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Updated: Jun 29, 2026
Surgical Correction for Pediatric Epiblepharon and Trichiasis
Published on: July 8, 2025
Postoperative outcomes in children with intermittent exotropia from a population-based cohort
Noha S Ekdawi1, Kevin J Nusz, Nancy N Diehl
1Department of Ophthalmology, Mayo Clinic and Mayo Foundation, Rochester, Minnesota, USA.
Insights
Surgery for intermittent exotropia in children offers moderate long-term success. Approximately half achieve alignment, and many retain good stereopsis, though some require repeat procedures.
Area of Science:
- Ophthalmology
- Pediatric Surgery
- Strabismus Surgery
Background:
- Intermittent exotropia is a common childhood eye misalignment.
- Surgical intervention is a primary treatment modality for intermittent exotropia.
- Long-term outcomes of surgery for intermittent exotropia in children are not well-established in population-based studies.
Purpose of the Study:
- To evaluate the long-term surgical outcomes in a population-based cohort of children diagnosed with intermittent exotropia.
Main Methods:
- Retrospective review of medical records for children (<19 years) with intermittent exotropia in Olmsted County, Minnesota (1975-1994).
- Inclusion criteria included diagnosis of intermittent exotropia and surgical management.
- Data collected included age at surgery, need for repeat surgery, final alignment, and stereopsis.
Main Results:
- 61 of 184 (33%) children with intermittent exotropia underwent surgery at a mean age of 7.6 years.
- 19.7% required a second surgery for recurrent exotropia or consecutive esotropia.
- At a mean follow-up of 7.4 years post-surgery, 55% achieved orthotropia within 9 prism diopters, and 45% had good stereopsis.
Conclusions:
- Surgery for intermittent exotropia in children provides moderate long-term success in alignment and stereopsis.
- While a significant proportion achieve successful outcomes, a notable percentage may require further surgical intervention.
- Population-based data suggest that surgical outcomes are durable for many, but long-term monitoring is essential.
Purpose:
To describe the long-term surgical outcomes in a population-based cohort of children with intermittent exotropia.
Methods:
The medical records of all children (<19 years) who were diagnosed with intermittent exotropia as residents of Olmsted County Minnesota, from January 1, 1975, through December 31, 1994, and managed with surgery were retrospectively reviewed.
Results:
Of 184 patients with intermittent exotropia, 61 (33%) underwent surgery at a mean age of 7.6 years (range, 3.2 to 23 years). Twelve of the 61 children (19.7%) underwent a second surgery (10 for recurrent exotropia and 2 for consecutive esotropia), and no patient received 3 or more surgeries during a mean follow-up of 10 years from the first surgery. The final postoperative measurements were recorded in 56 of 61 patients (92%) at a mean of 7.4 years (range, 0 to 18 years) after the first surgery: 31 of the 56 (55%) were within 9(Delta) of orthotropia at distance and 25 of 55 (45%) had better than 60 seconds of stereopsis. The Kaplan-Meier rate of developing >/=10(Delta) of misalignment after the first surgery was 54% by 5 years, 76% by 10 years, and 86% by 15 years.
Conclusions:
In this population-based study of surgery in children with intermittent exotropia, although only 1 in 5 received a second surgery, after a mean follow-up of 8 years, approximately half were successfully aligned and 45% had high-grade stereopsis.