Exotropia is a type of strabismus (eye misalignment), where one eye turns, or deviates, outward (away from the nose). The deviation may be constant or intermittent, and the deviating eye may always be one eye or may alternate between the two eyes. The deviation or eye turn may occur while fixating (looking at) distance objects, near objects, or both. Exotropia is also often called wall-eyed.

The Different Types of Exotropia

Congenital exotropia

Congenital exotropia is also called infantile exotropia. People with this condition have an outward turning of the eye or eyes from birth or early in infancy.

Congenital or infantile exotropia is an outward turning of the eyes from birth or early infancy. Esotropia (in-crossing of the eyes) is much more common than exotropia in infants. Constant exotropia in an infant should be evaluated by a pediatric ophthalmologist to evaluate for any associated medical conditions.

Sensory exotropia

Exotropia in an eye with poor vision is called sensory exotropia. In this case, the eye with reduced vision is unable to work together with the other eye, and therefore, the poorly seeing eye may have a tendency to drift outward. Sensory exotropia may occur at any age. If the visual problem is treatable, it should be addressed as soon as possible. In cases of permanent vision loss, surgery to straighten the eye is often an option.

Acquired exotropia

This type of exotropia is the result of a disease, trauma, or other health condition, particularly those that affect the brain. For example, stroke or Down syndrome may increase your risk for this condition.

Intermittent exotropia

This is the most common form of exotropia. It affects twice as many females as males.

Intermittent exotropia causes the eye to sometimes move outward, often when you’re tired, sick, daydreaming, or looking in the distance. Other times, the eye stays straight. This symptom may occur infrequently, or it can happen so often it eventually becomes constant.

Symptoms of exotropia

The distinguishing sign of exotropia is one or either eye wandering outward. Symptoms may be mild or severe. If suppression of the deviating eye occurs, the patient can have diminished binocular vision and diminished stereopsis. Patients may also experience diplopia (double-vision). Asthenopia (eye fatigue) can also occur with reading.

Other symptoms may include:

• one or both eyes turning outward
• frequent rubbing of the eyes
• squinting or covering one eye when looking into bright light or trying to see objects that are far away

Causes of exotropia

Exotropia occurs when there’s an imbalance in eye muscles or when there’s a signaling issue between the brain and eye. Sometimes a health condition, like cataracts or stroke, can cause this to occur. The condition may also be inherited.

Approximately 30 percent of children with strabismus have a family member with the condition. When no family history, illness, or condition can be identified, doctors aren’t sure what causes a strabismus like exotropia to develop.

Treatment for Exotropia

For people whose exotropia does not often occur, observation by an ophthalmologist might be the only treatment needed. For people who have more frequent exotropia, the goals for treatment include realigning the eyes, helping both eyes work together properly, and treating double vision and/or amblyopia, or “lazy eye”. 

• Glasses: Glasses that help correct near- or farsightedness will help keep the eyes aligned.
• Patching: People with exotropia tend to favour the aligned eye, so vision in the eye turned outward can weaken, resulting in amblyopia (lazy eye). To improve strength and vision in the misaligned eye, some doctors will recommend patching the “good” eye for up to several hours a day to encourage you to use the weaker eye.
• Exercises: Your doctor may suggest a variety of eye exercises to improve focus.

Media Contact
Sarah Rose
Journal Manager
The Ophthalmologist: Clinical and Therapeutic Journal
Email: ophthalmologist@eclinicalsci.com