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Exotropia is a type of strabismus or eye misalignment. In exotropia, eye deviates away from the nose. It usually appears at the age of 2 months and 5 years of age.


Most children with exotropia have intermittent exotropia. Intermittent indicates that your child’s eyes are not always turned outward. At certain times your child’s eyes may be straight and at other times an eye may drift outward. The outward drifting is often most apparent when your child is sick, tired or inattentive, particularly in the evening.

In the majority of children, this outward drifting occurs primarily on distance viewing. Therefore, when your child looks directly at you up close the outward turning of the eye may not be visible.

Child may develop double vision when his/her eye drifts outward. At first, child may close the drifting eye to prevent double vision. This double vision may also induce child to straighten his/her eyes. As child’s eye drifts outward more frequently he/she will become used to this misalignment. In effect, child will “turn off” the drifting eye to prevent double vision. This will lead to more frequent outward drifting of the eyes. Finally, child may completely loose the ability to use the eyes together and become constantly exotropic.

Causes of exotropia

Causes of exotropia are mostly unknown. Children with a family history of the disorder are more likely to get them. They are also common in children who have other systemic disorders.

  • No known cause (idiopathic); possibly familial
  • Down syndrome
  • Cerebral palsy
  • Hydrocephalus (Increased intra-cranial pressure)
  • Brain tumors
  • Head Trauma
  • Anisometropia


If child’s eye only turn outward occasionally, no treatment may be necessary. It is important to notice that how often child’s eyes turn out. If this outward turning begins to occur more frequently( more than 50% of the waking hours), surgery may be indicated.


Many children with intermittent exotropia will eventually require surgery. Strabismus surgery may be indicated if child’s eyes frequently turn outward. Surgery would also be indicated if child’s control over his/her ocular misalignment is clearly worsening and for cosmetic reason.

During surgery the extraocular muscles, which control the position of the eyes, are weakened or strengthened.

Strabismus surgery is usually successful. In fact, approximately 70% of children will require only one operation to obtain a satisfactory result.

After surgery it is frequent and often desirable for child’s eyes to be turned inwards slightly. This will usually resolve after a few weeks or months. Sometimes drops or glasses will be used to straighten eyes that are turned inwards after surgery.

Please note that in some children an eye may begin to drift outwards again months or years after an initially successful surgical procedure. Therefore, it is important to continue to observe your child’s eye position.




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