Skip to main content
Log in

Risk factors for spontaneous consecutive exotropia in children with refractive and nonrefractive accommodative esotropia

  • Clinical Investigation
  • Published:
Japanese Journal of Ophthalmology Aims and scope Submit manuscript

Abstract

Purpose

To investigate the risk factors for development of spontaneous consecutive exotropia (ScXT) among patients with refractive and nonrefractive accommodative esotropia (AET).

Study design

Retrospective.

Methods

Patients who were diagnosed with AET were reviewed from January, 2000 to December, 2016. The patients who developed ScXT after well corrected hyperopia were defined as exodeviation group (n = 51), and the patients who did not show exodeviation and were well controlled with eyeglasses were defined as the control group (n = 117). The changes in cycloplegic refraction, mean angle deviation at initial visit, time till the first correction of esodeviation, presence of amblyopia and accompanying strabismus were compared between the two groups.

Results

The mean interval from the first visit to correction of esodeviation under 8 PD in the exodeviation group was shorter than of the control group (P = 0.008). Patients in the exodeviation group showed more dissociated vertical deviation (DVD) (P = 0.015) and faster reduction in hyperopia per year (more hyperopic eye: P = 0.006; less hyperopic eye: P = 0.034) than the patients in the control group. Exodeviation was found mean 42.31 ± 41.13 months after hyperopia correction. There were no differences in angle deviation at initial visit, and presence of amblyopia.

Conclusion

ScXT can be found in AET with faster reduction in hyperopia per year, accompanied by DVD, or in eyes with esodeviation corrected in relatively shorter time. It can be noted even in patients with good alignment over a long-term, so long-term follow-up is recommended.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1

Similar content being viewed by others

References

  1. Berk AT, Kocak N, Ellidokuz H. Treatment outcomes in refractive accommodative esotropia. J AAPOS. 2004;8:384–8.

    Article  Google Scholar 

  2. Birch EE. Marshall Parks lecture. Binocular sensory outcomes in accommodative ET. J AAPOS. 2003;7:369–73.

    Article  Google Scholar 

  3. Reddy AK, Freeman CH, Paysse EA, Coats DK. A data-driven approach to the management of accommodative esotropia. Am J Ophthalmol. 2009;148:466–70.

    Article  Google Scholar 

  4. Beneish R, Williams F, Polomeno RC, Little JM. Consecutive exotropia after correction of hyperopia. Can J Ophthalmol. 1981;16:16–8.

    CAS  PubMed  Google Scholar 

  5. Watanabe-Numata K, Hayasaka S, Watanabe K, Hayasaka Y, Kadoi C. Changes in deviation following correction of hyperopia in children with fully refractive accommodative esotropia. Ophthalmologica. 2000;214:309–11.

    Article  CAS  Google Scholar 

  6. Swan KC. Accommodative esotropia long range follow-up. Ophthalmology. 1983;90:1141–5.

    Article  CAS  Google Scholar 

  7. Kim SH, Rah SH. Clinical characteristics of exodeviated patients with accomodative esotropia and hyperopia without strabismus. J Korean Ophthalmol Soc. 2015;56:1921–5.

    Article  Google Scholar 

  8. Raab EL. Etiologic factors in accommodative esodeviation. Trans Am Ophthalmol Soc. 1982;80:657–94.

    CAS  PubMed  PubMed Central  Google Scholar 

  9. Preslan MW, Beauchamp GR. Accommodative esotropia: review of current practices and controversies. Ophthalmic Surg. 1987;18:68–72.

