Squint or no squint?—Intermittent exotropia a very special kind of strabismus

Abstract

Background: Strabismus occurs in approximately 5–7% of healthy children. Globally divergent strabismus (1.24%) is less common than convergent strabismus. Intermittent exotropia is the most common form of divergent squint (40–90%). Intermittent exotropia has been described by many authors. Nevertheless, due to the variability of the clinical findings it remains a therapeutic challenge in clinical practice. Material and methods: The results of studies on intermittent exotropia with a focus on the clinical characteristics, examination criteria and therapeutic approaches were collected as part of a literature search, and the results are presented. Results: Intermittent exotropia is characterized by a special binocular situation, the symptoms of which are not fully clarified (photophobia, eye closure). The aim of the conservative therapeutic options is a stabilization of the visual system but in many cases squint surgery is needed. In the preoperative assessment particular attention should be paid to the stability of the angle of squint. The Newcastle control score is a proven tool to facilitate the decision for performing surgery or not. Conclusion: The clinical characteristics of intermittent exotropia have already been described very clearly. With respect to the therapeutic approaches, however, there are international differences. The importance of involving parents (shared decision making) in the assessment of squint frequency and decision for surgery is emphasized.