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What is Strabismus?
by Dr. Jeffrey Cooper & Rachel Cooper (no relation). © 2001-2014

All About Intermittent Exotropia

What is Intermittent Exotropia?

Pros and Cons of Intermittent Exotropia

Treatment of Intermittent Exotropia

Intermittent Exotropia Caused by Common Near Vision Disorder: Convergence Insuffiiciency

Exotropia -- deviated
Intermittent Exotropia -- Deviated
Large Angle (Extreme Deviation)


Exotropia -- straight
Intermittent Exotropia -- Straight

What is Intermittent Exotropia?
Exotropia -- a common type of strabismus -- is the outward deviation of an eye (eye turns away from the nose). When the eye turns outward only some of the time, it is called intermittent exotropia. Most exotropia is intermittent. In many cases, the eye turn might only be visible during stressful situations or when the person is tired, ill or anxious.

Pros: Advantages of Intermittent Eye Turn
When the eye turn is only occasional, the visual system (including the brain) still has many opportunities to develop. That is, as long as the eyes are straight some of the time, the brain and two eyes will develop some normal functioning (binocular vision and depth perception). Consequently, good possibilities for the development of improved vision in the future will still be present.

Cons: Disadvantages of Intermittent Eye Turn
When the eye turn happens some of the time, but not all the time, the outside observer(s) might conclude that there is no serious problem and fail to seek help. Or they might think the person is simply daydreaming, lazy, or not paying attention. Even worse, without knowing that there is a physical problem, the observer might feel uneasy or mistrustful of the person with intermittent exotropia who gives poor eye contact and comes off as distracted or "shifty-eyed."

In regards to diagnosis, the intermittent exotropia can also be tough for the eye doctor to catch. For example, the parents might notice the child's occasional eye turn, bring the kid in for an exam, and then the eye doctor won't be able to find it or induce it. In that case, the eye turn is not showing up during the "command performance" of the eye exam because the child is making an extra effort to pay attention, be "on good behavior," please the adults, etc. This in not unlikely with the child who only has the eye turn when fatigued, ill, etc. Miscellaneous clue: children with intermittent exotropia often close their eye in bright sunlight.

Treatment of Intermittent Exotropia
Treatment for intermittent exotropia does not have to occur immediately. Since the brain and eyes work properly some of the time, time is on your side. As a matter of fact, early surgery has the potential of disturbing the ability of the brain for fusion in the future and can cause a permanent reduction in vision (amblyopia).

Treatment options consist of Vision Therapy, patching, eyeglasses and/or, very rarely, surgery. The most successful form of treatment is in-office supervised Vision Therapy with home reinforcement. Therapy changes the brain and is directed at the cause and cure of the problem. In a comparative study using both Optometric and Ophthalmological journals, Vision Therapy had an overall success rate of 78% as compared to surgery of 48%. Surgery should be used as a last resort only for the large angle intermittent exotropes and only after in-office Vision Therapy not been as successful as expected. In those cases, surgery will probably only yield cosmetic benefits.

A Parent's Choice re: Treatment for Intermittent Exotropia
Read what one parent wrote regarding making the choice between surgery or Vision Therapy for intermittent exotropia.

Learn more about eye muscle surgery for intermittent exotropia and other types of strabismus.

Intermittent Exotropia as a Symptom of Another Common Vision Disorder
When the outward turn of one eye occurs only at near (when the person is looking at close objects), then the intermittent exotropia can be a symptom or result of another common binocular (two-eyed) vision problem called convergence insufficiency.

This is the most common type of eye muscle or visual-motor problem in the United States, with a reported prevalence among children and adults of anywhere from 5 to 13%. Principal symptoms can include diplopia (double vision), headaches, loss of concentration while reading, carsickness, avoidance of reading, blurred vision, and/or eyestrain. Symptoms are on the rise with increased reading, desk work, and computer use.

To learn all about this common vision problem, go to What is Convergence Insufficiency?

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