Intermittent Exotropia: What to Do When Corrective Lens Therapy Has Not Achieved Adequate Control

Intermittent exotropia is the most common form of childhood-onset exotropia. When prescription of corrective lenses for clinically significant refractive error does not achieve satisfactory control of the deviation, this next-line protocol provides a structured nonsurgical path forward.

Previous Treatment & Reason for Escalation

The preceding step — prescribing corrective lenses for any clinically significant refractive error — aimed to achieve improved control of the exotropia. When this goal is not met, escalation to the next treatment line is indicated.

Next-Line Approach (partial overview)

This protocol uses nonsurgical strategies directed at stimulating fusional control. The approach is tailored to the patient's refractive profile and may also involve an occlusion-based component. The complete selection criteria and therapeutic algorithm are available in the full protocol.

Treatment Goals

Improved fusional control and/or reduced angle of strabismus.

Instant Access to Structured Evidence-Based Regimens

References

DOI: 10.1016/j.ophtha.2022.11.002

Childhood-onset exotropia is typically intermittent and usually appears before 3 years of age, but it may be first detected later in childhood.
If fusional control of intermittent exotropia is suboptimal despite providing image clarity with refractive correction, it may be improved in many cases by increasing myopic correction in myopes, reducing hyperopic correction in hyperopes, or prescribing myopic correction in ametropes.
In some cases, part-time patching (e.g., 2 to 6 horns daily) may improve fusional control and/or reduce the angle of strabismus, particularly in the 3- to 10-year age group.

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