Post Operative

Infantile exotropia is an exodeviation that develops within the first 6 months of life and persists. It can be primary or secondary to an ocular or systemic problem: e.g., ptosis, albinism, ocular motor apraxia, optic nerve anomalies, and with diseases that lead to vision loss, including retinoblastoma, retinoschisis, iridolenticular abnormalities, and cataracts. Exotropia can be a feature of several congenital strabismus syndromes, including third nerve palsies, Duane syndrome, congenital fibrosis of the extraocular muscles, and strabismus fixus. It may be associated with systemic disorders, which include cerebral palsy, hydrocephalus, craniofacial syndromes, and various chromosomal anomalies.

Patients with infantile exotropia should be approached in the same manner as those with infantile esotropia: surgery should align the eyes before the age of 24 months to achieve optimal motor and sensory results. Earlier surgery may be beneficial but is controversial. Once the diagnosis of infantile exotropia is confirmed and any refractive error or amblyopia is corrected, the child should be followed for a few weeks to be sure the angle of the strabismus is stable.

Angles under 40 PD can usually be successfully treated with surgery on two horizontal muscles, either bilateral lateral rectus recessions or a unilateral lateral rectus recession with a medial rectus resection. Treatment of angles over 40 PD may require “supramaximal” amounts of recessions or resections if surgery is planned on two muscles. Alternatively, surgery of more “regular” dosages can be planned on three or four horizontal muscles.