Exotropia (Exophoria)

A form of ocular misalignment where the visual axes diverge inappropriately. For example, medial rectus muscle weakness may produce this condition as the affected eye will deviate laterally upon attempted forward gaze. An exotropia occurs due to the relatively unopposed force exerted on the eye by the lateral rectus muscle, which pulls the eye in an outward direction.

Also Known As:

Networked: 252 relevant articles (13 outcomes, 17 trials/studies)

Relationship Network

Disease Context: Research Results

Related Diseases

1.	Exotropia (Exophoria)
2.	Refractive Errors (Refractive Error)
3.	Esotropia (Esophoria)
4.	Amblyopia (Lazy Eye)
5.	Ocular Motility Disorders (Convergence Insufficiency)

Experts

1.	Lee, Jong Bok: 4 articles (01/2015 - 01/2007)
2.	Chung, Seung Ah: 3 articles (01/2015 - 09/2011)
3.	Holmes, Jonathan M: 3 articles (09/2014 - 04/2010)
4.	Han, Sueng-Han: 3 articles (06/2010 - 12/2006)
5.	Hong, Samin: 3 articles (06/2010 - 12/2006)
6.	Broniarczyk-Loba, Anna: 3 articles (01/2010 - 01/2003)
7.	Saunte, Jon Peiter: 2 articles (08/2015 - 09/2014)
8.	Sharifi, Mohammad: 2 articles (12/2014 - 10/2008)
9.	Sanac, Ali Sefik: 2 articles (04/2014 - 02/2004)
10.	Sener, Emin Cumhur: 2 articles (04/2014 - 02/2004)

Drugs and Biologics

Drugs and Important Biological Agents (IBA) related to Exotropia:

