Intermittent exotropia

Santiago, Alvina Pauline; Clarke, Michael

doi:10.1016/b978-0-7020-4691-9.00077-7

Cited by 4 publications

(6 citation statements)

References 64 publications

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“…We tried to group the children on the basis of existing detailed classifications of distance exotropia (Kushner 1988; Plenty 1988; Santiago & Rosenbaum 2005). Although such classification was possible, the data were spread across a continuum of increases after occlusion or lenses and near/distance differences (Fig.…”

Section: Resultsmentioning

confidence: 99%

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Evidence that convergence rather than accommodation controls intermittent distance exotropia

Horwood

Riddell

2012

Acta Ophthalmologica

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. Purpose: This study considered whether vergence drives accommodation or accommodation drives vergence during the control of distance exotropia for near fixation. High accommodative convergence to accommodation (AC/A) ratios are often used to explain this control, but the role of convergence to drive accommodation (the CA/C relationship) is rarely considered. Atypical CA/C characteristics could equally, or better, explain common clinical findings. Methods: Nineteen distance exotropes, aged 4–11 years, were compared while controlling their deviation with 27 non‐exotropic controls aged 5–9 years. Simultaneous vergence and accommodation responses were measured to a range of targets incorporating different combinations of blur, disparity and looming cues at four fixation distances between 2 m and 33 cm. Stimulus and response AC/A and CA/C ratios were calculated. Results: Accommodation responses for near targets (p = 0.017) and response gains (p = 0.026) were greater in the exotropes than in the controls. Despite higher clinical stimulus AC/A ratios, the distance exotropes showed lower laboratory response AC/A ratios (p = 0.02), but significantly higher CA/C ratios (p = 0.02). All the exotropes, whether the angle changed most with lenses (‘controlled by accommodation’) or on occlusion (‘controlled by fusion’), used binocular disparity not blur as their main cue to target distance. Conclusions: Increased vergence demand to control intermittent distance exotropia for near also drives significantly more accommodation. Minus lens therapy is more likely to act by correcting overaccommodation driven by controlling convergence, rather than by inducing blur‐driven vergence. The use of convergence as a major drive to accommodation explains many clinical characteristics of distance exotropia, including apparently high near stimulus AC/A ratios.

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Section: Resultsmentioning

confidence: 99%

“…They were not selected on the basis of any specific sub‐classification of distance exotropia, e.g. true/simulated, controlled by accommodation/fusion, but represented a wide range within published classifications (Kushner 1988; Plenty 1988; Santiago & Rosenbaum 2005).…”

Section: Methodsmentioning

confidence: 99%

Evidence that convergence rather than accommodation controls intermittent distance exotropia

Horwood

Riddell

2012

Acta Ophthalmologica

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“…[ 1 ] It is well known that patients with intermittent exotropia are asymptomatic because of a well-developed suppression mechanism. [ 2 ] However, it is not rare to encounter patients with intermittent exotropia who have subjective awareness of exodeviation. Patients with subjective awareness of exodeviation may experience ocular fatigue, blurred vision, headache, and diplopia to control exodeviation and maintain ocular alignment.…”

Section: Introductionmentioning

confidence: 99%

“…Patients with subjective awareness of exodeviation may experience ocular fatigue, blurred vision, headache, and diplopia to control exodeviation and maintain ocular alignment. [ 2 – 4 ]…”

Section: Introductionmentioning

confidence: 99%

The comparison of postoperative changes in subjective awareness of exodeviation between pediatric and adult patients with intermittent exotropia

Jeong,

Han,

Kim

2024

Medicine

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To evaluate pre- and postoperative changes in the subjective awareness of exodeviation in patients with intermittent exotropia and compare pediatric and adult patients. This retrospective study included pediatric (6–17 years) and adult patients (≥18 years) with intermittent exotropia who underwent surgery. Patients with subjective awareness of exodeviation associated with exotropia were included. Postoperative improvement was defined as a decrease in the subjective awareness of exodeviation and alleviation of associated symptoms after surgery. Changes in subjective awareness of exodeviation after surgery were evaluated and compared between pediatric and adult patients. Clinical factors associated with postoperative improvement in subjective awareness of exodeviation were analyzed. A total of 195 patients (159 pediatric and 36 adult) were included. Among the included patients, 145 (74.4%, 145/195) reported postoperative improvements in their subjective awareness of exodeviation. A lower percentage of adult patients (15/36, 41.7%) showed postoperative improvement in subjective awareness of exodeviation than that of pediatric patients (130/159, 81.8%, P < .001). The level of distant control was significantly associated with postoperative improvement in subjective awareness of exodeviation in adult patients (odds ratio, 1.151; 95% confidence interval, 0.030–0.758; P = .022). There was a significant difference in the postoperative change in the subjective awareness of exodeviation between pediatric and adult patients with intermittent exotropia. Adult patients are less likely to exhibit postoperative improvement in subjective awareness of exodeviation than pediatric patients. Adult patients with a better level of distant control are more likely to show postoperative improvement in their subjective awareness of exodeviation.

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“…It has a tendency to recur following strabismus surgery. The deviation is exacerbated by fatigue, inattention and bright light, and is often accompanied by ipsilateral lid closure 1 …”

mentioning

confidence: 99%

Ipsilateral pupil dilation associated with unilateral intermittent exotropia: a new observation

Dunlop

2011

Clinical &Amp; Experimental Ophthalmology

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Intermittent exotropia

Cited by 4 publications

References 64 publications

Evidence that convergence rather than accommodation controls intermittent distance exotropia

Evidence that convergence rather than accommodation controls intermittent distance exotropia

The comparison of postoperative changes in subjective awareness of exodeviation between pediatric and adult patients with intermittent exotropia

Ipsilateral pupil dilation associated with unilateral intermittent exotropia: a new observation

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