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Amer. Orthoptic Jrnl. 59(1):5-9 (2009); doi:10.3368/aoj.59.1.5
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Symposium: Drifting Apart from Birth to Adulthood: How to Manage Exotropia

Assessment of Control in Intermittent Exotropia

Jonathan M. Holmes, B.M., B.Ch.

From the Department of Ophthalmology, Mayo Clinic, Rochester, Minnesota.

Correspondence: Requests for reprints should be addressed to: Dr. Jonathan Holmes, Department of Ophthalmology W7, Mayo Clinic, 200 First St. SW, Rochester, MN 55905.


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In the context of intermittent exotropia, the term "control" is used to refer to the proportion of the time the eyes are manifestly exotropic and the time to recovery of fusion after the eyes have been dissociated. In the past, the degree of control has been used to determine whether and when to perform surgery. Control has been assessed in a variety of ways; parental report, office assessment, and combined scales. Using a new office scale, variability of control was assessed during the course of a single day, and found to be highly variable in about half of children with IXT. We need more complete data before we can use control to guide surgical decision making. Currently, a conservative approach might be most reasonable, reserving surgery for children who show deterioration of near motor fusion, deterioration of near stereoacuity, emergence of clear symptoms or social concerns. Future studies of natural history, outcomes, and randomized clinical trials are needed to develop truly evidence-based management strategies.

Key words: intermittent exotropia, control, stereoacuity, surgery


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 REFERENCES
 

  1. von Noorden GK, Campos EC: Exodeviations. In: von Noorden GK Campos EC, eds., Binocular Vision and Ocular Motility: Theory and Management of Strabismus . St. Louis: Mosby; 2002, pp. 356–376.
  2. Stathacopoulos RA, Rosenbaum AL, Zanoni D, et al.: Distance stereoacuity: Assessing control in intermittent exotropia. Ophthalmology 1993; 100:495–500.[Medline]
  3. Chia A, Seenyen L, Long QB: A retrospective review of 287 consecutive children in Singapore presenting with intermittent exotropia. J AAPOS 2005; 9:257–263.[CrossRef][Medline]
  4. Petrunak JL, Rao R: The evaluation of office control in intermittent exotropia: A systematic approach. Am Orthopt J 2003; 53:98–104.[CrossRef]
  5. Haggerty H, Richardson S, Hrisos S, Strong NP, Clarke MP: The Newcastle Control Score: A new method of grading the severity of intermittent distance exotropia. Br J Ophthalmol 2004; 88:233–235.[Abstract/Free Full Text]
  6. Buck D, Clarke MP, Haggerty H, et al.: Grading the severity of intermittent distance exotropia: The revised Newcastle Control Score. Br J Ophthalmol 2008; 92:577.[Free Full Text]
  7. Mohney BG, Holmes JM: An office-based scale for assessing control in intermittent exotropia. Strabismus 2006; 14:147–150.[CrossRef][Medline]
  8. Hatt SR, Mohney BG, Leske DA, Holmes JM: Variability of control in intermittent exotropia. Ophthalmology 2008; 115:371–376.[CrossRef][Medline]
  9. Hatt SR, Mohney BG, Leske DA, Holmes JM: Variability of stereoacuity in intermittent exotropia. Am J Ophthalmol 2008; 145:556–561.[CrossRef][Medline]
  10. Adams WE, Leske DA, Hatt SR, et al.: Improvement in distance stereoacuity following surgery for intermittent exotropia. J AAPOS 2008; 12:141–144.[CrossRef][Medline]
  11. Hatt SR, Leske DA, Adams WE, Kirgis PA, Bradley EA, Holmes JM: Quality of life in intermittent exotropia: Child and parent concerns. Arch Ophthalmol 2008; 126:1525–1529.[Abstract/Free Full Text]




This Article
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