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Long-Term Results of Exotropia: Can It Be Cured?

From the Department of Ophthalmology, University of Texas Southwestern Medical Center, Dallas, Texas, and Pediatric Ophthalmology, P.A., and Center for Adult Strabismus, Dallas, Texas.

Correspondence: Requests for reprints should be addressed to: David Stager Sr., M.D., Pediatric Ophthalmology, P.A., and Center for Adult Strabismus, 8222 Douglas Ave., Suite 400, Dallas, TX 75225.

The objective of this paper is to determine if exotropia (XT) can be cured in children and/or in adults. This would include motor and sensory outcomes. Extensive documentation has been published regarding XT correction in children and fewer regarding XT correction in both children and adults. Few studies have been done regarding treatment of adult XT. A current study is being done to assess the motor outcome of adults with XT. This study involved 140 adults examining the age of onset of this problem, previous surgery and current success rate. This study suggests that XT in adults is no more curable than XT in children. An optimal cure rate may be a more practical goal. Sixty-four percent of these cases had a childhood onset, 45% of those had surgery as a child, 32% for exotropia in childhood. The success rate for XT surgery decreased with larger angles.

Although short-term outcomes up to two months postoperative are important in establishing guidelines for surgery and the effectiveness of the adjustable techniques, long-term outcomes with lifetime tables will be necessary to determine a true cure rate. A multi-centered prospective study will be needed involving both alignment and sensory data. Inaccurate surgery, changes in the elasticity of the eye muscles and orbit, concurrent lifetime diseases, and trauma over a period of years and decades may make a permanent cure unrealistic.

Key words: exotropia, long-term outcomes, adult strabismus