1.	Botulinum Toxins (Botulinum Toxin)IBA 12/01/2014 - "This study was designed to evaluate the efficacy of botulinum toxin injection in the treatment of intermittent exotropia (IXT). " 12/01/2014 - "Efficacy of botulinum toxin in the treatment of intermittent exotropia." 11/01/1997 - "This study presents long-term observations on the use of botulinum toxin for the treatment of intermittent exotropia in children. " 07/01/2015 - "As the disease progresses and nonsurgical management fails, botulinum toxin may play a role or be an alternative option in the early treatment of intermittent exotropia. " 12/01/2014 - "Botulinum toxin injection to lateral rectus muscles seems to be a promising procedure in the management of fusional control, far and near deviations in patients with intermittent exotropia in short time."
2.	Retinaldehyde (Retinal)IBA 01/01/2015 - "Ten patients with intermittent exotropia who manifested TPF were measured at 6 m, 1/3 m, again at 1/3 m after 1 hour of monocular occlusion, and at 1/3 m with a peripheral crossed localization stimulating device (PCLSD) that simulated the retinal bitemporal disparity and peripheral crossed localization usually found with distance fixation. " 04/01/2011 - "In two patients, the simulated exodeviation might have triggered a shift from normal to anomalous retinal correspondence. " 01/01/2007 - "We have analyzed the patients with different types of divergent strabismus, the condition of sensors before and after operation, and influence of retinal relationships to post-operative result, with regards to long-time stablization of the angle of anomaly and stereo acuity. " 01/01/2000 - "Intermittent exotropia: stimulus characteristics affect tests for retinal correspondence and suppression." 11/01/1997 - "Significant predictive factors in exotropia were absence of previous surgery; visual acuity of the deviating eye > 0.5; an increase in the spherical equivalent of the deviating eye, and normal retinal correspondence. "
3.	GABA-B Receptor AgonistsIBA 02/01/2015 - "PHARMACOLOGICAL TREATMENT: Depending on the pathophysiology of different types of nystagmus, several drugs were effective in clinical application (off-label use): (i) gabapentin (non-selective GABAergic and anti-glutamatergic effect): up to 2400 mg/d in infantile nystagmus, acquired pendular nystagmus and oculopalatal tremor, (ii) nemantine (anti-glutamatergic effect): dosage up to 40 mg/d in infantile nystagmus, also in acquired pendular nystagmus and oculopalatal tremor, (iii) baclofen (GABA-B-receptor agonist): 3 × 5-10 mg/d in periodic alternating nystagmus and in upbeat nystagmus, (iv) 4-aminopyridine (non-selective blocker of voltage-gated potassium channels): 3 × 5 mg/d or 1-2 × 10 mg Fampridin in downbeat nystagmus and upbeat nystagmus, (v) acetazolamide (carbonic anhydrase inhibitor): in hereditary episodic ataxia type 2. OPTICAL DEVICES: (i) Contact lenses are used in infantile nystagmus in order to overcome negative effects of eye glasses in abnormal head posture, lateral gaze, and higher refractive errors, (ii) spectacle prisms are useful to induce an artificial exophoria (base-out prisms) or to shift an excentric null zone (base in direction of head posture) of infantile nystagmus with abnormal head posture, (iii) low vision aids may be necessary and should be prescribed according to magnification requirements."
4.	Voltage-Gated Potassium Channels (Voltage-Gated Potassium Channel)IBA 02/01/2015 - "PHARMACOLOGICAL TREATMENT: Depending on the pathophysiology of different types of nystagmus, several drugs were effective in clinical application (off-label use): (i) gabapentin (non-selective GABAergic and anti-glutamatergic effect): up to 2400 mg/d in infantile nystagmus, acquired pendular nystagmus and oculopalatal tremor, (ii) nemantine (anti-glutamatergic effect): dosage up to 40 mg/d in infantile nystagmus, also in acquired pendular nystagmus and oculopalatal tremor, (iii) baclofen (GABA-B-receptor agonist): 3 × 5-10 mg/d in periodic alternating nystagmus and in upbeat nystagmus, (iv) 