She was told that it was too late for strabismus surgery or lazy eye patching for. Management of intermittent exotropia of the divergence excess. These findings are similar to those previously reported in the 3 to 10year cohort. To study the factors affecting residual exotropia 10 pd at 46wk postoperative visit following two rectus muscle surgery for intermittent exotropia bilateral lateral rectus lr recession. Symptomatic vertical deviations are commonly managed with vertical prism in spectacles because it. Intermittent exotropia is an exodeviation intermittently controlled by fusional mechanisms. Exotropia a common type of strabismus is the outward deviation of an eye eye turns away from the nose. I took her to the paediatric opthalmologist when she was almost 6 months old. Some of the causes of amblyopia are misaligned eyes strabismus, unequal focus between the eyes.
New research sheds light on intermittent exotropia american. Most people who suffer from exotropia have an intermittent exotropia. I was diagnosed with strabismus at 18 months old and wore an eye patch for the next four years. Patching usually does not change the natural course of the problem. Does patching ever helps treat intermittent exotropia. Commonly missed diagnoses in the childhood eye examination. At that point, in the early 70s, my parents were being told that not getting surgery would condemn me to blindness and that visual therapy was akin to quackery. Additionally, i have a page dedicated to all of our intermittent exotropia updates including resources so if you havent checked it out already, have at it. Light transmission and preference of eye patches for occlusion. Now i am patching the right eye for 1 1\2 hours and left eye for 1\2 hour alternate days. Does occlusion therapy improve control in intermittent exotropia. Intermittent exotropia develops in early childhood and is generally reported to be progressive. While many instances of lazy eye are obvious due to strabismus, there are several cases in young children in which. Exodeviations are much more common in a latent or intermittent form than are esodeviations.
Intermittent exotropia and mental illness mayo clinic. I took her to the paediatric opthalmologist when she. The deviation may be constant or intermittent, and the deviating eye may always be one eye or may alternate between the two eyes. If you missed my last update, back to patching, feel free to catch up. Parents will note that the drifting is seen more often when the child is tired or sick. May 16, 20 its been awhile since i blogged about alivias intermittent exotropia.
A randomized trial comparing parttime patching with observation for intermittent exotropia in children 12 to 35 months of age brian g. Course 227 classroom accommodations for students with visual issues k5 learn how visual conditions affect classroom performance. N2 three common nonsurgical management strategies for childhood intermittent exotropia are observation alone, parttime patching, and overminus spectacles. What is the difference between convergence insufficiency and exotropia. Sensory exotropia takes place in the existence of bad vision. He has worn a patch everyday since july 8th, and will continue until september 15th. Although the benefit is usually temporary, occlusion can be used to postpone surgical intervention in responsive patients 32. Parttime patching vs observation for intermittent exotropia. Esotropia is an eye condition where either one or both of your eyes turn inward. Pdf factors affecting residual exotropia after two muscle. Treatment options consist of vision therapy, patching, eyeglasses andor, very. Participants were assigned randomly to either observation no treatment for 6 months or patching prescribed for 3 hours daily for 5 months, followed by 1 month of no patching. Patients in this study, which will have a threeyear followup period, are randomized to receive no treatment or to undergo six months of patching of one eye for two hours per day. A randomized trial comparing parttime patching with.
Burian classified intermittent exotropia into three types. Exotropia also known as walleye or divergent strabismus differs from its opposite form, esotropia eye turns in toward nose, in that exotropic eyes point outward or away from the nose. Then ure enough i took her to the pediatrician and then to the ophthalmologist and she has exotropia and has to wear an eye patch. In the ideal situation, patching is gradually reduced and then stopped when the vision is equal in both eyes. In intermittent exotropia, sometimes one eye is turning out and other times both eyes are straight. Intermittent exotropia is the second most common type of strabismus 19% and the most prevalent type of exotropia in childhood 52%. Incorporate inexpensive and successful modifications to help your students succeed.
You should see an eye md ophthalmologist that specilizes in strabismus. Only one eye turns out at a time while the other eye points straight forward. Article 4 vision therapy management for intermittent. Current nonsurgical management of intermittent exotropia. Classroom accommodations for students with visual issues. These children have binocular fusion and are well aligned most of the time. To determine the effectiveness of prescribed parttime patching for treatment of intermittent exotropia ixt in children.
Hello, all my son has intermittent exotropia since a young age 1 years. Infantile exotropia in some cases called hereditary exotropia is seen during the first year of life, and is less typical than essential exotropia which generally emerges several years. Exotropia may be congenital present at birth or acquired. Main outcome measures the primary outcome was deterioration, defined as constant exotropia measuring at least 10. Although adverse psychosocial effects are well documented among patients affl icted with strabismus, recent studies have shown that children with intermittent exotropia, unlike the more prevalent forms of esotropia, are at an increased risk for developing frank. Learn the latest information on how to fix this issue. Prevalence exodeviations are much more common in latent or intermittent form than are esodeviations. The deviation or eye turn may occur while fixating looking at distance objects, near objects, or both. New research sheds light on intermittent exotropia. What is your feeling on patching children with intermittent exotropia who do not have amblyopia.
