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More about Squints


Exotropia is a type of squint or strabismus or eye misalignment. In exotropia, the eye deviates away from the nose. It usually appears in older children and gradually worsens.  Sometimes children are born with this type of squint.   In the first picture, the right eye is deviating outwards whereas in the second picture it's the left eye.


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.

Children may develop double vision when his/her eye drifts outward though this is not very common. At first, the child may close the drifting eye to prevent double vision. This double vision may also induce the child to straighten his/her eyes. As a child’s eye drifts outward more frequently he/she will become used to this misalignment. In effect, the child will “turn off” the drifting eye to prevent double vision. This will lead to more frequent outward drifting of the eyes. Finally, children may completely lose the ability to use the eyes together and become constantly exotropia.  

What is the risk to vision with this squint?

As long as the child is squinting sometimes we are not worried about what is known as the Lazy eye or Amblyopia.  If the squint becomes constant and if the child is below the age of 6-8 years there is always a risk of the child developing amblyopia.

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)
  • Down syndrome
  • Cerebral palsy
  • Hydrocephalus (increased intracranial pressure)
  • Brain tumors
  • Head Trauma
  • Anisometropia


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


Many children with intermittent exotropia will eventually require surgery. Strabismus surgery may be indicated if the child’s eyes frequently turn outward. Surgery would also be indicated if the child’s control over his/her ocular misalignment is clearly worsening and for cosmetic reasons.  Also, the squint may not be very visible but if the child is complaining of headaches or eyestrain then she may need to undergo surgery.

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

Strabismus surgery is usually successful. In fact, approximately 80% of children will require only one operation to obtain a satisfactory result.

After surgery, it is frequent and often desirable for a 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.

Frequently Asked Questions ?

Is surgery the only option for treating Exotropia ?
Nothing is a 100% in medicine and so it is with the need for surgery for Exotropia. However, that being said more often than not surgery will most likely be needed.
What is the right age to operate on Exotropias ?
For Exotropia there is no right age. It actually is dependant on three criteria. Based on the following criteria the age can range from very young to middle age.

Is the squint present for more than 50% of the waking hours. If it is then we need to perform surgery

The squint may not be present for 50% of waking hours, but if the child is complaining of headaches or eyestrain then squint surgery may be the answer.

Let me explain a bit here. Basically the child is very good at controlling the squint. so the squint is not visible much. But this constant control that the child is exerting is like lifting weights and if one were to lift weights for the whole day there will be pain. Thus the child complains of pain or headaches or eyestrain.

Cosmetic appearance would be the third reason to correct squint.
What happens after surgery ?
Recovery post surgery usually takes 3-4 weeks. Your doctor may advise you not to take a head bath for a few days and use some eyedrops and eye ointment for 3-4 weeks. The patient may have pain for a day or two.

Specifically post a surgery for exotropia there may be complaints of double vision. Actually this is desirable and this double vision gradually decreases and dissapears in less than a couple of weeks.
Does the vision get affected after squint surgery ?
No. The vision should not get affected after a squint surgery. What we are doing in a squint surgery is changing the postiion of the muscles. The muscles are located on the outer wall of the eyeball and thus during a squint surgery the eyeball is not entered or punctured. However, when we are reattaching the muscle to the eyeball and taking sutures there does exist a small possibility of what we call as globe perforation. The idea is not to alarm you because we almost never see this happen.
Do the glasses go after squint surgery ?
We perform a squint surgery to change the position of the eyes. We do this by moving the muscles of the eyeball. This a squint surgery would have no impact on the glasses that the child/adult already wear. The glasses will remain.
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