    CAS  PubMed  Google Scholar 

  10. Baker JD, Parks MM. Early-onset accommodative esotropia. Am J Ophthalmol. 1980;90:11–8.

    Article  CAS  Google Scholar 

  11. Parks MM. Abnormal accommodative convergence in squint. AMA Arch Ophthalmol. 1958;59:364–80.

    Article  CAS  Google Scholar 

  12. Burian HM. Hypermetropia and esotropia. J Pediatr Ophthalmol Strabismus. 1972;9:135–43.

    Google Scholar 

  13. Senior JD, Chandna A, O'Connor AR. Spontaneous consecutive exotropia in childhood. Strabismus. 2009;17:33–6.

    Article  Google Scholar 

  14. Stager DR, Weakley DR, Everett M, Birch EE. Delayed consecutive exotropia following 7-millimeter bilateral medial rectus recession for congenital esotropia. J Pediatr Ophthalmol Strabismus. 1994;31:147–50 (discussion 51–52).

    CAS  PubMed  Google Scholar 

  15. Oguz V, Arvas S, Yolar M, Kizilkaya M, Tolun H. Consecutive exotropia following strabismus surgery. Ophthalmologica. 2002;216:246–8.

    Article  Google Scholar 

  16. Khaouam E, Jampolsky A. Non-surgical consecutive exotropia. Presented at Proceedings of IV Afro-Asian Congress of Ophthalmology, Beirut, Lebanon; 1968. pp. 255–65.

  17. Moore S. The natural course of esotropia. Am Orthopt J. 1971;21:80–3.

    CAS  PubMed  Google Scholar 

  18. Weir CR, Cleary M, Dutton GN. Spontaneous consecutive extropia in children with motor fusion. Br J Ophthalmol. 2001;85:242–3.

    Article  CAS  Google Scholar 

  19. Mohan K, Sharma A. Long-term treatment results of accommodative esotropia. J AAPOS. 2014;18:261–5.

    Article  Google Scholar 

  20. Ceylan OM, Gokce G, Mutlu FM, Uludag HA, Turk A, Altinsoy HI. Consecutive exotropia: risk factor analysis and management outcomes. Eur J Ophthalmol. 2014;24:153–8.

    Article  Google Scholar 

  21. Cheeseman EW Jr, Guyton DL. Vertical fusional vergence: the key to dissociated vertical deviation. Arch Ophthalmol. 1999;117:1188–91.

    Article  Google Scholar 

  22. Van Rijn LJ, Simonsz HJ, Tusscher MP. Dissociated vertical deviation and eye torsion: relation to disparity-induced vertical vergence. Strabismus. 1997;5:13–20.

    Article  Google Scholar 

  23. Han SY, Han J, Rhiu S, Lee JB, Han SH. Risk factors for consecutive exotropia after esotropia surgery. Jpn J Ophthalmol. 2016;60:333–40.

    Article  Google Scholar 

  24. Costenbader FD. Clinical course and management of esotropia. In: James H Allen; New Orleans Academy of Ophthalmology. Strabismus Ophthalmic Symposium II. St. Louis, Mo.: Mosby, 1958, pp. 325–353.

  25. Parks MM, Wheeler MB. Concomitant esodeviations. In: Tasman W, Jaeger EA, editors. Clinical ophthalmology. Philadelphia: Lippincott-Raven; 1996. p. 10.

    Google Scholar 

  26. Brodsky MC, Jung J. Intermittent exotropia and accommodative esotropia: distinct disorders or two ends of a spectrum? Ophthalmology. 2015;122:1543–6.

    Article  Google Scholar 

  27. Ciner EB, Herzberg C. Optometric management of optically induced consecutive exotropia. J Am Optom Assoc. 1992;63:266–71.

    CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to So Young Han.

Ethics declarations

Conflicts of interest

D. H. Shin, None; C. Y. Choi, None; S. Y. Han, None.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Corresponding Author: So Young Han

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Shin, D.H., Choi, C.Y. & Han, S.Y. Risk factors for spontaneous consecutive exotropia in children with refractive and nonrefractive accommodative esotropia. Jpn J Ophthalmol 64, 292–297 (2020). https://doi.org/10.1007/s10384-020-00724-5

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10384-020-00724-5

Keywords

Navigation