4-aminopyridine (non-selective blocker of voltage-gated potassium channels): 3 × 5 mg/d or 1-2 × 10 mg Fampridin in downbeat nystagmus and upbeat nystagmus, (v) acetazolamide (carbonic anhydrase inhibitor): in hereditary episodic ataxia type 2. OPTICAL DEVICES: (i) Contact lenses are used in infantile nystagmus in order to overcome negative effects of eye glasses in abnormal head posture, lateral gaze, and higher refractive errors, (ii) spectacle prisms are useful to induce an artificial exophoria (base-out prisms) or to shift an excentric null zone (base in direction of head posture) of infantile nystagmus with abnormal head posture, (iii) low vision aids may be necessary and should be prescribed according to magnification requirements."
5.	DexmedetomidineFDA Link 01/01/1991 - "The higher dose dexmedetomidine also caused impaired cognitive, coordinative and reactive skills (although a trend towards improved coordination was found at 6 h), reduced attention, produced exophoria, increased body sway with the eyes open and caused drowsiness, clumsiness, passiveness and mental slowness on the appropriate VAS scales. "
6.	4-Aminopyridine (4 Aminopyridine)IBA 02/01/2015 - "PHARMACOLOGICAL TREATMENT: Depending on the pathophysiology of different types of nystagmus, several drugs were effective in clinical application (off-label use): (i) gabapentin (non-selective GABAergic and anti-glutamatergic effect): up to 2400 mg/d in infantile nystagmus, acquired pendular nystagmus and oculopalatal tremor, (ii) nemantine (anti-glutamatergic effect): dosage up to 40 mg/d in infantile nystagmus, also in acquired pendular nystagmus and oculopalatal tremor, (iii) baclofen (GABA-B-receptor agonist): 3 × 5-10 mg/d in periodic alternating nystagmus and in upbeat nystagmus, (iv) 4-aminopyridine (non-selective blocker of voltage-gated potassium channels): 3 × 5 mg/d or 1-2 × 10 mg Fampridin in downbeat nystagmus and upbeat nystagmus, (v) acetazolamide (carbonic anhydrase inhibitor): in hereditary episodic ataxia type 2. OPTICAL DEVICES: (i) Contact lenses are used in infantile nystagmus in order to overcome negative effects of eye glasses in abnormal head posture, lateral gaze, and higher refractive errors, (ii) spectacle prisms are useful to induce an artificial exophoria (base-out prisms) or to shift an excentric null zone (base in direction of head posture) of infantile nystagmus with abnormal head posture, (iii) low vision aids may be necessary and should be prescribed according to magnification requirements."
7.	Carbonic Anhydrases (Carbonic Anhydrase)IBA 02/01/2015 - "PHARMACOLOGICAL TREATMENT: Depending on the pathophysiology of different types of nystagmus, several drugs were effective in clinical application (off-label use): (i) gabapentin (non-selective GABAergic and anti-glutamatergic effect): up to 2400 mg/d in infantile nystagmus, acquired pendular nystagmus and oculopalatal tremor, (ii) nemantine (anti-glutamatergic effect): dosage up to 40 mg/d in infantile nystagmus, also in acquired pendular nystagmus and oculopalatal tremor, (iii) baclofen (GABA-B-receptor agonist): 3 × 5-10 mg/d in periodic alternating nystagmus and in upbeat nystagmus, (iv) 4-aminopyridine (non-selective blocker of voltage-gated potassium channels): 3 × 5 mg/d or 1-2 × 10 mg Fampridin in downbeat nystagmus and upbeat nystagmus, (v) acetazolamide (carbonic anhydrase inhibitor): in hereditary episodic ataxia type 2. OPTICAL DEVICES: (i) Contact lenses are used in infantile nystagmus in order to overcome negative effects of eye glasses in abnormal head posture, lateral gaze, and higher refractive errors, (ii) spectacle prisms are useful to induce an artificial exophoria (base-out prisms) or to shift an excentric null zone (base in direction of head posture) of infantile nystagmus with abnormal head posture, (iii) low vision aids may be necessary and should be prescribed according to magnification requirements."
