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    What's the best non-surgical treatment for exotropia?

    Observation looks favorable; overminus lenses have emerging promise


    Questions that are still unanswered regarding IXT include whether long-term observation has any harmful effects, such as entrenched suppression and whether children with monofixational IXT behave differently and warrant a different approach. “It is also important to remember to assess the psychosocial effect of IXT in older children, and, if so, surgery rather than non-surgical management is very reasonable,” Dr. Holmes said.

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    Dr. Holmes concluded that observation appears reasonable in many cases of childhood IXT based on current research. Part-time patching does not appear to have a great benefit and children dislike it, and overminus spectacle treatment may be helpful. Other nonsurgical treatments such as orthoptics and vision therapy are awaiting well-designed studies.


    1. Buck D, Powell CJ, Sloper JJ, Taylor R, Tiffin P, Clarke MP. Improving Outcomes in Intermittent Exotropia (IOXT) Study group. Surgical intervention in childhood intermittent exotropia: current practice and clinical outcomes from an observational cohort study. Br J Ophthalmol. 2012;96:1291-5.

    2. Holmes JM, Leske DA, et al. Stability of near stereoacuity in childhood intermittent exotropia. J AAPOS. 2011;15:462-467.

    3. Pediatric Eye Disease Investigator Group, Cotter SA, Mohney BG, Chandler DL, Holmes JM et al. A randomized trial comparing part-time patching with observation for children 3 to 10 years of age with intermittent exotropia. Ophthalmology. 2014;121:2299-2310.

    4. Pediatric Eye Disease Investigator Group, Mohney BG, Cotter SA, Chandler DL, Holmes JM, et al. A Randomized Trial Comparing Part-time Patching with Observation for Intermittent Exotropia in Children 12 to 35 Months of Age. Ophthalmology. 2015 122:1718-25.



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