Current concepts in the management of concomitant exodeviations

Intermittent exotropia is the most common form of divergent strabismus. Treatment is indicated with increasing tropia phase to preserve or restore binocular function and restore/reconstruct normal ocular alignment. While medical treatment is sometimes helpful for temporary relief, surgical therapy is the preferred definitive treatment modality by most pediatric ophthalmologists and strabismologists. Congenital exotropia is rare and is associated with a high incidence of amblyopia. The treatment of choice in this condition is also surgical. Sensory exotropia is most often acquired after monocular visual loss. The preferred treatment is surgical recession/resection on the impaired eye. Convergence insufficiency is usually not diagnosed until the teenage years or later, and it is best approached nonsurgically with convergence exercises. In this article, we review the current literature and practice on the diagnosis and management of exotropia with emphasis on intermittent exotropia.