Exotropic deviations

Abstract

• Exotropic deviations include exophoria, infantile exotropia, sensory exotropia, consecutive exotropia, intermittent exotropia, and dissociated horizontal deviation. • The decision whether to treat should be based on control, and how to treat is based on the magnitude of the deviation. • Burian's classic treatment recommendations and classification of exotropia are based on some assumptions that are probably incorrect. They need not be strictly followed. • Intermittent exotropes with a true high AC/A ratio are uncommon but do exist. Standard surgery based on the distance angle frequently results in an overcorrection at near. • Patients with fusional convergence insufficiency are different from exotropes with accommodative convergence insufficiency; the latter have a low or absent AC/A ratio and are difficult to treat surgically; the former do well with orthoptic exercises. • Patients with intermittent exotropia and monofixation syndrome have a poorer sensory outcome after surgery. © 2009 Springer Berlin Heidelberg.