8.	BaclofenFDA LinkGeneric 02/01/2015 - "PHARMACOLOGICAL TREATMENT: Depending on the pathophysiology of different types of nystagmus, several drugs were effective in clinical application (off-label use): (i) gabapentin (non-selective GABAergic and anti-glutamatergic effect): up to 2400 mg/d in infantile nystagmus, acquired pendular nystagmus and oculopalatal tremor, (ii) nemantine (anti-glutamatergic effect): dosage up to 40 mg/d in infantile nystagmus, also in acquired pendular nystagmus and oculopalatal tremor, (iii) baclofen (GABA-B-receptor agonist): 3 × 5-10 mg/d in periodic alternating nystagmus and in upbeat nystagmus, (iv) 4-aminopyridine (non-selective blocker of voltage-gated potassium channels): 3 × 5 mg/d or 1-2 × 10 mg Fampridin in downbeat nystagmus and upbeat nystagmus, (v) acetazolamide (carbonic anhydrase inhibitor): in hereditary episodic ataxia type 2. OPTICAL DEVICES: (i) Contact lenses are used in infantile nystagmus in order to overcome negative effects of eye glasses in abnormal head posture, lateral gaze, and higher refractive errors, (ii) spectacle prisms are useful to induce an artificial exophoria (base-out prisms) or to shift an excentric null zone (base in direction of head posture) of infantile nystagmus with abnormal head posture, (iii) low vision aids may be necessary and should be prescribed according to magnification requirements."
9.	Acetazolamide (Diamox)FDA LinkGeneric 02/01/2015 - "PHARMACOLOGICAL TREATMENT: Depending on the pathophysiology of different types of nystagmus, several drugs were effective in clinical application (off-label use): (i) gabapentin (non-selective GABAergic and anti-glutamatergic effect): up to 2400 mg/d in infantile nystagmus, acquired pendular nystagmus and oculopalatal tremor, (ii) nemantine (anti-glutamatergic effect): dosage up to 40 mg/d in infantile nystagmus, also in acquired pendular nystagmus and oculopalatal tremor, (iii) baclofen (GABA-B-receptor agonist): 3 × 5-10 mg/d in periodic alternating nystagmus and in upbeat nystagmus, (iv) 4-aminopyridine (non-selective blocker of voltage-gated potassium channels): 3 × 5 mg/d or 1-2 × 10 mg Fampridin in downbeat nystagmus and upbeat nystagmus, (v) acetazolamide (carbonic anhydrase inhibitor): in hereditary episodic ataxia type 2. OPTICAL DEVICES: (i) Contact lenses are used in infantile nystagmus in order to overcome negative effects of eye glasses in abnormal head posture, lateral gaze, and higher refractive errors, (ii) spectacle prisms are useful to induce an artificial exophoria (base-out prisms) or to shift an excentric null zone (base in direction of head posture) of infantile nystagmus with abnormal head posture, (iii) low vision aids may be necessary and should be prescribed according to magnification requirements."
10.	Episodic ataxia with nystagmusIBA 02/01/2015 - "PHARMACOLOGICAL TREATMENT: Depending on the pathophysiology of different types of nystagmus, several drugs were effective in clinical application (off-label use): (i) gabapentin (non-selective GABAergic and anti-glutamatergic effect): up to 2400 mg/d in infantile nystagmus, acquired pendular nystagmus and oculopalatal tremor, (ii) nemantine (anti-glutamatergic effect): dosage up to 40 mg/d in infantile nystagmus, also in acquired pendular nystagmus and oculopalatal tremor, (iii) baclofen (GABA-B-receptor agonist): 3 × 5-10 mg/d in periodic alternating nystagmus and in upbeat nystagmus, (iv) 4-aminopyridine (non-selective blocker of voltage-gated potassium channels): 3 × 5 mg/d or 1-2 × 10 mg Fampridin in downbeat nystagmus and upbeat nystagmus, (v) acetazolamide (carbonic anhydrase inhibitor): in hereditary episodic ataxia type 2. OPTICAL DEVICES: (i) Contact lenses are used in infantile nystagmus in order to overcome negative effects of eye glasses in abnormal head posture, lateral gaze, and higher refractive errors, (ii) spectacle prisms are useful to induce an artificial exophoria (base-out prisms) or to shift an excentric null zone (base in direction of head posture) of infantile nystagmus with abnormal head posture, (iii) low vision aids may be necessary and should be prescribed according to magnification requirements."

