Exotropia
WHAT IS EXOTROPIA?
Exotropia is when one or both of the eyes turn outward, instead of looking straight. It is the opposite of crossed in eyes, also called esotropia. Exotropia can happen from time to time (called intermittent exotropia) or it can be constant. People of all ages can have exotropia.
[See figures 1 and 2].
Fig. 1: Eyes aligned, straight.
Fig. 2: Right eye turned out, exotropic
WHAT ARE THE DIFFERENT TYPES OF EXOTROPIA?
Exotropia can be present at birth (called congenital exotropia) or develop later in life. The types of exotropia that develop later are intermittent exotropia, sensory exotropia, and consecutive exotropia (which happens after surgery to fix crossed eyes)
WHAT IS CONGENITAL EXOTROPIA?
Congenital exotropia happens when a baby’s eyes turn outward from birth or early childhood. Esotropia, or eyes turning inward, is more common in babies. If a baby has constant exotropia, a pediatric ophthalmologist should check for other health issues.
WHAT IS INTERMITTENT EXOTROPIA?
Intermittent exotropia is when one eye turns out sometimes, but other times both eyes are straight. It can happen when the person is tired, sick, or daydreaming. Sometimes it happens when the person is looking at things far away. In some people, intermittent exotropia may become more frequent or even constant over time.
DOES EXOTROPIA RUN IN FAMILIES?
Strabismus, which is the medical term for eye misalignment, can run in families. 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, a child should see a pediatric ophthalmologist.
WHAT ARE THE SIGNS OF INTERMITTENT EXOTROPIA?
People with intermittent exotropia may notice that their eyes drift 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 their eye drifts outward. Some people say their vision gets blurry or they see double when their eyes are not straight. Some people can 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 eye drifts, and only know they have exotropia because other people notice their eye turning out.
WHY DOES SOMEONE WITH INTERMITTENT EXOTROPIA CLOSE ONE EYE FREQUENTLY?
Children with intermittent exotropia sometimes squint or close one eye, especially in bright sunlight. The reason for this isn’t fully understood, but closing one eye can help them see better in the light. Sunglasses can sometimes help with the squinting. If a child won’t wear sunglasses, a hat with a brim, like a baseball cap, can help protect their eyes from the sun and reduce squinting.
IS IT POSSIBLE TO OUTGROW INTERMITTENT EXOTROPIA?
Exotropia might happen less often as a person gets older, but most types don’t go away completely. Many people end up needing surgery to fix it. However, some people can learn to control the drifting of their eyes with glasses or other treatments without surgery.
CAN ANYTHING BE DONE TO KEEP INTERMITTENT EXOTROPIA FROM GETTING WORSE?
We can’t predict if or when intermittent exotropia will get worse.
Simple things like getting enough sleep and staying healthy can help control intermittent exotropia, as illness or fever can make it happen more often. It’s also important to see the eye doctor regularly to make sure your vision is doing well and glasses are correct. The ophthalmologist can let you know if there are other treatments that can help.
DOES WATCHING TOO MUCH TELEVISION OR PLAYING TOO MANY VIDEO GAMES MAKE EXOTROPIA WORSE? OR CAN VIDEO GAMES HELP?
Normal activities, like reading or playing outside, do not affect exotropia. However, it is a good idea for parents to limit the time their kids spend watching TV, playing video games, or using computers for other health reasons. For more information, see our information on screentime.
WHAT IS SENSORY EXOTROPIA?
Sensory exotropia happens when one eye has poor vision. The weaker eye can’t work well with the other eye, so it might turn outward. This can happen at any age. If the vision problem can be treated, it should be treated early. If the vision is permanently lost, surgery to straighten the eye might be helpful.
HOW IS EXOTROPIA TREATED?
Exotropia can sometimes be treated without surgery. Glasses may help, and sometimes patching the stronger eye is used. If the eyes are misaligned often, surgery may be needed to fix the eyes. The pediatric ophthalmologist will tell you the best time for surgery.
WHEN IS SURGERY FOR EXOTROPIA NEEDED?
Surgery may be needed if exotropia happens a lot, if there are problems like eyestrain or double vision, or if the patient starts losing "binocular vision" (the ability to use both eyes together). Surgery might not be needed 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 "3-D 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 happens most of the time, no matter the patient’s age.
CAN EXOTROPIA BE TREATED WITH PATCHING?
For young children who prefer using one eye most of the time, patching the stronger eye part-time can help the weaker eye see better. Some doctors may suggest patching the eyes on alternate days to help the eyes work better together.
CAN EXOTROPIA BE TREATED WITH GLASSES?
It depends on the glasses prescription. If someone is nearsighted or has a lot of astigmatism, wearing the right glasses can help keep the eyes straight and working together.
CAN EXOTROPIA BE TREATED WITH PRISMS IN THE GLASSES?
If the exotropia is mild or small, prisms in glasses might help with double vision, especially in adults. But prisms don't fix the eye movement problem.
WHAT ABOUT EXERCISES OR VISION THERAPY FOR THE EYES?
Exercises have only been proven to work with convergence insufficiency, a specific eye movement problem that happens when focusing on things close up. These exercises can be done at home. If the pediatric ophthalmologist recommends this, they can show you how to do the exercises. Some people suggest exercises for other types of exotropia, but there’s no proven evidence that they help with intermittent exotropia.
Updated: 12/2024