Jump to topic
Exotropia refers to a type of strabismus (eye misalignment) in which either one or both of the eyes turn outward. It is not the same as esotropia, in which either one or both of the eyes turn inward.
Exotropia is a common condition. It comprises 25% of all ocular misalignment cases in young children. While it could happen periodically (e.g., intermittent exotropia), it could also be constant.
However, it is more typical to find exotropia developed while a child is 1 to 4 years old. Parents may notice this form of strabismus, especially when the child is daydreaming, sick, or tired.
It may also be apparent when the child attempts to focus on distant objects. Conversely, when a child focuses on items up close, it may be difficult to notice the eye condition.
If there is suspicion of exotropia, it is important to seek an eye care specialist. An eye doctor can perform a comprehensive eye exam and differential diagnosis to rule out other possible conditions.
Jump to topic
Exotropia can be classified into different subsets. Speaking with your ophthalmologist and undergoing an eye exam can help determine which type of exotropia you or your child has.
If a person has sensory exotropia, the eye may suffer from poor vision or blindness. It will also turn outward.
Initially, if an infant or young child has a blind or poorly seeing eye, esotropia (cross-eyes) develops. However, in older children (between the ages of 2 and 4 years), the eye often becomes exotropic.
With intermittent exotropia, one eye turns outward on occasions. Other times, the eyes are straight, and there is no apparent indication of the condition. Family members or friends may observe the exotropia when the person with the condition is either tired or daydreaming.
Also, intermittent exotropia may be more noticeable when the person looks at distant objects.
While it is rare and will cause no to few symptoms, intermittent exotropia can occur more often or progress to becoming constant.
Some may refer to congenital exotropia as infantile exotropia. This outward turning of the eyes is present since birth or during early infancy.
While esotropia is more common in infants, a pediatric ophthalmologist should evaluate constant exotropia. The latter condition may be associated with an underlying medical condition.
As the name suggests, people with an alternating exotropia have an outward eye turn that alternates both eyes. The condition can be constant or intermittent and vary in degree of severity.
Intermittent exotropia is the most frequent type of strabismus, impacting as much as 1% of the U.S. population. It is more common in females than in males.
There is no specific, known cause of exotropia.
However, exotropia may be common in children with either sensory exotropia or an underlying genetic disorder that impacts eye movements.
Here is a list of some diseases that could increase the likelihood of developing exotropia:
Additionally, having some of the risk factors below may raise the probability of exotropia:
It is important to distinguish that exotropia is not a disease in and of itself. This condition refers to a motility disturbance (abnormal eye movements or trouble in managing eye movements). It can occur as a result of a particular medical disease or disorder.
Those with exotropia may experience some symptoms of exotropia or show signs. For example, they may have:
While these symptoms do not always indicate exotropia, it is important to seek an eye consultation if one or more of these symptoms are present.
Intermittent exotropia may occur in infants as young as 1 to 2 months of age. If the condition is mild, it may go away on its own within 6 to 8 weeks of birth.
In other cases of exotropia, it is not common to find a complete resolution of the condition. While patching, glasses, or vision therapy can help, exotropia may remain present.
Exotropia can cause complications, including:
According to the American Journal of Ophthalmology, more than 90% of children with intermittent exotropia studied would develop myopia by 20 years of age.
An eye doctor, such as an ophthalmologist or optometrist, will perform an exotropia diagnosis based on family history, symptoms, and vision testing.
Vision tests can consist of:
Those with exotropia can explore both non-surgical and surgical treatment options.
Non-surgical treatment possibilities include:
Surgical treatments may be performed to maintain or restore binocular capability. It may also help provide relief for diplopia (double vision) or cosmesis (to enhance physical appearance). There is a higher success rate in the long run for those with intermittent exotropia and with stronger binocular function at the time of surgery.
To determine which treatment is most suitable, you should visit your local eye clinic and speak with a professional eye care specialist.
Ekdawi, Noha S. “The Development of Myopia Among Children With Intermittent Exotropia.” American Journal of Ophthalmology , 1 Mar. 2010, www.ajo.com/article/S0002-9394(09)00791-0/fulltext.
“Exotropia.” Exotropia - American Association for Pediatric Ophthalmology and Strabismus, aapos.org/glossary/exotropia.
“Exotropia.” Exotropia | Kellogg Eye Center | Michigan Medicine, www.umkelloggeye.org/conditions-treatments/exotropia.
“Exotropia.” EyeWiki, 21 Jan. 2015, eyewiki.aao.org/Exotropia.
“Intermittent Exotropia.” Intermittent Exotropia | Texas Children's Hospital, www.texaschildrens.org/departments/ophthalmology/conditions-we-treat/intermittent-exotropia.
Oatts, Julius T. “Intermittent Exotropia.” American Academy of Ophthalmology, 9 Apr. 2020, www.aao.org/disease-review/intermittent-exotropia-2.
“Strabismus (Crossed Eyes): Types, Causes, Symptoms & Treatment.” Cleveland Clinic, my.clevelandclinic.org/health/articles/crossed-eyes-strabismus.