Therapies and Procedures

1.	Eyeglasses (Spectacles) 12/01/2013 - "Two (50%) of the four patients who underwent vertical rectus transposition cases developed consecutive exotropia, one of whom did not have spectacles prescribed pre-operatively. " 09/01/2011 - "With spectacle correction, the mean exodeviation increased significantly in group I, but did not change in groups II or III. Thirteen patients in group I (34%) showed a more than 10 prism diopters (PD) exotropic shift after wearing spectacles. " 09/01/2011 - "After at least 6 months wearing spectacles, changes in exodeviation were compared. " 10/01/2005 - "There was associated ametropic amblyopia and exotropia in the patient, which were effectively treated with spectacles and occlusion therapy, with the patient responding conventionally. " 10/01/2012 - "Twenty-three exotropic children were treated with spectacles: 15 were fully corrected, 10 of whose exotropia improved; 8 received partial correction of their hyperopia, 3 of whose exotropia improved. "
2.	Lenses 10/01/2005 - "Using the NCS minus lenses significantly (P = 0.041) improved control of exotropia. " 10/01/2009 - "The results of our experimental study showed an initial increase in exophoria (a divergent open-loop vergence position) and convergence-accommodation (CA) when viewing through +2D lenses. " 02/01/2009 - "The aim of this study is to evaluate the use of overcorrecting minus lenses as a primary treatment option for intermittent distance exotropia (IDEX) and determine ocular alignment status after 5 years from commencement of the study. " 11/01/1986 - "This paper is a study in the use of overminus lenses for 37 patients with postoperative exodeviations. " 12/01/2010 - "The use of distance stereoacuity assessment in determining the effectiveness of minus lenses in intermittent exotropia."
3.	Sutures (Suture) 08/01/2006 - "The following quantitative characteristics of the results of bilateral medial rectus muscle recessions were chosen for study to see whether the new torque vector model or the classic length-tension model would better predict these characteristics: (1) larger bilateral medial rectus muscle recessions produce more effect per millimeter, with the dose-response curve approximating an exponential shape; (2) the exact location of the preplaced medial rectus muscle suture prior to muscle disinsertion in recessions has minimal effect on the postoperative ocular alignment; and (3) medial rectus muscle recessions of more than eight mm are likely to produce an early consecutive exotropia. " 01/01/2003 - "The aim of this study is to present the results of surgery in intermittent divergent strabismus with adjustable sutures, and to compare them to the results of conventional technique. " 06/01/2010 - "The most effective procedure for exotropia was maximal, bilateral lateral rectus recessions (8 mm or 17 mm from the limbus) with medial rectus resections (7 mm) using adjustable sutures. " 04/01/2010 - "In this case series, a lateral rectus muscle posterior fixation suture was useful in addressing incomitant exodeviations. " 12/01/2006 - "Full tendon transposition augmented with posterior intermuscular suture and recession-resection surgery was performed for a 26-year-old male patient had monocular elevation deficiency (MED) and large exotropia. "
4.	Orthoptics (Orthoptic) 04/01/2006 - "Surgery with orthoptic/occlusion therapy was more effective in reducing exodeviation (prism dioptres per millimetre of horizontal rectus surgery), compared with surgery only." 01/01/1994 - "The aim of the study is to evaluate the results obtained in treatment of Intermittent Exotropia with the therapeutic programme applied at the Orthoptic Centre of Sassari Oculist Clinic. " 08/01/2011 - "Thirty consecutive patients of intermittent exotropia X (T) scheduled for surgical intervention underwent preoperative evaluation, including complete ophthalmic and orthoptic examination. " 04/01/2006 - "Reduction of exodeviation in prism dioptres per millimetre of horizontal rectus surgery performed was significantly higher (P < 0.05) in the surgery with orthoptic/occlusion therapy group as compared with surgery only at all follow ups. " 04/01/2006 - "ANOVA analysis revealed that surgery with orthoptic/occlusion therapy resulted significantly (P < 0.001) in the highest reduction of exodeviation as compared with the other three treatment modalities at each follow up. "
5.	Injections 01/01/2005 - "Two patients with exotropia and one patient with esotropia had injections of BTX A to the lateral rectus muscles of the affected side. " 01/01/2013 - "The major ocular complications that were associated with IVB injections included vitreous or preretinal hemorrhage in 2 eyes (1%); cataract in 1 eye (1%); and exotropia in 1 eye (1%). " 02/01/1998 - "The lasting effects of the injections on strabismic angle were largest in esotropia, consecutive exotropia and abducens palsy, and amounted to, on an average, 12 prism diopters or 6 degrees. " 12/01/2013 - "Nineteen patients with esotropia received bupivacaine injections in the lateral rectus muscle, and 12 patients with exotropia received bupivacaine injections in the medial rectus. " 10/01/2013 - "We used unilateral injections of the GABAA agonist muscimol to reversibly inactivate the cFN (4 injections in exotropic monkey S1 with ≈ 4° of exotropia; 5 injections in esotropic monkey S2 with ≈ 34° of esotropia) and the PIN (3 injections in monkey S1). "