This protocol covers the specific presentation of exotropia in patients with convergence insufficiency, where the outward deviation occurs intermittently at near fixation alongside measurable deficits in fusional convergence.
Older children and teenagers with convergence insufficiency typically have intermittent exotropia at near fixation, reduced fusional convergence amplitudes, and a remote near point of convergence. They often report asthenopic symptoms — eye strain, difficulty reading, or discomfort — particularly with sustained near work.
The approach centres on orthoptic therapy — a structured programme of convergence exercises designed to strengthen fusional convergence amplitudes. The specific sequence and methods depend on individual findings; the complete regimen is available in the full protocol.
Improvement of fusional control and resolution of asthenopic symptoms with near work. Treatment is tapered as symptoms improve, and may need to be resumed if symptoms recur.
Older children and teenagers with convergence insufficiency typically have intermittent exotropia at near fixation, reduced fusional convergence amplitudes, and a remote near point of convergence.
They often report asthenopic symptoms with near work.
Orthoptic therapy may improve fusional control in children or adults with convergence insufficiency and with small- to moderate-angle exodeviations (i.e., 20 prism diopters or less), with the goal of strengthening fusional convergence amplitudes.
Near point of convergence exercises on an accommodative target are useful if the near point of convergence is distant.
Convergence exercises with a base-out prism may be beneficial once the near point of convergence improves.
Other treatments include computer-based convergence exercises and in-office orthoptics.
Treatment is tapered as symptoms improve, and it may need to be resumed if symptoms recur.
View source ↗