Intermittent exotropia ixt is the most common form of childhood exotropia 1, 2 with an incidence of 32. Both surgical and nonsurgical management options are commonly prescribed, but there is controversy. Comparison of patching with observation for children with. He said my daughter seems to have a pigment spot or hole. Information on strabismus crossed eyes intermittent exotropia. Eye muscle surgery is the treatment of choice for most forms of intermittent exotropia. When the eye turns outward only some of the time, it is called intermittent exotropia. Treatment for a type of childhood strabismus where one or both eyes intermittently turn outwards strabismus is a condition in which the eyes are not normally aligned, that is one eye looks straight ahead whilst the other eye turns inwards, outwards, up or down.
Exotropia pictures,symptoms,causes,complications and. Capturing the moment of fusion loss in intermittent exotropia. Both surgical and nonsurgical management options are commonly prescribed, but there is controversy regarding both the optimal timing and method of treatment. People with exotropia often experience crossed diplopia. However a more common scenario is that the vision in the amblyopic eye plateaus at 612 or 2040 level and patching is tapered off at this point. Exotropia is a common type of strabismus that occurs when misaligned eyes deviate outward. Intermittent exotropia comprises about 7590% of the cases of exotropia and is usually preceded by a stage of exophoria. As with any type of strabismus, surgical intervention is directed toward preservation or restoration of binocular vision, prevention of amblyopia, as well as cosmesis.
The different types of acquired exotropia are intermittent exotropia, sensory exotropia, exotropia with neurologic causes and field defects, and consecutive exotropia. Exotropia may occur from time to time intermittent exotropia or may be constant, and is found in every age group. Nov 30, 2015 most exotropia conditions are classified as constant or intermittent exotropia. To characterize eye movements made by patients with intermittent exotropia when fusion loss.
Intermittent exotropia ixt is the most common form of childhood exotropia 1, 2 and the most prevalent form of strabismus in some populations. The medical records of patients who underwent surgery for exotropia with. Surgery, if considered at all, should be a last resort. T1 current nonsurgical management of intermittent exotropia. Exotropia is a type of strabismus characterised by outward deviation of an eye. Esotropia and exotropia are the most common types of strabismus. The risks of exotropia are equal in both male and female. Although exotropia can occur at any age, younger children are majorly targeted. Typically, one eye will turn outward intermittent exotropia when focusing on a word or object at near. Listing a study does not mean it has been evaluated by the u. Strabismus treatment options include vision therapy, eye muscle surgery, and glasses.
The acquired forms of exotropia include intermittent exotropia, sensory exotropia, and consecutive exotropia. One or both eyes turn out toward the ear occasionally. It is pretty minimal, and no one has ever noticed it besides us and dr. In our office, the parents are told of these possible problems following surgery, and that patching, special glasses, and even more than one operation may. In many cases, the eye turn might only be visible during stressful situations or. May 16, 2017 exotropia is a category of strabismus, a defect in which ones eyes deviate outward or away from each other. The first study will explore the natural history of intermittent exotropia by comparing patching against no treatment. This study will highlight the importance of patching ixt patients and assist to approach the proper use of occlusion therapy. Convergence insufficiency american association for. Treatment for a type of childhood strabismus where one or.
Jun 23, 2015 the investigators examined parttime patching for intermittent exotropia in children 12 to 35 months old. Exotropia is a form of strabismus where the eyes are deviated outward. Back to patching another intermittent exotropia update. Capturing the moment of fusion loss in intermittent exotropia john r. This investigators in this clinical trial assessed the effectiveness of patching in children with intermittent exotropia. Intermittent exotropia is a very common type of eye misalignment.
Intermittent exotropia caused by common near vision disorder. Approximately 70% of children achieve this level of vision with patching treatment. They found that children who underwent three hours of daily patching experienced less deterioration of ixt than. Diagnostic occlusion test in intermittent exotropia. Exotropia in 2yd old the daycare provider noticed that one of my babys eyes are misaligned. Discuss specific accommodations for standardized and computerbased testing. The effect of preoperative occlusion therapy on longterm. Intermittent exotropia xt is a strabismus condition with outward drifting of either eye interspersed with periods of good alignment or orthotropia fig. If these are normal, we will recommend exercises or do some patching or even prescribe.
Intermittent exotropia xt is one of the most common types of childhood strabismus, occurring in. Children with intermittent eye turns should be handled with judicious patching, special glasses, andor vision therapy. Try the brock string exercise to improve eye coordination and focus. People with intermittent exotropia will often be noted to close one eye, especially when they are outside in. It is the opposite of esotropia and usually involves more severe axis deviation than exophoria. The aim of this study was to evaluate the effectiveness of occlusion therapy in the control of intermittent exotropia ixt in children between 4 and 10 years in saudi arabia. Ixt is a common form of childhood exotropia, accounting for about 5090% of all the exotropia and affecting about 1% of the general population. Has anyone had success with using an eye patch to treat. Strabismus, misaligned eyes childrens eye care of michigan. Although there is a slightly lower deterioration rate with patching, both management approaches are reasonable for treating children 3 to 10 years of age with ixt. Some patients or family members notice the exotropia more when the patient is tired or daydreaming.
