Esotropia and Exotropia

Publication Date: December 14, 2022
Last Updated: January 2, 2023


  • 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

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