Esotropia and Exotropia
HIGHLIGHTED FINDINGS AND RECOMMENDATIONS FOR CARE
- Strabismus in children under 4 months of age sometimes resolves without treatment, particularly if the deviation is intermittent, variable, or measures less than 40 prism diopters.
- Repeat cycloplegic refraction is indicated when esotropia does not respond to an initial prescription for hyperopia or when esotropia recurs after surgery.
- Acquired esotropia should be evaluated and treated promptly.
- Young children with intermittent exotropia and good fusional control can be followed without surgery because there is a low rate of deterioration to constant exotropia or reduced stereopsis.
- Indications for surgery in intermittent exotropia include a progression to constant or nearly constant deviation, reduced stereopsis, and/or a negative effect on social interactions.
- Unilateral recess-resect and bilateral lateral rectus recessions are both effective initial surgical procedures for the treatment of intermittent exotropia.
- Convergence insufficiency occurs in children and adults, and symptoms with near viewing can often be improved using vergence exercises.
- Simultaneous prism and cover testing measures the manifest angle of strabismus, and prism and alternate cover testing measures the total angle of misalignment. Both inform the ophthalmologist’s decisions regarding management and surgical indications.
Esotropia and Exotropia
December 14, 2022
Last Updated Month/Year
August 9, 2023
External Publication Status
Country of Publication
Identify children at risk for esotropia. Detect esotropia. Detect and treat amblyopia that may cause, or be caused by, esotropia. Educate the patient and/or family caregiver, as appropriate. Inform the patient’s other health providers of the diagnosis and treatment plan. Treat the esotropia to promote and maintain binocular vision (fusion, stereopsis), prevent amblyopia or facilitate its treatment, and restore normal appearance. Maximize quality of life by optimizing binocular alignment and visual acuity. Monitor vision and binocular alignment, and modify therapy as appropriate.
Male, Female, Adolescent, Child, Infant
Health Care Settings
Ambulatory, Hospital, Outpatient
Nurse, nurse practitioner, optometrist, physician, physician assistant
Diagnosis, Treatment, Management
D013285 - Strabismus
Strabismus, esotropia, Exotropia, crossed eyes
Sprunger DT, Lambert SR, Hercinovic A, Morse CL, Repka MX, Guyton DL, Hutchinson AK, Cruz OA, Wallace DK; American Academy of Ophthalmology Preferred Practice Pattern Pediatric Ophthalmology/Strabismus Panel. Esotropia and Exotropia Preferred Practice Pattern®. Ophthalmology. 2022 Dec 14:S0161-6420(22)00864-8. doi: 10.1016/j.ophtha.2022.11.002. Epub ahead of print. PMID: 36526451.