Twenty-year follow-up of surgery for intermittent exotropia

We sought to evaluate the 20-year follow-up of intermittent exotropia surgery performed before the age of 10 years to determine the stability of alignment and the effect of strabismus on visual function.

Patients meeting the inclusion criteria were identified from surgical logs, contacted, and examined. The history obtained assessed the effect of their strabismus on education, career choices, driving, and reading ability. Histories were also obtained from adults presenting with exotropia to determine what type of strabismus, if any, they had younger in life.

Thirty patients were examined more than 20 years after exotropia surgery. All had good alignment on the study examination. Twenty-one of 30 had required only a single surgery, 7 had undergone 2 surgeries, and 2 had 3. The average age at the last office visit prior to the study was 11.8 years; the average age at the study visit was 29.4 years. Of 66 adults presenting with exotropia, 9% had a previous history of exotropia surgery, and 32% had a history of an untreated exodeviation in childhood.

When intermittent exotropia was surgically aligned and stable to about 11 years of age, it tended to remain so, at least until age 30. Few adults presenting with exotropia had a history of exotropia surgery as a child.