Dec 15, 2009 observation versus occlusion therapy for intermittent exotropia ixt2 the safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Management of intermittent exotropia of the divergence. Frantz, od, illinois college of optometry, chicago, illinois kyle otteson, od, bismarck, north dakota abstract background. Observation versus occlusion therapy for intermittent. In contrast to esotropia, which requires urgent intervention, the treatment of intermittent exotropia is elective.
If exotropia affects both eyes, as a result of which the individual is unable to align both eyes, the condition is termed as convergence insufficiency or exophoria. Although the benefit is usually temporary, occlusion can be used to postpone surgical intervention in responsive patients 18. Intermittent exotropia usually starts to be seen after the age of 2 to 3 years but can be seen at any age. I believe the univeristy of missouri in columbia has one in their ophthalmology department.
In exotropia, one or both eyes may be outward turning. Intermittent exotropia is a fairly typical condition. Intermittent exotropia is a condition in which there are times when one eye has drifted outwards, and other times when the eyes are straight. A randomized trial comparing parttime patching with observation for intermittent exotropia in children 12 to 35 months of age article in ophthalmology 1228 june 2015 with 75 reads. This causes the other eyes vision to be weak or poor. Remember that lazy eye is not a diagnosis and is a very imprecise term since the following medical terms are sometimes called a lazy eye. Colloquially known as a squint or an eye turn and sometimes erroneously as a lazy eye amblyopia. Rachel was misdiagnosed as having amblyopia or lazy eye as a child. Know the causes, symptoms, treatment, prognosis and complications of exotropia. Sensory exotropia occurs in the presence of poor vision. Exotropia is when one eye drifts outwards towards the ear, and esotropia is when one eye drifts in towards the nose.
The pupil is the black hole in the center of the colored part of our eye that allows. The ongoing challenge of intermittent exotropia american. Parttime patch therapy for treatment of intermittent. A randomized trial comparing parttime patching with observation for intermittent exotropia in children 12 to 35 months of age. Part time patching of the nondeviating eye for four to six hours daily may convert an intermittent exotropia to a phoria. Does patching ever helps treat intermittent exotropia my 8 month old daughter is diagnosed with intermittent exotropia two days ago. After each patch covered the hole of the model eye, the transmitted. Over a 5month period, there was no significant change in intermittent exotropia with or without patching for 3 hours per day. Intermittent exotropia is a fairly common condition. Both parttime patching and observation are appropriate choices for the treatment of intermittent exotropia ixt in children aged 3 to 10 years, researchers conclude in a study published online. Intermittent exotropia is the most common exodeviation and is found in 1% of the population.
Nov 15, 2018 exodeviation is a horizontal form of strabismus characterized by visual axes that form a divergent angle. See eye muscle surgery as treatment for strabismus, including intermittent exotropia. The further the object being focused upon, the greater the outward deviation. Squint clinic visual development what is amblyopia. Article 4 vision therapy management for intermittent hypertropia with exotropia kelly a. Theories historical theories innervational imbalance between convergence and divergence duane divergence. Donahue, who is also the protocol chair and a member of the pediatric eye disease investigator group pedig executive committee, described two studies on intermittent exotropia that are underway. Glasses and prisms may be prescribed, but generally, surgery seems to be the best course of action.
Of all the exotropia intermittent exotropia comprises. Monocular eye closure may occur during exodeviation. Cause of intermittent exotropia the cause of this condition is not known. Parttime patching or observation for intermittent exotropia. A constant exotropia will typically involve one eye that remains turned out. Transient intermittent exotropia is sometimes seen in the first 4 6 weeks of life and, if mild, can resolve spontaneously by 6 8 weeks of age. Information on strabismus crossed eyes intermittent. Parttime patching was shown to be no more effective than observation among children between the ages of 12 months and 35 months with intermittent exotropia. Exotropiaor an outward turning of the eyesis a common type of strabismus accounting for up to 25 percent of all ocular misalignment in early childhood. Then, the examiner determined which eye the patient was using to see through the hole. Ashraful huq fcps consultant bangladesh eye trust hospital dhaka, bangladesh slideshare uses cookies to improve functionality and performance, and to provide you with relevant advertising. Exotropia is often intermittent and worse while looking at the distance.
Intermittent exotropia is the most common type of exotropia in children. One eye may look straight ahead, while the other eye turns inward esotropia, outward exotropia, upward hypertropia, or downward hypotropia. A large cohort of children aged 3 to patching daily for 5 months or no treatmentobservation. At the time i thought that patching her right eye is what caused it to start to deviating but apparently that was incorrect. Exotropia is a type of strabismus eye misalignment, where one eye turns, or deviates, outward away from the nose. Children aged 3 to 10 years with intermittent exotropia saw little deterioration in their condition after 6 months, whether treated with parttime patching or observation. Convergence insufficiency is the inability to maintain binocular function keeping the two eyes working together while working at a near distance. Atropine works like patching, except that the eye drops dilate the pupil and blur the.