be a key element in identifying the type of exotropia or intermittent exotropia. The purpose of this paper is to discuss the classification of exotropia.

Methods: In order to unveil the tenacious nature of fusion, classic tests may be required with additional provisions. The gradient AC /A ratio calculation as well as distance and near measurements taken after monocular occlusion may be necessary to reveal facts critical in determining the proper classification.

Conclusions: Once assembled, information from specially conducted tests permit the appropriate classification of a patient’s exotropia. This suggests optical versus specific surgical choices to best treat it.

Key words: exotropia, intermittent exotropia, AC/A ratio, tenacious proximal fusion, patch test, simulated divergence excess