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Exotropia, Acquired (Treatment)

eMedicine.com, 2011

Treatment Medical Care Nonsurgical treatment is indicated in patients with excellent or good control of the deviation as measured by normal distance stereoacuity and in young children where the risk of surgical overcorrection is undesirable.
Nonsurgical treatment modalities Correction of refractive error: All kinds of refractive errors, particularly astigmatism and anisometropia, must be corrected.
The associated improvement in visual acuity could be associated with increased fusional ability and better control of intermittent exotropia.
Minus lenses: The lenses stimulate convergence through the accommodative convergence synkinesis and help control divergence.
The larger the AC/A ratio, the larger the effect (ie, patients can compensate for larger deviations).
Various studies have reported not only an improvement in quality of fusion but also a quantitative decrease in the angle of deviation.
Minus lenses range from –2 D to –4 D; they may be most helpful in younger children with exodeviations of 5-15 PD.
A recent study showed that the overcorrecting minus lenses worked well in children aged 2-17 years and that the average reduction in the exodeviation was approximately 10 PD.
Occlusion: Patching the dominant eye or alternate patching of either eye is suggested to interrupt the process of suppression and to reduce the progression of the exotropia.
Prisms: Base-in prisms may aid control and relieve asthenopic symptoms in small comitant exodeviations of up to approximately 20 PD.
Orthoptics: Convergence exercises improve convergence fusional amplitudes and the near point of convergence.