Printed version
Printed version (Arabic)
Intermittent exotropia of a leaf
(Adapted from educational materials provided by VCU Ophthalmology – Drs. Amanda Pfeifer and Evan Silverstein)
Intermittent Exotropia One Leaf (Spanish)
(Adapted from educational materials provided by VCU Ophthalmology – Drs. Amanda Pfeifer and Evan Silverstein)
WHAT IS EXOTROPIA?
Exotropia is when one or both eyes turn outward, rather than looking straight. It is the opposite of crossed eyes, also called esotropia. Exotropia may occur from time to time (called intermittent exotropia) or it may be constant. People of all ages can have exotropia.
[See figures 1 and 2].
Figure 1: Eyes aligned, straight.
Figure 2: Right eye turned out to be exotropic.
WHAT ARE THE DIFFERENT TYPES OF EXOTROPIA?
Exotropia may be present at birth (called congenital exotropia) or develop later in life. Types of exotropia that develop later are intermittent exotropia, sensory exotropia, and consecutive exotropia (which occurs after surgery to correct crossed eyes).
WHAT IS CONGENITAL EXOTROPIA?
Congenital exotropia occurs when a baby’s eyes turn outward from birth or early infancy. Esotropia, or inward-turned eyes, is more common in babies. If a baby has constant exotropia, a pediatric ophthalmologist should check for other health problems.
WHAT IS INTERMITTENT EXOTROPIA?
Intermittent exotropia is when sometimes one eye turns outward, but other times both eyes are straight. It can occur when the person is tired, sick, or daydreaming. Sometimes it happens when the person looks at things far away. In some people, intermittent exotropia may become more frequent or even constant over time.
Is exotropia hereditary?
Strabismus, which is the medical term for misalignment of the eyes, can be hereditary. However, people in the same family may not have the same type or severity of strabismus. If someone in the family has exotropia or strabismus, the child should consult a pediatric ophthalmologist.
WHAT ARE THE SIGNS OF INTERMITTENT EXOTROPIA?
People with intermittent exotropia may notice that their eyes turn outward, especially when they are tired, sick, bored, or after drinking alcohol. Children may squint one eye in bright sunlight or rub their eyes when the eye turns outward. Some people say their vision becomes blurry or they see double when their eyes are not straight. Some people may even “feel” that one eye is out of place, even if they don’t see anything unusual. Some people may not feel anything when their eyes wander and only know they have exotropia because other people notice their eyes drifting.
WHY DOES SOMEONE WITH INTERMITTENT EXOTROPIA CLOSE ONE EYE OFTEN?
Children with intermittent exotropia sometimes squint or close one eye, especially in bright sunlight. The reason for this is not fully understood, but closing one eye may help them see better under light. Sunglasses can sometimes help with squinting. If a child does not wear sunglasses, a hat with a brim, such as a baseball cap, can help protect his or her eyes from the sun and reduce squinting.
IS IT POSSIBLE TO OVERCOME INTERMITTENT EXOTROPIA?
Exotropia may occur less frequently as a person ages, but most types do not go away completely. Many people end up needing surgery to fix it. However, some people can learn to control the deviation of their eyes with glasses or other non-surgical treatments.
CAN ANYTHING BE DONE TO PREVENT INTERMITTENT EXOTROPIA FROM GETTING WORSE?
We cannot predict if or when intermittent exotropia will get worse.
Simple things like getting enough sleep and staying healthy can help manage intermittent exotropia, as illness or fever can cause this to occur more frequently. It’s also important to see your ophthalmologist regularly to make sure your vision is fine and your glasses are correct. The ophthalmologist will be able to tell you if there are other treatments that can help.
DOES WATCHING TOO MUCH TV OR PLAYING TOO MANY VIDEO GAMES MAKE EXOTROPIA WORSE? OR CAN VIDEO GAMES HELP?
Normal activities, such as reading or playing outside, do not affect exotropia. However, it is a good idea for parents to limit the time their children spend watching television, playing video games, or using computers for other health reasons. For more information, please see our information at screen time.
WHAT IS SENSORY EXOTROPIA?
Sensory exotropia occurs when one eye has poor vision. The weaker eye cannot work well with the other eye, so it may turn outward. This can happen at any age. If the vision problem can be treated, it should be treated early. If vision is permanently lost, surgery to straighten the eye may be helpful.
HOW IS EXOTROPIA TREATED?
Sometimes exotropia can be treated without surgery. Glasses can help, and patches are sometimes used on the stronger eye. If your eyes are frequently misaligned, surgery may be needed to fix them. The pediatric ophthalmologist will tell you the best time for surgery.
WHEN IS EXOTROPIA SURGERY NECESSARY?
Surgery may be needed if exotropia occurs very frequently, if there are problems such as eyestrain or double vision, or if the patient begins to lose “binocular vision” (the ability to use both eyes at once). Surgery may not be necessary if glasses or other treatments work.
WHAT IS BINOCULAR VISION?
Binocular vision means using both eyes together to see objects clearly. This helps with depth perception or “three-dimensional vision.” Your pediatric ophthalmologist can test for this in the office.
WHAT AGE IS BEST FOR EXOTROPIA SURGERY?
Age is not the main reason for exotropia surgery. Surgery is considered when exotropia occurs most of the time, regardless of the patient’s age.
CAN EXOTROPIA BE TREATED WITH PATCHES?
For young children who prefer to use one eye most of the time, patching the stronger eye part-time can help the weaker eye see better. Some doctors may suggest putting eye patches on every other day to help your eyes work better together.
CAN EXOTROPIA BE TREATED WITH GLASSES?
It depends on the prescription of the glasses. If someone is nearsighted or has severe astigmatism, wearing the right glasses can help keep the eyes straight and working together.
CAN EXOTROPIA BE TREATED WITH PRISMS IN GLASSES?
If the exotropia is mild or small, prisms in glasses can help with double vision, especially in adults. But prisms do not solve the problem of eye movement.
WHAT ABOUT THE EXERCISES OR VISION THERAPY FOR THE EYES?
The exercises have only been shown to work with convergence insufficiency, a specific eye movement problem that occurs when focusing on things up close. These exercises can be done at home. If the pediatric ophthalmologist recommends it, he or she can show you how to do the exercises. Some people suggest exercises for other types of exotropia, but there is no proven evidence that they help with intermittent exotropia.
Updated: 12/2024
