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Amer. Orthoptic Jrnl. 59(1):2-4 (2009); doi:10.3368/aoj.59.1.2
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Symposium: Drifting Apart from Birth to Adulthood: How to Manage Exotropia

Classification of Exotropia

Gail V. Morton, C.O.

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


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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


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  1. Duane A: A new classification of the motor anomalies of the eyes based upon physiological principles. Ann Ophthalmol 1897; 6:84–122.
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  3. Burian HM: Selected problems in the diagnosis and treatment of the neuromuscular anomalies of the eyes. In: Curso Internacional de Oftalmologica , Vol. 2. Barcelona: Publicaciones del Instituto Barraquar; 1958, pp. 456–467.
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  7. Kushner BJ: Exotropic deviations: A functional classification and approach to treatment. Am Orthopt J 1988; 38:81–93.
  8. Kushner BJ, Morton GV: Distance/near differences in intermittent exotropia. Arch Ophthalmol 1998; 116:478–486.[Abstract/Free Full Text]




This Article
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