Vision therapy for basic exotropia in adults: 2 case studies

Basic exotropia accounts for approximately 50% of all intermittent exotropias. Many clinicians view treating these patients, especially adults with childhood-onset exotropia, as challenging. Conflicting opinions still exist regarding prescribing any treatment for adult strabismics, including surgical realignment and optometric vision therapy (VT).

Two cases are discussed, both of which are adult patients with moderate-size intermittent exotropia of the basic type who presented with asthenopia, headaches, and/or diplopia. Twenty to 30 in-office VT sessions were recommended to reduce the magnitude and frequency of the deviation as well as improve their binocularity and decrease their symptoms. After completing VT, both patients became phoric for all distances, had normal vergence ability, and had normal near points of convergence. In the second case, the long-term outcome was evaluated 5 years post-therapy.

Optometric VT was highly successful in both patients with childhood intermittent exotropia of the basic type. Most important, optometric VT eliminated the patients' symptoms of asthenopia and diplopia without the need for surgery.